The Association of Lung Function, Bronchial Hyperresponsiveness, and Exhaled Nitric Oxide Differs Between Atopic and Non-atopic Asthma in Children

PURPOSE: Although many previous studies have attempted to identify differences between atopic asthma (AA) and non-atopic asthma (NAA), they have mainly focused on the difference of each variable of lung function and airway inflammation. The aim of this study was to evaluate relationships between lung function, bronchial hyperresponsiveness (BHR), and the exhaled nitric oxide (eNO) levels in children with AA and NAA. METHODS: One hundred and thirty six asthmatic children aged 5-15 years and 40 normal controls were recruited. Asthma cases were classified as AA (n=100) or NAA (n=36) from skin prick test results. Lung function, BHR to methacholine and adenosine-5'-monophosphate (AMP), eNO, blood eosinophils, and serum total IgE were measured. RESULTS: The AA and NAA cases shared common features including a reduced small airway function and increased BHR to methacholine. However, children with AA showed higher BHR to AMP and eNO levels than those with NAA. When the relationships among these variables in the AA and NAA cases were evaluated, the AA group showed significant relationships between lung function, BHR to AMP or methacholine and eNO levels. However, the children in the NAA group showed an association between small airway function and BHR to methacholine only. CONCLUSIONS: These findings suggest that the pathogenesis of NAA may differ from that of AA during childhood in terms of the relationship between lung function, airway inflammation and BHR.

Relationship between duration of disease and bronchial responsiveness in 6-8 years old children with asthma

PURPOSE: Bronchial hyperresponsiveness is considered as a hallmark of asthma. The duration of asthma was demonstrated to be associated with bronchial responsiveness, expressed as methacholine PC20. We investigated the relationship between duration of asthma and percentage fall in forced vital capacity (FVC) at PC20 (DeltaFVC), another index of bronchial responsiveness, which reflects excessive bronchoconstriction. METHODS: Six- to 8-year-old children with asthma underwent methacholine inhalation test. The PC20 and DeltaFVC were calculated for each individual. The subjects were classified into those with wheezing onset in the first three years of life (early-onset asthma [EA], n=63) and those with wheezing onset from three years onwards (late-onset asthma [LA], n=99). RESULTS: From the time of wheezing onset, duration of asthma ranged from 0.2 to 8.3 years. The mean duration of asthma in patients with EA was 5.6 years (standard deviation [SD], 1.2 years), compared with 2.2 years (SD, 1.3 years) in the patients with LA. Patients with EA had a significantly lower forced expiratory volume in 1 second/FVC than did those with LA (84.6%+/-5.9% vs. 86.8%+/-5.1%, P<0.05). The DeltaFVC was significantly higher in patients with EA than in those with LA (19.4%+/-5.1% vs. 17.0%+/-4.5%, P<0.01), but PC20 was not different between the two groups. In total subjects, asthma duration correlated significantly with DeltaFVC (r=0.222, P<0.01), but not with PC20. CONCLUSION: These data suggest that prolonged asthma is associated with worsened bronchial responsiveness during childhood, and such an association may be reflected primarily by DeltaFVC rather than PC20.

Acute Disseminated Encephalomyelitis with Psychotic and Parkinsonian Features: A Case Report

Acute disseminated encephalomyelitis (ADEM) is a monophasic immune-mediated demyelination disorder that can arise following infection or immunization. Typical MRI findings show multifocal demyelinating lesions in the CNS. The presenting features include acute encephalopathy with multifocal neurologic signs, and patients often progress to develop delirium and/or coma, but acute psychosis is rare. In our current report, we describe a case of a 14-year-old boy presenting with parkinsonian features (masked face, bradykinesia, resting tremor, slow strides) as well as aggressive behavior and irritability with persecutory delusions that developed 3 days after an upper respiratory tract infection. T2-weighted/FLAIR brain MRI showed increased signal intensity in the hippocampus and basal ganglia including in the caudate nuclei. Cerebrospinal fluid (CSF) enterovirus PCR was positive. After treatment with high-dose methylprednisolone and antipsychotics, he recovered without permanent disabilities, and the initial lesions found on MRI disappeared on follow-up.