A case of airway hemangioma in a 1-month-old infant with dyspnea

Infantile hemangiomas are the most common benign tumors of infancy. However, hemangiomas located in the respiratory tract are rare and could cause life-threatening events due to airway obstruction. To date, the best recommended treatment for infantile hemangioma is oral propranolol because it demonstrates faster effects and fewer adverse effects than systemic corticosteroid therapy. Here, we report a case of a 1-month-old girl who presented with respiratory symptoms and hemangioma on the scalp. The hemangioma extended from the right base of the skull to thoracic inlet, causing inspiratory stridor and dyspnea. Treatment with oral propranolol was initiated and her symptoms regressed. Imaging showed regression of the hemangioma. This is a rare case of skin hemangioma found on the scalp, in which the hemangioma extended from the base of the skull to the subglottis, precipitating respiratory symptoms from airway obstruction. Based on this encounter, the presentation of skin hemangioma on the head, coupled with respiratory symptoms, necessitates the use of imaging studies, such as computed tomography, ultrasound, and magnetic resonance imaging to ascertain the extent of hemangioma.

Changes in levels of fractional exhaled and nasal nitric oxide after treatment in allergic rhinitis

Purpose@#Recent studies have reported that nasal nitric oxide (NO) increases in patients with allergic rhinitis (AR) and bronchial asthma (BA), and can be used as a noninvasive test to determine treatment efficacy. We aimed to investigate the changes in fractional exhaled NO (FeNO) and nasal NO levels before and after treatment in patients with AR and asthma. @*Methods@#Children aged 6–18 years who visited Dong-A University Hospital from August 2013 to July 2014 were treated for mildpersistent or severe-intermittent AR according to Allergic Rhinitis and its Impact on Asthma guidelines. FeNO and nasal NO were measured using NObreath. Among all patients, rhinitis was treated for 1 month, and the results were evaluated in patients with improved AR (n = 31), improved AR+BA (n = 23), and control (n = 19) groups. @*Results@#Sex, age, body mass index, allergy, serum total eosinophil count and immunoglobulin E, erythrocyte sedimentation rate, and C-reactive protein showed no intergroup differences before or after treatment. Nasal NO before treatment was higher in the BA+AR and AR groups than controls (P = 0.005), but there was no difference between disease groups after treatment. Both groups showed a significant decrease in nasal NO after treatment compared with measurements before treatment (AR, P = 0.044; AR+BA, P = 0.004). @*Conclusion@#Nasal NO can be effectively used as a noninvasive test for clinical efficacy because it was significantly reduced by improving symptoms in AR patients with and without asthma.

Analysis of factors affecting clinical feature and disease severity according to the subtypes of respiratory syncytial virus

Purpose@#Respiratory syncytial virus (RSV) is one of the most common causes of respiratory tract infections, especially in patients aged 39°C) was slightly higher in the RSV B group (13.6%) than in the RSV A group (11.7%), although the difference was not statistically significant. Laboratory findings, including the neutrophil-lymphocyte ratio, were similar between the groups. The incidence of systemic steroid therapy was higher in the RSV A group (12.6%) than in the RSV B (3.0%) group (P= 0.03). Patients aged < 12 months, the incidences of oxygen therapy (P= 0.03) and systemic steroid therapy (P= 0.04) were higher in the RSV A group, suggesting that patients aged < 12 months with RSV A infection may have clinically more severe disease. @*Conclusion@#We recommend intensive monitoring if RSV A infection is detected in young children under 12 months.

A Child who has Nasal Polyposis Combined with Bronchiectasis

Nasal polyps are inflammatory lesions of sinonasal tissue that are associated with chronic rhinosinusitis, allergic reaction, and other diseases. Although it is the most common cause of nasal polyps, chronic inflammation of the nasal cavity is not common in children. When nasal polyps are found in childhood, it is important to investigate the cause, such as immunodeficiency disease, cystic fibrosis, primary ciliary dyskinesia, and other syndromes such as Woakes’ syndrome. We report a child who presented with nasal polyps combined with bronchiectasis with a review of related literature.

Cystic fibrosis lung disease: Current perspectives

Cystic fibrosis (CF) is an autosomal recessive disease caused by mutations in the gene encoding the cystic fibrosis transmembrane conductance regulator (CFTR). These mutations alter the synthesis, processing, function, or half-life of CFTR, the main chloride channel expressed in the apical membrane of epithelial cells in the airway, intestine, pancreas, and reproductive tract. Lung disease is the most critical manifestation of CF. It is characterized by airway obstruction, infection, and inflammation that lead to fatal tissue destruction, which causes most CF morbidity and mortality. This article reviews the pathophysiology of CF, recent animal models, and current treatment of CF.

Risk Factors and Comorbidities Associated With the Allergic Rhinitis Phenotype in Children According to the ARIA Classification

PURPOSE: Data are lacking on the association between the allergic rhinitis (AR) phenotype and sensitization to specific allergens or bronchial hyperresponsiveness (BHR) in children. We here investigated risk factors and comorbidities, including sensitization to specific allergens and BHR, for the AR phenotype by AR and its Impact on Asthma (ARIA) classification in a general population-based birth cohort study. METHODS: We enrolled 606 children aged 7 years from the Panel Study of Korean Children. The AR phenotype was assigned in accordance with the ARIA classification in children. Skin prick tests and Provocholine provocation test were performed. Risk factors and comorbidities for AR phenotypes were then analyzed. RESULTS: The prevalence of mild and moderate to severe AR in our study cohort was 37.2% and 8.8%, respectively. Recent use of analgesics or antipyretics and current cat ownership were associated with the risk of mild persistent AR. Sensitizations to Dermatophagoides Pteronyssinus (Der p), Japanese hop and cat were associated with moderate to severe persistent AR. Children with moderate to severe AR had a higher risk of current asthma and BHR compared to mild AR cases (adjusted odds ratio [aOR], 5.26; 95% confidence interval [CI], 1.77–15.62). Moderate to severe AR with allergic sensitization was associated with the highest risk of BHR (aOR, 11.77; 95% CI, 3.40–40.74). CONCLUSIONS: Moderate to severe-persistent AR is more closely related to respiratory comorbidities and sensitizations than mild AR. Stratifying the AR phenotype by ARIA classification may assist in disease management.

Indoor pet ownership in infancy is a risk factor for the development of sensitization to pets and asthma in childhood

PURPOSE: It is controversial whether indoor pet exposure is either a risk or protective factor developing sensitization to pet allergens or asthma. Therefore, we investigated whether indoor pet ownership entails a risk for the development of asthma and sensitization in childhood. METHODS: The Panel Study of Korean Children (PSKC) is a general-population-based birth cohort study that recruited 2,078 mother-baby dyads in Korea between April and July of 2008. Among 1,577 children who were followed up in 2015, 559 underwent skin prick tests, spirometry and bronchial provocation tests using Provocholine. Having a cat or a dog and the prevalence of asthma were evaluated by using self-reported questionnaires and physicians’ medical records. RESULTS: During infancy, the rate of dog ownership was 4.5% (71 of 1,574) and that of cat ownership was 0.5% (8 of 1,574). Of the subjects, 7.9% (n=109) currently had at least 1 dog and 2.5% (n=34) had at least 1 cat. Pet ownership during infancy was associated with sensitization to cats or dogs (adjusted odds ratio [aOR], 4.24; 95% confidence interval [CI], 1.29–13.98), wheezing within 12 months (aOR, 5.56; 95% CI, 1.65–18.75) and current asthma (wheezing episode in the last 12 months+diagnosed asthma by physicians) (aOR, 6.36; 95% CI, 1.54–26.28). In contrast, pet ownership during the last 12 months was not associated with sensitization to cats or dogs or current asthma. CONCLUSION: Indoor pet exposure during infancy can be critical for developing sensitization to cats or dogs and asthma in childhood. Avoidance of pet exposure in early life may reduce sensitization to cats or dogs and development of asthma.

Multicenter Adherence Study of Asthma Medication for Children in Korea

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered “taking as prescribed” was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was “Easy” or “Very easy” to use (P < 0.001). “Method of administration” was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., “Frequency of administration”). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.

Prevalence, Risk Factors and Cutoff Values for Bronchial Hyperresponsiveness to Provocholine in 7-Year-Old Children

BACKGROUND: A US Food and Drug Administration (FDA)-approved drug methacholine chloride (Provocholine®) was recently introduced to Korea where it is now widely used in clinical practice. We aimed to evaluate the prevalence, risk factors and cutoff value of bronchial hyperresponsiveness (BHR) to Provocholine in 7-year-old children. METHODS: Six hundred and thirty-three children from the Panel Study on Korean Children who visited 16 regional hospitals were evaluated. Skin prick tests, spirometry and bronchial provocation tests for Provocholine as well as a detailed history and physical examinations were performed. The bronchial provocation test was reliably performed on 559 of these children. RESULTS: The prevalence of ever-diagnosed asthma via medical records was 7.7%, and that of current asthma (wheezy episode in the last 12 months + diagnosed asthma by physicians) was 3.2%. The prevalence of BHR to Provocholine was 17.2% and 25.8%, respectively, for a PC20 < 8 and < 16 mg/mL. The risk factors for BHR (PC20 < 16 mg/mL) were atopic dermatitis diagnosis and current dog ownership, whereas those for current asthma were allergy rhinitis diagnosis, a history of bronchiolitis before the age of 3, recent use of analgesics/antipyretics and maternal history of asthma. The BHR prevalence trend showed an increase along with the increased immunoglobulin E (IgE) quartile. The cutoff value of PC20 for the diagnosis of current asthma in children at age 7 was 5.8 mg/mL (sensitivity: 47.1%, specificity: 87.4%). CONCLUSIONS: BHR to Provocholine (PC20 < 8 mg/mL) was observed in 17.2% of 7-year-olds children from the general population and the cutoff value of PC20 for the diagnosis of current asthma was 5.8 mg/mL in this age group. The risk factors for BHR and current asthma showed discrepancies suggesting different underlying mechanisms. Bronchial provocation testing with Provocholine will be a useful clinical tool in the future.

Analysis of pediatric adverse drug reactions reported to regional pharmacovigilance center of a single university hospital

PURPOSE: Adverse drug reactions (ADRs) are a recurring problem among pediatric patients, and the incidence is increasing. However, there have been only a few studies on the clinical presentation of pediatric ADRs in Korea. This study investigated the clinical presentation of ADRs and the causative drugs in pediatric patients from a single university hospital. METHODS: We retrospectively collected the data on pediatric ADRs as reported to the Regional Pharmacovigilance Center in Dong-A University Hospital between March 2013 and July 2016. We analyzed clinical presentations associated with the events. To determinate causality, we evaluated each ADR according to the Naranjo probability scale, the World Health Organization-Uppsala Monitoring Centre (WHO-UMC) criteria and the Korean ADR algorithm. RESULTS: A total of 365 ADR cases were reported. Sixty-eight patients (26.5%) responded to 2 or more drugs. Antibiotics (43.3%) were the most common causative drugs, of whom the third generation cephalosphorins caused most ADRs. The most common clinical presentations were gastrointestinal manifestations (36.6%). A total of 312 ADRs were reported in 257 patients based on both the Naranjo probability scale and the Korean ADR algorithm. In addition, 323 ADRs were reported in 257 patients based on the WHO-UMC criteria. CONCLUSION: Various drugs are related to ADRs in pediatric patients. Further efforts to improve ADR-reporting systems and to increase awareness of ADRs in pediatric patients are needed.

Factors associated with the treatment of chronic spontaneous urticaria in children

PURPOSE: Chronic spontaneous urticaria (CSU) in children is a common skin disorder, but its clinical course varies. We investigated the clinical course and associated factors for CSU treatment in children. METHODS: A total of 107 children, diagnosed with CSU from 2001 to 2016 in Dong-A University Hospital, who had been followed up for more than 6 months after treatment, were enrolled. The laboratory findings, and clinical aspects and courses were retrospectively investigated by a medical record review. We divided the 152 patients into 3 groups according to the treatment modalities: group 1, 1 antihistamine; group 2, more than 2 kinds of antihistamines; and group 3, antihistamines plus leukotriene receptor antagonist. RESULTS: The mean age of patients in group 3 was 3.4 years (range, 2.6–4.2 years), which was significantly lower than those at the other 2 group patients (P=0.01). The urticaria activity score (UAS) of group 3 (6.1 [5.7–6.6]) was significantly higher compared to those of the other 2 groups (P=0.01). The improvement rate of the condition in children with positive specific immunoglobulin E (sIgE) reactivity to food or inhalant allergens was significantly lower than that of children with negative sIgE reactivity (P=0.01). Sex, age, history of allergic diseases, disease duration, UAS, previous treatment, and treatment modality were not correlated with the symptom improvement rate. CONCLUSION: Younger children and those with higher UAS needed more medication to ensure the improvement in symptoms. Moreover, it took more time for the improvement in symptoms in children who were sensitized to food or inhalant allergens.

Clinical considerations of febrile infants with respiratory symptoms according to the respiratory viral detection

PURPOSE: Respiratory viral infection is one of the most common diseases in febrile infants. This study evaluates the clinical characteristics of febrile infants who were hospitalized for respiratory symptoms, with or without respiratory viral detection. METHODS: Seventy-six hospitalized infants aged 28-90 days with fever and respiratory symptoms from January 2011 to December 2012 were enrolled in this study. We performed reverse transcriptase polymerase chain reaction to identify 7 respiratory viruses from nasopharyngeal swabs. Also, we retrospectively reviewed the medical records to analyze the clinical features. RESULTS: Respiratory viruses were detected in 45 patients (RVP group). Respiratory syncytial virus (n=16) was most frequently detected, followed by human rhinovirus (n=10). Age, sex, past illness, and sibling's respiratory symptoms showed no differences between the 2 groups. Infants in the RVP group had a significantly higher incidence of tachypnea (22.2%) and abnormal breathing sounds (wheezing and rales, 57.8%) than those in the negative group (P=0.021, P=0.002 each). There were no significant differences in laboratory findings between the 2 groups. CONCLUSION: In our study, RSV was the most common virus in febrile infants aged 28-90 days with respiratory symptoms. Tachypnea and abnormal breathing sounds were more reliable clinical features to guess the detection of respiratory viruses. Further studies are required to confirm the values of these clinical features in febrile infants who have lower respiratory tract infections.

Behavioral characteristics and parental stress in elementary school children with bronchial asthma and allergic rhinitis

PURPOSE: The aim of this study was to investigate the differences in behavioral characteristics and parental stress between allergic and nonallergic elementary school children. METHODS: Ninety-one elementary school children who had allergic disease were enrolled (asthma, n=27; allergic rhinitis, n=35; combined, n=29). Also one hundred six nonallergic elementary school children were enrolled for the control group. The Korean Child Behavior Check List (K-CBCL) and Korean Parenting Stress Index-Short Form (K-PSI-SF) were completed by their mothers. RESULTS: According to the analysis of K-CBCL, the score for Internalizing, anxious/depressed and somatic complaints were significantly higher in the combined group than in the control group. The score for Diagnostic and Statistical Manual of Mental Disorders (DSM)-affective problems in the combined group and DSM-somatic problems were significantly higher in the asthma group than in the control group. According to the analysis of K-PSI-SF, the score for parental distress was significantly higher in the allergic rhinitis group than in the control group. The scores for behavioral problems and parental stress were significantly correlated to allergic disease groups. CONCLUSION: Behavioral problems and parental stress were significantly associated with asthma and allergic rhinitis. The results of this study suggest the importance of psychosocial support for mothers and children with allergic diseases.

Clinical characteristics related to onset age of wheeze in school-age children and adolescents with asthma

PURPOSE: We aimed to investigate the clinical characteristics and their relationship with the onset age of wheeze in school-age children and adolescents with asthma. METHODS: Three hundred twenty-six patients, aged 6 to 19 years, diagnosed with asthma at 6 hospitals from Seoul, Gyeonggi, Daegu, and Busan were enrolled. They were categorized into 3 groups by the onset age of wheeze: group A, early onset (age or =6 years). Clinical characteristics including atopic sensitization, family history, combined allergic diseases, severity of asthma, and influence of asthma on daily life were examined. A history of hospitalization for early lower respiratory infection (LRI) and environmental tobacco smoking were studied and lung function tests were also performed. RESULTS: There was no difference in demographics, prevalence of atopy, combined allergic diseases, and family history of allergy between 3 groups. A history of sever LRI in early life was more common in groups A and B compared with group C. Sensitization to Dermatophagoides pteronyssinus was more prevalent in groups A and B than in group C. Forced expiratory flow between 25% to 75% (FEF(25%-75%)) was lower in groups A and B than in group C, and methacholine PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second) was lowest in group B. Significantly lower FEF(25%-75%) and methacholine PC20 were observed in the patients who had been hospitalized with LRI in early life. CONCLUSION: Our study shows significant difference in lung function and atopic sensitization in relation to the onset age of wheeze in school-age children and adolescents with asthma, and suggests that early LRI might contribute to the development of asthma in early life.

Association between social economic status and atopic dermatitis in Korean adult: an analysis of the Fifth Korea National Health and Nutrition Examination Survey (2010-2012)

PURPOSE: Atopic dermatitis is one of the most common allergic diseases, and its prevalence has been increasing in recent decades. Social economic status is a well-known risk factor for allergic disease. This study was performed to investigate the relationship between social economic status and atopic dermatitis in Korean adults. METHODS: Data were acquired from 18,066 men and women aged older than 19 years who participated in the Fifth Korea National Health and Nutrition Examination Surveys (KNHANES), which was conducted from 2010 to 2012. The presence of atopic dermatitis was based on self-reported physician diagnosis of atopic dermatitis in the Health Interview Surveys. RESULTS: The prevalence of atopic dermatitis was 2.3%, which decreased with age. In univariate analysis, adults with atopic dermatitis were younger, well-educated, had higher monthly family income, had more household members, and lived in the urban area (P<0.05), whereas sex, residential type, or smoking status was not associated with the presence of atopic dermatitis. The prevalence of hypertension, diabetes mellitus, and obesity were lower in atopic dermatitis subjects, while asthma was higher (P<0.05). Binary logistic regression analysis showed that younger age and the presence of asthma were associated with higher prevalence of atopic dermatitis (P<0.01). CONCLUSION: The results of this study suggest that younger age and the prevalence of asthma may be important risk factors for the prevalence of atopic dermatitis in Korean adults. These results warrant future studies to explore mechanisms underlying the association between social economic status and atopic dermatitis.

Factors associated with serum vitamin D levels in children with recurrent wheezing less than 3 years old

PURPOSE: We evaluated the relationship between laboratory/clinical factors and vitamin D levels in recurrent wheezers less than 3 years old. METHODS: We retrospectively analyzed clinical data and laboratory factors (25-hydroxyvitamin D, complete blood count, C-reactive protein, glutamic oxaloacetic transaminase, glutamyl purovic transaminase, alkaline phosphatase [ALP], eosinophil counts, and serum IgE IgG, IgA, IgM) of 84 children less than 3 years who had experienced wheezing episodes at least 3 times. RESULTS: Children in the normal group (1.4+/-0.9 years) were younger than those in the deficient (2.2+/-1.2 years) and insuffient (2.3+/-1.0 years) groups (P=0.010). Glutamyl purovic transaminase were higher in the normal group (24.5+/-19.4 IU/L) than in the deficient (16.0+/-4.7 IU/L) and insufficient (15.3+/-4.5 IU/L) groups (P=0.009). ALP were higher in the deficient (791.4+/-180.8 IU/L) and insufficient (770.4+/-251.2 IU/L) groups than in the normal group (631.9+/-127.0 IU/L, P=0.034). Total IgE levels were higher in the deficient group (171.9+/-212.1 kU/L) than in the normal group (43.7+/-58.3 kU/L, P<0.05), and the rate of sensitization to aeroallergens was higher in the insufficient group (36.1%) than in the normal group (10%, P<0.05). CONCLUSION: Among children with recurrent wheezing less than 3 years old, low vitamin D levels may be associated with older age, total IgE, ALP level, glutamic pyruvate transaminase level, and rate of sensitization to aeroallergens.

Characteristics between IgE mediated and non-IgE mediated atopic dermatitis in children

PURPOSE: Atopic dermatitis (AD) is a chronic inflammatory skin disorder with a association of genetic, environmental, and immunologic factors in the development of AD. And AD can be classified into IgE mediated and non-IgE mediated. We investigated a difference of clinical characteristics and immune response between the two groups. METHODS: From January 2008 to December 2011, we enrolled 125 children who visited Dong-A University Medical Center and Busan Medical Center, and were diagnosed as AD with the Haniffin and Rajka's criteria. We checked the history of combined asthma and allergic rhinitis and allergic disease of family in patients. We measured serum total IgE, specific IgE by ImmunoCAP or skin prick test. We measured serum interleukin (IL) 4 (IL-4), interferon-gamma (IFN-gamma), IL-10, and IL-17, which are associated with chronic inflammatory disorder by flow cytometry method (Luminex). RESULTS: Eighty (64%) were included in the IgE mediated group, while forty-five (36%) were included in the non-IgE mediated group. The frequency of combined allergic disorder and serum total eosinophil count were relatively higher in IgE mediated group (P=0.023, P=0.032). The incidence of a family history in allergic disease and the mean of SCORing Atopic Dermatitis index had no difference between the two groups. Serum IL-4, IFN-gamma, IL-10, IL-17 were higher in the IgE mediated group, but there were no statistically significant differences between two groups (P>0.05). CONCLUSION: IgE mediated AD showed higher total eosinophil count and higher incidence of bronchial asthma and allergic rhinitis than non IgE mediated AD.

Usefulness of Influenza Rapid Antigen Test in Influenza A (H1N1) / 소아알레르기및호흡기학회지

PURPOSE: The aim of this study was to examine the sensitivity and specificity of the influenza rapid antigen test, in comparison with reverse transcription polymerase chain reaction (RT-PCR), according to the time of the test from symptom onset and the clinical manifestations in the patients tested for suspected infection of the influenza A (H1N1) at a second hospital. METHODS: A total of 529 pediatric patients, aged between 6 and 12 years old, who visited the emergency department from October 1, 2009 to December 31, 2009, received the influenza rapid antigen test and RT-PCR. We examined the sensitivity and specificity of the influenza rapid antigen test in comparison with RT-PCR according to the time of the test from symptom onset (72 hours) and clinical manifestations (fever, cough, rhinorrhea.nasal obstruction, sore throat, gastrointestinal symptoms, and general symptoms) in a retrospective study based on hospital charts. RESULTS: The sensitivity of the influenza rapid antigen test at elapsed times of less than 24 hours, 24 to 48 hours, and 48 to 72 hours after the onset of the symptoms was 53.9%, 61.4%, and 62.1% respectively. When the elapse time was greater than 72 hours, the sensitivity was 31.6%; thus, the sensitivity of the influenza rapid antigen test tended to decrease with elapsed time. The sensitivity of the test was 79% in patients presenting with gastrointestinal symptoms, which was the highest, but there was no statistical difference according to the clinical manifestations of the patients. CONCLUSION: Our study suggests that more accurate results might be gained when the influenza rapid antigen test is performed within 72 hours after symptom onset.

The Evaluation of an Education Program for Using an Inhaler Devices in Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: Asthma inhalation therapy is important for the treatment of childhood asthma. Therefore, it is necessary to educate patients on the correct inhalation techniques. The purpose of this study was to determine the effectiveness and necessity of educating patients on the correct inhalation techniques. METHODS: A total of 86 patients with bronchial asthma and who were over 7 years old were enrolled and educated on handling inhaler devices for 2 years. The inhaler devices used were the diskus (n=27), turbuhaler (n=12) and metered dose inhaler with a spacer (n=47). Trained pharmacists provided the education. Four steps (breathing out prior to inhalation, inhalation, holding the breath, exhaling slowly) that were critical for handling each device were evaluated and each step was scored as good, fair or poor. We evaluated the symptom score (daytime cough, nighttime cough, sleep disturbance and limitation of activity) and lung function before treatment and 4 weeks later. RESULTS: Over 90.0% of the diskus users performed fair to good in each step. The symptom score and lung function at 4 weeks later after education were significantly improved (P=0.000). The turbuhaler users all performed fair to good on each step. The symptom score was significantly improved (P<0.005), but the lung function was not difference. Over 95% of the users of a metered dose inhaler with a spacer performed moderate to good on each step. The symptom score and lung function were significantly improved (P<0.05). CONCLUSION: The structured, detailed education on inhaler devices by trained specialists was very important for performing correct inhalation therapy to control asthma, and repeated education might be also necessary.

Sensitization to Aeroallergens in Korean Children: A Population-based Study in 2010

We performed this study to assess the prevalence of sensitization to aeroallergens and to analyze the difference between prevalence rates according to children's ages and residential areas. In this nationwide cross-sectional study, first grade students of 45 elementary schools and 40 middle schools were randomly selected, and skin prick tests were performed for 18 inhalant allergens between October and November 2010. Of 7,829 analyzed subjects, 3,753 (47.9%) were sensitized to at least one aeroallergen. Sensitization to Dermatophagoides farinae was found to be the most prevalent in elementary schoolchildren (32.4%), followed by Dermatophagoides pteronyssinus, Tyrophagus putrescentiae, Japanese hop, and oak. In middle schoolchildren, D. pteronyssinus yielded the highest prevalence (42.7%), followed by D. farinae, T. putrescentiae, Japanese hop, and cat. In middle schoolchildren, the sensitization rate to aeroallergens in metropolitan, urban, and rural areas was 57.2%, 54.3%, and 49.8%, respectively (P = 0.019). In this age group, the sensitization rate in low, middle, high, and very high income groups was 53.8%, 51.8%, 59.0%, and 59.6%, respectively (P = 0.002). In conclusion, the sensitization rate is 47.9% and house dust mite is the most prevalent allergen in the pediatric population in Korea. The rate is higher in metropolitan areas and the highest income group than in rural areas and low income groups.