Utility of Streptococcal Rapid Antigen Detection Test in Children with Acute Pharyngitis / 소아알레르기및호흡기학회지

PURPOSE: The purpose of this study was to evaluate the utility of rapid antigen detection test for group A streptococci in children with acute pharyngitis. METHODS: Seventy children with acute pharyngitis enrolled the study, who visited the Department of Pediatrics, Kangdong Sacred Heart Hospital, Hallym Medical Center from September 2004 to August 2005. The presence of clinical features such as tonsillar exudates, fever, scarletiniform rash and previous antibiotic use were evaluated and throat swab culture, rapid antigen detection test for group A Streptococci, CBC, ASO, and CRP were performed. RESULTS: Among 70 children with acute pharyngitis, the prevalence of group A beta-hemolytic Streptococcus by throat swab culture and rapid antigen detection test was 14(20.0 %) and 22(31.4%), respectively. The sensitivity of the rapid antigen detection test was 78.6 %, specificity was 80.4%, the positive predictive value was 50.0% and the negative predictive value was 93.8%. The positivity of the throat swab culture and rapid antigen detection test showed no signigicant differences according to the presence of the clinical symptoms except scarletiniform rash. Laboratory data such as CBC, ASO or CRP proved not valuable to predict the positivity of the throat swab culture and/or rapid antigen detection test for group A Streptococcus. There was a tendency of negative throat swab culture and positive rapid antigen detection test in cases of previous antibiotic use. CONCLUSION: The rapid antigen detection test can be a useful diagnostic tool for early detection of the group A Streptococcus in children with acute pharyngitis and can be helpful for the clinician to reduce the inappropriate use of antibiotics.

Survey on the Current Status of Asthma Maintenance Therapy and the Impact of Asthma on Children and Family Life / 소아알레르기및호흡기학회지

PURPOSE: In spite of the development of asthma management guidelines, there are discrepancies between the guidelines and real management. We surveyed the insights and the real management of asthma to assess the current status of its management in Korea. METHODS: The objects of the survey were 266 parents with asthmatic children, who attended an educational lecture by the Korean World Asthma Day Project Office (KWADPO). Face to face interviews with questionnaires of 11 questions about understanding of asthma maintenance therapy, actual conditions of taking medicine and the impact of asthma on the family life were undertaken. RESULTS: The Median age of the patients was 5.2 years old and their parents' age ranged from those in their twenties to those in their forties. The number of the patients actually taking asthma maintenance medicine (40.6 percent) was a little bit lower than the level of awareness (53.0 percent). As a controller, patients are using short-acting beta2 inhalers (35.3 percent), steroid inhalers (including combination inhaler) (31.6 percent), leukotriene receptor antagonists (24.8 percent), antihistamines (25.6 percent), theophylline (2.3 percent), etc. Regular visits to hospital or clinic were done in 53.0 percent of the patients. As a controllers, oral medications (69.2 percent) was preferred to inhalers (18.0 percent) due to better compliance and easier dosage adjustment. CONCLUSION: According to the survey, asthma had negative effects on the life quality of patients and their families. Remarkable discrepancies were noticed between the guidelines and the real-world status of taking medicine in asthmatic children. It is necessary to have patients participate actively in making asthma management plans to raise their efficacy.

The Efficacy and Safety of Inhaled Steroid Therapy for Prevention of Recurrent Wheezing after Bronchiolitis / 소아알레르기및호흡기학회지

PURPOSE: The purpose of this study was to evaluate the efficacy and metabolism of inhaled steroids to prevent recurrent wheezing after bronchiolitis. METHODS: Sixty two patients were randomly divided into study (n=31) and control (n=31) groups. All of them received budesonide 500 microgram and salbutamol 1.25 mg 4 times a day via nebulizer during admission period (5.5+/-2.5 days). After discharge, the study group patients received fluticasone 50 microgram twice a day with metered dose inhaler with mask spacer for 12 weeks, and the control group received none of inhaled steroids. Serum cortisol and dehydroepiandrosterone sulfate (DHEA-S) concentrations were measured at admission and at the end of the inhaled corticosteroid (ICS) therapy. Weight and height of all patients were checked during the follow-up period. RESULTS: Atopic dermatitis of the patient and allergy family history proved statistically significant. Among high risk group patients, the attack rate of recurrent wheezing in the study group was significantly reduced as compared with the control group. Cortisol levels checked at the end of the ICS therapy were not significantly different from the level checked at admission. In the study group, there was no statistically significant difference between dehydroepiandrosterone sulfate (DHEA-S) level at admission and at the end of the ICS therapy. There was no statistically significant difference of height and weight SDS (standard deviation score) between baseline and 12 weeks later. CONCLUSION: This study suggest that inhaled corticosteroid can be used prophylactically for reducing recurrent wheezing after bronchiolitis in high risk group for asthma.