Association between brain-derived neurotrophic factor and severity of asthma in children / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the association between the serum level of brain-derived neurotrophic factor (BDNF) and the severity of asthma in children.</p><p><b>METHODS</b>A total of 60 children with acute exacerbation of asthma were enrolled and divided according to the severity of the disease into mild group (n=18), moderate group (n=25), and severe group (n=17). Sixty healthy children were enrolled as controls. ELISA was used to measure the serum BDNF level in each group and the association between serum BDNF level and the severity of asthma was analyzed.</p><p><b>RESULTS</b>The asthmatic children at the acute exacerbation and remission stages had significantly higher serum BDNF levels than healthy controls (P<0.05). The serum BDNF level was significantly reduced in the remission stage compared with that in the acute exacerbation stage in asthmatic children (P<0.05). The children with varying degrees of severity at the acute exacerbation stage had different serum BDNF levels: the severe group had the highest serum BDNF level and the mild group had the lowest level (P<0.05).</p><p><b>CONCLUSIONS</b>BDNF may play an important role in the pathogenesis of childhood asthma and is related to the severity of the disease.</p>

Effect of obesity on treatment outcome of asthma predictive index-positive infants and young children with wheezing / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the effect of obesity on the treatment outcome of asthma predictive index (API)-positive infants and young children with wheezing.</p><p><b>METHODS</b>A total of 208 API-positive infants and young children with wheezing were enrolled. According to the Kaup index, the patients were divided into an obese group (n=93) and a non-obese group (n=115). The patients were given multimodality therapy in an acute episode of wheezing and aerosol inhalation of inhaled corticosteroid (ICS) budesonide suspension in the remission stage. The dose of ICS was adjusted according to clinical control. The patients were treated for 6 months, and were followed up at 2 weeks after treatment and once per month afterwards.</p><p><b>RESULTS</b>At 2 weeks and 1 month after treatment, the obese group had significantly lower remission rates of clinical symptoms than the non-obese group (35.5%/75.3% vs 53.0%/87.8%; P<0.05). Compared with the non-obese group, the obese group had significantly higher incidence rates of wheezing at 3 and 6 months after treatment and a significantly higher proportion of patients who visited the emergency service or were hospitalized due to wheezing within 6 months (P<0.05).</p><p><b>CONCLUSIONS</b>Obesity can inhibit the response to ICS treatment in API-positive infants and young children with wheezing.</p>

Clinical characteristics of different ages of children with acute exacerbation of bronchial asthma / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To investigate the clinical characteristics of different ages of children with acute exacerbation of bronchial asthma.</p><p><b>METHODS</b>The clinical data of 118 children with an acute exacerbation of bronchial asthma between June 2012 and June 2015 were retrospectively analyzed. These patients were classified into infant group (<3 years old), preschool group (3-6 years old), and school-age group (6-14 years old) to compare their clinical characteristics.</p><p><b>RESULTS</b>The infant group had the highest rate of pneumonia, the highest rate of hospital use of antibacterial agents, the highest hospital costs, and the longest length of hospital stay, followed by the preschool group and the school-age group (P<0.05). For the maintenance treatment of asthma, the rate of use of inhaled corticosteroids was highest in the school-age group (70%), followed by the preschool group (50% )and the infant group (38%) (P<0.05).</p><p><b>CONCLUSIONS</b>The clinical characteristics vary between different ages of children with acute exacerbation of bronchial asthma: the children less than 3 years old have a higher rate of pneumonia, a higher rate of use of antibacterial agents, higher hospital costs, a longer length of hospital stay, and a lower rate of standard treatment.</p>

Clinical application of portable spirometry in asthma / 中国医学科学院学报

<p><b>OBJECTIVE</b>To investigate the clinical applications of portable spirometry in asthma.</p><p><b>METHODS</b>Twenty patients with asthma were recruited from Peking Union Medical College Hospital. Flow-volume loop, simultaneous asthma symptoms, and mood were monitored three times a day for consecutive 14 days.</p><p><b>RESULTS</b>In patients with a normal daytime spirometry, marked decline of forced expiratory volume in one second (FEV1) and peak expiratory flow (PEF) were observed at night and/or in the early morning. A within subject correlation analysis between FEV1, PEF, and asthma symptoms showed that the correlation between symptoms and airway obstruction was found only in seven out of twenty patients (35%). Four patients (20%) reported many symptoms with nearly normal portable spirometry. Accordingly, their symptoms were not correlated with FEV1 and PEF. This group of patients was defined as over-perceivers. On the contrary, another two patients (10%) did not report any symptoms while obvious airways obstruction was recorded by a portable spirometry. These patients were defined as under-perceivers.</p><p><b>CONCLUSIONS</b>Dynamic monitoring of flow-volume loop with a portable spirometry is more accurate than routine lung function test in assessment of asthma severity. In addition, combined with simultaneous monitoring of symptoms, it would be of particularly helpful in identifying two specific types of asthma patients, e.g. over-perceivers and under-perceivers.</p>

Medically unexplained dyspnea in children: a review of 34 cases / 中华儿科杂志

<p><b>OBJECTIVE</b>Medically unexplained dyspnea is common in adult and accounts for 14% patients complaining of dyspnea. Its occurrence in children is seldom recognized. In the present paper, 34 children with medically unexplained dyspnea (age 10 to 18 years) seen in Peking Union Medical College Hospital from 1996 to 2002 are reported.</p><p><b>METHODS</b>The diagnosis of medically unexplained dyspnea was clinical: it was based on the presence of dyspnea and other complaints which cannot be explained by an organic disease. The patients answered Nijmegen questionnaire and state and trait anxiety (STAI), and performed hyperventilation provocation test. Twenty sessions of breathing therapy were applied and 13 out of 34 children were followed up after the therapy.</p><p><b>RESULTS</b>Among the children, 75% started to have symptoms at the age of 13 to 16 years, though the age of first episode could be as early as 8 years. In most of the cases, the course was chronic clinically. In addition to marked dyspnea, their clinical profile included symptoms of hyperventilation i.e. blurred vision, dizziness, tingling, stiff fingers or arm. The symptoms of anxiety were less frequent in children and accordingly the level of anxiety evaluated by means of STAI was lower in children compared to adult patients. The precipitating psychological factors appeared to be related to middle school competition. Pressure from exams, reprimand from stern and unsympathetic teachers coupled with high parental expectation could be emotionally damaging to psychologically susceptible children. Thirteen patients were followed up after 2-3 months of breathing therapy with emphasis on abdominal breathing and slowing down of expiration. After therapy, the sum score of the Nijmegen Questionnaire was markedly decreased. Dyspnea and symptoms of hyperventilation were improved. The level of anxiety was minimally modified.</p><p><b>CONCLUSION</b>The cases illustrated the need for careful diagnostic evaluation and treatment because of the high rate of chronicity of the disorder.</p>