Prevalence and Treatment of Children's Asthma in Rural Areas Compared with Urban Areas in Beijing / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>The prevalence of childhood asthma has been increasing in China. This study aimed to compare the prevalence, diagnosis, and treatment of asthmatic children from urban and rural areas in Beijing, China.</p><p><b>METHODS</b>Schools, communities, and kindergartens were randomly selected by cluster random sampling from urban and rural areas in Beijing. Parents were surveyed by the same screening questionnaires. On-the-spot inquiries, physical examinations, medical records, and previous test results were used to diagnose asthmatic children. Information on previous diagnoses, treatments, and control of symptoms was obtained.</p><p><b>RESULTS</b>From 7209 children in rural areas and 13,513 children in urban areas who completed screening questionnaires, 587 children were diagnosed as asthma. The prevalence of asthma in rural areas was lower than in urban areas (1.25% vs. 3.68%, χ2 = 100.80, P < 0.001). The diagnosis of asthma in rural areas was lower than in urban areas (48.9% vs. 73.9%, χ2 = 34.6, P < 0.001). Compared with urban asthmatic children (56.5%), only 35.6% of rural asthmatic children received inhaled corticosteroids (P < 0.05). The use of bronchodilators was also lower in rural areas than in urban areas (56.5% vs. 66.4%, χ2 = 14.2, P < 0.01).</p><p><b>CONCLUSION</b>The prevalence of asthma in children was lower in rural areas compared with children in the urban area of Beijing. A considerable number of children were not diagnosed and inadequately treated in rural areas.</p>

Exhaled nitric oxide levels in school children of Beijing / 中华儿科杂志

<p><b>OBJECTIVE</b>To learn the normal values of exhaled nitric oxide (eNO) in children.</p><p><b>METHOD</b>School children in Beijing from 11 to 18 years of age were included in the study. All the students were assigned into two groups: normal group and abnormal group (with allergic disease) according to the International Study of Asthma and Allergy in Childhood questionnaires. eNO, peak expiratory flow rate and sensitization were measured.</p><p><b>RESULT</b>Totally 395 students were screened out as normal subject (male: 177, female: 218). The eNO level was not significantly different between genders (P > 0.05), but was associated positively with age in both male and female group (P = 0.008 and P = 0.05 respectively) and associated with height in male students (P = 0.02). The geometric mean value of eNO was 11.22 ppb (parts per billion, ppb = 10(9)) in children aged from 11 to 14 years and 14.13 ppb in children aged from 14 to 18 years, with 95% confidence interval 4.17 - 30.20, 5.50 - 36.31 ppb. The eNO level was significantly increased in children who "ever had asthma or wheezing" (n = 68), and children who "ever had rhinitis" (n = 96) compared with normal subjects (P = 0.001 and P = 0.008). The geometric mean value of eNO was 16.98 ppb in children with positive skin prick test and was significantly increased as compared with children with negative skin prick test with eNO level at 11.75 ppb (P = 0.001).</p><p><b>CONCLUSION</b>eNO level varied between 10.72 ppb and 13.80 ppb in normal children 11 - 18 years of age, and was positively associated with age and height, but not with gender. eNO level increased significantly in children with wheezing and atopy.</p>

Effects of 2-n-nonyl-1,3-dioxolane as an enhanceron transdermal absorption of Salvia miltiorrhiza gel / 中国中药杂志

<p><b>OBJECTIVE</b>To choose the most suitable concentration of 2-n-nonyl-1,3-dioxolane as a penetration enhancer in tanshinone gel preparation.</p><p><b>METHOD</b>In vitro, transdermal absorption was studied using improved Frans equipment and rats skin. Tanshinone II A was tested by HPLC.</p><p><b>RESULT</b>The 4.0% concentration of 2-n-nonyl-1,3-dioxolane enhanced the transdermal absorption significantly in the preparation.</p><p><b>CONCLUSION</b>2-n-nonyl-1,3-dioxolane was a new effective permeaton enhancer.</p>

Disparity of asthma prevalence in Chinese schoolchildren is due to differences in lifestyle factors / 中华儿科杂志

<p><b>OBJECTIVE</b>To investigate the environmental lifestyle risk factors which may explain the disparity of asthma prevalence in the Chinese population.</p><p><b>METHODS</b>In a cross-sectional study, 10 902 schoolchildren were recruited from Hong Kong (n = 3110), Beijing (n = 4277), and Guangzhou (n = 3565) using the ISAAC Phase II protocol. The average age of the children among three cities was 10.1-10.4 years and 50%-53% were male. Each subject was given an ISAAC Phase II questionnaire to be completed by the parents or guardians. Random subgroups of at least 1000 children from each city, added up to 3479 children underwent skin-prick testing. The sensitivity to eight common aeroallergens was assessed. Logistic regression analysis was used to determine the environmental and lifestyle risk factors for asthma and atopy.</p><p><b>RESULTS</b>The prevalence of wheezing in the past 12 months (Hong Kong, 5.8%; Beijing, 3.8%; Guangzhou, 3.4%) was significantly higher in schoolchildren from Hong Kong than that from the Mainland of China (OR 1.64, 95% CI 1.35-1.99). Multivariate logistic regression analyses revealed that the use of gas cooking (OR 2.08, 95% CI 1.32-3.26), foam pillow (OR 1.94, 95% CI 1.19-3.16), and house dampness (OR 1.84, 95% CI 1.25-2.71) were significant risk factors for "current wheezing". The use of cotton quilt (OR 0.70, 95% CI 0.56-0.87), breast-feeding (OR 0.79, 95% CI 0.66-0.96), and attendance of daycare (OR 0.73, 95% CI 0.59-0.88) were protective factors against "current wheezing". When a summary measure of these variables was introduced into a regression model, the Mainland residency was no longer associated with "current asthma" or "current wheezing" suggesting that either these factors or other unmeasured factors associated with above factors are responsible for the lower prevalence of asthma in the Mainland of China.</p><p><b>CONCLUSION</b>Several environmental and lifestyle factors represented characteristic of life in Mainland of China, including breast feeding, attendance of daycare, use of cotton quilt, use of pillow other than foam pillow, use of cooking fuel other than gas, and the absence of damp spots on the walls or ceiling, were the significant risk factors contributed to the disparity of asthma prevalence in children from Hong Kong and the Mainland of China.</p>

Diagnostic Value of Nebulized Bronchodilator Test with Tidal Breathing Analysis for Infants with Asthma / 实用儿科临床杂志

Objective To evaluate the effect of nebulized bronchodilator on the change of tidal breathing in infants with asthma.This may provide some objective evidence for clinical diagnosis.Methods One hundred and five infants with asthma and 26 cases with pneumonia were involved for the study.Tidal breathing flow-volume was obtained before and 10-15 minutes after nebulized bronchodilator was given.Accor-ding to the basic lung function results,59 cases as a mild group [the ratio of time taken to reach peak expiratory flow to total expiratory time(TPTEF/Te) ≥15%],and 46 cases of the infant asthma as a severe group(TPTEF/Te0.05).Moreover,in severe group,expect for RR and expiratory time(Te),the other indices significantly increased after administration of nebulized bronchodilator(P

Determination of positive bronchodilating response using impulse oscillation system in children / 中华儿科杂志

<p><b>OBJECTIVE</b>Impulse oscillation system (IOS) as an approach to lung function determination is suitable for children, especially for preschool children in that it only requires the individual to be examined to breathing stably with tidal volume. However, until now there have been no uniformly agreed criteria for positive bronchial reversibility test in clinical practice. A screening method was applied to seek for answer when this question in the hope of providing objective evidence for clinical diagnosis of respiratory diseases, esp. asthma.</p><p><b>METHODS</b>One hundred and fifty-six children patients during asthma attack were recruited randomly for this study from January to December, 2004. These patients included 103 boys and 53 girls aged from 5 to 18 years with mean age of 8.84 +/- 2.58 years, who visited the doctors in the Clinical and Educational Centre for Asthma, Capital Institute of Pediatrics and were diagnosed as asthma. Maximal expiratory flow volume and IOS lung function were determined followed by bronchodilator reversibility test in all patients. The sensitivity and specificity of IOS parameters, total respiratory impedance (Zrs), respiratory resistance at 5 Hz (R5) and reactance at 5 Hz (X5) for diagnosing asthma at different improvement levels after inhalation of bronchodilator were calculated respectively using forced expiratory volume in first second (FEV(1)) and maximal mid-expiratory flow (MMEF) as gold standard. And the regression equation between parameters of lung function which were determined with the two different methods was analyzed.</p><p><b>RESULTS</b>After inhalation of bronchodilator, the lung function of the children was improved significantly (P < 0.01), with the FEV(1), MMEF increase and Zrs, R5, and X5 decrease. There were significantly positive correlations (P < 0.01) between the improvement rate of parameters of lung functions determined with the two methods, and the highest correlation coefficients existed between X5 and FEV(1) and MMEF (respectively 0.676, 0.571), correlation coefficients between X5 and Zrs ranked second (0.519 and 0.505, respectively). When an increase of FEV(1) equal to or greater than 15%, or increase of MMEF equal to or greater than 30% was used as reference for positive bronchial reversibility, the sensitivity and specificity were relatively high for considering positive bronchial reversibility test with at least 20% decrease of Zrs, R5, and 30% decrease of X5 with IOS lung function. The sensitivity and specificity of Zrs, R5 and X5 calculated from FEV(1) were 0.62, 0.51; 0.49, 0.54; 0.70, and 0.54, respectively. The sensitivity and specificity of Zrs, R5 and X5 calculated from MMEF were 0.63, 0.54; 0.53, 0.60; 0.60, and 0.58, respectively. The regression equation showed that the decrease of Zrs, R5 and X5 corresponding to 15% increase of FEV(1) and 30% increase of MMEF were 21.7%, 21.3%; 19.9%, 19.5%; 30.1%, and 29.6%, respectively.</p><p><b>CONCLUSION</b>When lung function is determined with IOS in children, only when decrease of Zrs and R5 is equal to or more than 20% and decrease of X5 is 30% or more after inhalation of bronchodilator, can the bronchial reversibility test be considered as positive.</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>

Significance of Detection of Allergen-Specific Serum Immunoglobulin E in Children with Asthma / 实用儿科临床杂志

Objective To investigate the positive rates of food allergen (fx5),mixed molds (mx1),phadiatop and house dust mites (d1) allergen-specific serum immunoglobulin E(sIgE) in children with asthma or cough variant asthma (CVA).Their age distribution characte-ristics were also compared and analysed.Methods Blood samples of 597 asthmatic children aging from 6 months to 16 years old were applied to fx5,mx1,pha-diatop and d1 test by using fluoroenzyme-immunometricassay,UniCAP100.The positive rate of fx5,mx1,phadiatop and d1 were compared.Age distribution characteristics of children with positive sIgE were analysed.Results 1.The positive rate of fx5,mx1,pha-diatop and d1 were 34.6%,30.0%,35.2% and 23.5%,respectively.2.The highest positive rate of phadiatop and d1 were highest in children of 6-16 age group(67.8% and 46.3%);The positive rate of fx5,mx1 peaked in children of 2 years and 5 years separately(44.1% and 53.6%);3.Among 181 children with mx1 positivity 90 cases manifested phadiatop negativity.4.Sixty-five percent of children with clinically diagnosed asthma or CVA presented positivity in test in fx5,mx1 or phadiatop at least.Conclusions Two thirds asthma and CVA patients exist sIgE.Asthmatic infants mainly manifest food allergen sensitization.The positive of phadiatop increased with age.Positivity of mx1 increased with age ≤5 years old in children,and it decreases in older children(≥6 years old).Mx1 is one of the main allergens in asthmatic children.

A nationwide survey in China on prevalence of asthma in urban children / 中华儿科杂志

<p><b>OBJECTIVE</b>Asthma is one of the most common chronic disorders in childhood. The prevalence rate of asthma and other atopic diseases have increased steadily in many countries. The present survey was conducted to find out the prevalence of childhood asthma in urban areas in China, and to assess the influence of asthma on patients' social life and their families.</p><p><b>METHODS</b>A nationwide randomized survey, covering 43 cities in 31 provinces, on the prevalence of childhood asthma was carried out by the National Pediatric Cooperative Group on Asthma Research from June to October 2000, including a population of 437,873 children aged 0-14 years. Patients who had asthma, infantile asthma, cough variant asthma and questionable asthma (including asthmatic bronchitis) were chosen as subjects.</p><p><b>RESULTS</b>Totally 10,065 subjects were screened out as asthma associated children by means of questionnaire to the parents, physical examination and case history review. Among them 7401 (73.53%) children, aged 3 years or more, were diagnosed as asthma of children; 1109 (11.02%) infants and young children, aged less than 3 years, as asthma of infants and young children; 785 (7.80%) as cough variant asthma; and 770 (7.65%) as questionable asthma. The prevalence of the average accumulated asthma of all the 0-14 years old asthma population (including asthma of older children and of infants) in the 31 provinces, 43 cities was 1.97%. Male/female ratio was 1.75:1. There was statistically significant difference in asthma prevalence among the 43 cities, with the highest rate in Chongqing (4.63%) and the lowest in Xining (0.25%). Overall, within China, the prevalence rate in North China was relatively lower (0.99%) and was higher in South China (1.54%), the highest was seen in eastern areas of China (2.37%), 4670 patients (70.00%) of the children had their onset before three years of age. The current 2 years prevalence of Chinese urban children was 1.54%. Thirty-six of the 43 cities had received the same kind of asthma prevalence survey 10 years ago, which made a longitudinal comparison of the two surveys available. For 6370 patients (95.47%) the family members' work was affected because of their asthma attacks. One third of the patients had used inhaler corticosteroids. In about 2/3 of patients the diagnosis of asthma was correct, while only 1/3 patients' cough variant asthma was correct compared with their early diagnosis. Sixteen percent of patients were never diagnosed to have asthmatic diseases previously.</p><p><b>CONCLUSIONS</b>There has been a significantly increasing trend of asthma prevalence during the ten years, especially in the older age group. From the data of present survey it was inferred that there has been certain improvement, although not ideal, in the accuracy of diagnosis and in the practice of steroid inhalation therapy by the pediatricians in different cities.</p>

Individual allergens as risk factors for asthma and bronchial hyperresponsiveness in Chinese children / 中华儿科杂志

OBJECTIVE This study aimed to determine the relationship between individual allergens with current wheezing and bronchial hyperresponsiveness (BHR) in schoolchildren from three chinese cities: Beijing, Guangzhou and Hong Kong. METHODS Community-based random samples of 10-yr-old schoolchildren from the 3 cities were recruited for study using the International Study of Asthma and Allergies in Childhood (ISAAC) Phase II protocol. The subjects were studied by parental questionnaires (n = 10,902), skin-prick tests (n = 3478), and methacholine challenge tests (n = 608). RESULTS The highest prevalence rates of wheezing in the past 12 months (Beijing, 3.8%; Guangzhou, 3.4%; Hong Kong, 5.8%) and atopy (Beijing, 23.9%; Guangzhou, 30.8%; Hong Kong, 41.2%, defined as having <or= 1 positive skin-prick tests,) were seen in schoolchildren from Hong Kong. The highest prevalence rates of BHR (Beijing, 33.2%; Guangzhou, 45.8%; Hong Kong, 30.7%) were seen in schoolchildren from Guangzhou. Multivariate-logistic regression analyses revealed that sensitization to Dermatophagoides pteronyssinus [odds ratio ((OR)) = 4.48; 95% confidence interval ((CI)); 3.02-6.66], cat ((OR) 2.85; 95% (CI) 1.24-6.50), Dermatophagoides farinae (DF) ((OR) 2.41, 95% (CI) 1.65-3.51) and Mixed grass pollen ((OR) 2.85, 95% (CI) 1.24-6.50) were significantly associate with current wheezing atopy ((OR) 1.29, 95% (CI) 0.74-2.24), was not an independent risk factor for current wheezing in children from any of the three cities. Furthermore, atopy ((OR) 2.53, 95% (CI) 1.93-6.97) were significantly associated with BHR. CONCLUSION The authors confirmed that sensitization to house dust mite and cat was significantly associated with current wheezing and bronchial hyperresponsiveness in Chinese schoolchildren.