Influence of serum vitamin D levels on control and severity of asthma in children

Background: To determine the association between the serum vitamin D levels with the control and severity of asthma.Methods: A total of 113 asthmatic children were enrolled in the study who were on regular follow-up and treatment for the past 6 or more months. The demographic details, presenting complaints, aggravating factors, allergic rhinitis, atopic dermatitis, hospital and ICU stay, duration of sunlight exposure, drug compliance and detailed clinical examination findings were noted in the predesigned proforma. Control of asthma was assessed based on GINA guidelines 2018 as well controlled, partly controlled and poorly controlled. The partly controlled and the poorly controlled group were further combined and labelled as not well controlled group. Severity of asthma was categorized into intermittent, mild persistent, moderate persistent and severe persistent. Serum 25 hydroxy vitamin D was assessed by solid phase ELISA. The well controlled and partly controlled group were compared for all studied parameters.Results: Asthma status of the subjects was categorized as well controlled (59%) as partly controlled (40%) and as poorly controlled (1%). Children with partly and poorly controlled asthma had significantly more vitamin D deficiency (10.9%) and insufficiency (32.6%) compared to well controlled group (4.5% and 4.5% respectively), with p value= 0.000. Low serum vitamin D levels are significantly associated with moderate and severe persistent asthma (p value= 0.009). Exercise significantly induced symptoms in 47.8% of not well controlled group and about 25.4% in well controlled group (p value= 0.014). Examination findings such as wheeze on auscultation was significantly more in not well controlled group.Conclusions: Low serum vitamin D levels are associated with poor control of asthma in children and the severity of asthma is inversely proportional to the serum vitamin D levels.

Clinical Observation of Alprostadil Combined with Salvia Ligustrazine in the Treatment of Aged Patients with Unstable Angina Pectoris / 中国药房

OBJECTIVE:To observe clinical efficacy and safety of alprostadil combined with salvia ligustrazine in the treat-ment of aged patrents with unstable angina pectoris. METHODS:A total of 150 patients with unstable angina pectoris department of our hospital during Oct. 2011-Mar. 2015 were randomly divided into alprostadil group,salvia ligustrazine group and combination group according to random number table,with 50 cases in each group. Three groups received routine treatment. Alprostadil group additionally received Alprostadil injection 100 μg added into 0.9％ Sodium chloride injection 250 mL,ivgtt,qd,on the basis of routine treatment. Salvia ligustrazine group additionally received Salvia ligustrazine injection 10 mL added into 0.9％ Sodium chlo-ride injection 250 mL,ivgtt,qd,on the basis of routine treatment. Combination group additionally received constant dose of Al-prostadil injection and Salvia ligustrazine injection. Hemorheological indexes (high shear whole blood viscosity,low shear whole blood viscosity,plasma viscosity,hematocrit,fibrinogen),cardiac function indexes(LVEF,SV,LVEFD,LVST),serum CRP, NO,ET,SOD and clinical efficacies were observed in 2 groups before and after treatment;the occurrence of ADR was compared between 2 groups. RESULTS:Before treatment,there was no statistical significance in hemorheological indexes,cardiac function indexes or serum CRP,NO,ET,SOD level between 2 groups (P>0.05). After treatment,plasma viscosity,the whole blood high and low shear viscosity,hematocrit,fibrinogen,serum CRP and ET levels of 3 groups were decreased significantly,while LVEF,SV,serum levels of NO and SOD were increased significantly,combination group was significantly better than alprostadil group and salvia ligustrazine group,with statistical significance (P0.05). CONCLUSIONS:Alprostadil combined with salvia ligustrazine can effectively reduce the blood viscosity of patients with unstable angina pectoris,improve cardi-ac function and endothelial function,reduce myocardial ischemia injury and show significant therapeutic efficacy and safety without increasing the incidence of ADR.

A Comparison of International Guidelines for Pediatric Asthma Pharmacotherapy

OBJECTIVE: International institutes such as Global institute for Asthma(GINA), KAAACI(Republic of Korea), NHLBI(USA), BTS(UK) and JSA(Japan) have published guidelines for asthma treatment. The aim of this study was to compare the representatives' international guidelines of pharmacotherapy for pediatric asthma. METHODS: The recommendations related to pharmacotherapy for pediatric asthma were extracted from the latest representatives' international guidelines, and comprehensive comparisons were conducted. RESULTS: Major comparison outcomes between international guidelines were evaluated as follows: classification system on severity and pediatric age group, recommendation for inhaled corticosteroid dose, recommendation for pediatric age group of theophylline in mild asthma, and recommendation for pediatric age group of tiotropium in severe asthma. Clinical trials emphasized the adverse effects of theophylline, whereas tiotropium demonstrated beneficial actions for pediatric asthma. Therefore, theophylline was recommended for older patients with persistent asthma, and tiotropium was considered to be suitable for younger patients with severe asthma according to GINA guidelines. CONCLUSION: These findings address the requirement to harmonize international guidelines of pharmacotherapy in pediatric asthma. In addition, the findings suggest that KAAACI needs to update its pharmacotherapy guidelines of theophylline, tiotropium and other medicines recently approved.

Evaluation of symptoms & spirometry in children treated for asthma.

Background & objectives: Spirometry plays an important role in the assessment and long term monitoring of patients with asthma. Difficulty in performing spirometry in children has resulted in a paucity of Indian studies using spirometry regularly for research in the paediatric population. This study was undertaken to assess the clinical improvement and changes in spirometric measurements with treatment in children with newly diagnosed asthma and to compare the changes in the symptom score and spirometric measurements. Methods: This prospective study included 32 children between 6 to 12 yr of age (enrolled over a period of one year with follow up of six months) who were newly diagnosed as cases of asthma on the basis of symptoms and medical history. Baseline symptom score and spirometric measurements were determined at the first visit. The children were treated and followed up at six weeks, three and six months of initiating treatment. Symptom score and spirometric measurements were repeated at every visit. Results: Significant improvement in symptom score was evident at six weeks of therapy (P<0.05) while the lung function parameters FEV1 (forced expiratory volume in 1 second) and FVC (forced vital capacity) showed significant improvement at three months of therapy. Peak expiratory flow rate (PEFR) was found to improve at six months. There was a positive linear correlation between the changes in symptom score and FEV1, FVC and PEFR with treatment. Interpretation & conclusions: Symptomatic improvement became apparent before the improvement in spirometric parameters in children with asthma (after treatment initiation).

Allergic Rhinitis in Children with Asthma: A Questionnaire Based Study in Lebanon.

Introduction: Allergic rhinitis and asthma frequently coexist but has rarely been evaluated in Lebanese children. Aim: This prospective study aimed to estimate the prevalence of allergic rhinitis in asthmatic children in Lebanon, and to ascertain whether allergic rhinitis is a risk factor for the severity of asthma. Patients and Methods: Parents of 124 children aged 1-13 years admitted to the pediatric floor of the Makassed General Hospital between July 2008 and March 2009 and diagnosed as having asthma; parents were interviewed and followed up with a questionnaire concerning allergic rhinitis symptoms and signs with para-clinical data if available. The questionnaire was based on a study done in France by Hammouda et al. (2005). This was modified from an adult score for allergic rhinitis (SFAR). Results: This well recognized score defines the association of allergic rhinitis and asthma in children. A score of ³ 9 out of 17 total score corresponds to the presence of allergic rhinitis in asthmatic children. The prevalence of allergic rhinitis was recognized in 67 patients out of 124 (54%). This prevalence was evident mainly in the age group 3-5 years. Conclusion: Allergic rhinitis is prevalent in children of the Lebanese population, the severity of asthma was found to be clearly associated with allergic rhinitis. The SFAR modified for children was found to be a simple and reliable tool to detect allergic rhinitis in asthmatic children.

Update of asthma management guideline: GINA 2006 / 대한내과학회지

Asthma is a serious global health problem. People of all ages in countries throughout the world are affected by this chronic airway disorder that, when uncontrolled, can place severe limits on daily life and is sometimes fatal. The prevalence of asthma is increasing in most countries, especially among children. Asthma is a significant burden, not only in terms of health care costs but also of lost productivity and reduced participation in family life. In 2002, the GINA Report stated that "it is reasonable to expect that in most patients with asthma, control of the disease can, and should be achieved and maintained". To meet this challenge, in 2005, Executive Committee recommended preparation of a new report not only to incorporate updated scientific information but to implement an approach to asthma management based on asthma control, rather than asthma severity. Recommendations to assess, treat and maintain asthma control are provided in the new GINA Report revised in 2006. Here, we summarize the main concepts and major changes of the new GINA guideline.

Guidelines for Asthma Management

Asthama is a chronic inflammatory disorder of the airway with recurrent airflow obstruction. Chronic airway inflammation is invariably associated with injury and repair of the bronchial epithelium, which results in structural and functional changes known as remodeling Inflammation, remodeling, and altered neural control of the airway are responsible for both recurrent exacerbations of asthma and more permanent airflow obstruction. Asthma exacerbations may be caused by a variety of risk factors including allergens, pollutants, foods and drugs. Prevention of exacerbation aims to reduce the exposure to these risk factors to improve the control of asthma and reduce medication needs. Although no cure for asthma has yet been found, it is resonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained. Patient education involves a understanding of why and how to manage asthma and how to prevent asthma exacerbation. Medications for asthma can be administered in different ways, including inhaled, oral and parenteral. The major advantage of delivering drugs directly into the airways via inhalation is that high concentrations can be delivered more effectively to the airways, and systemic side effects are avoided or minimized. Therapy should be selected on the basis of the severity of a patient's asthma. According to the GINA guideline 2002, for intermittent asthma, no daily medication is reconmmended for the vast majority of patients. A rapid-acting inhaled β2-agonist may be taken as needed to relieve asthma symptoms. The occasional patient with intermittent asthma, but severe exacerbations, should be treated as having moderate persistent asthma. Patients with mild persistent asthma require controller medication every day to achieve and maintain control of their asthma. Treatment with an inhaled glucocorticosteroid is preferred. Sustained-relase theophyline cromolynes or a leukotriene modifier are other options. The preferred therapy for moderate persistent asthma is regular treatment with a combination of inhaled glucocorticosteroid and a long-acting inhaled glucocorticosteroid and a long-acting inhaled β2-agonist twice daily. Sustained-release theophyline or a leukotriene modifier are alternatives to the β2-agonist in this combination therapy. An alternative to combination therapy is a higher dose of inhaled glucocorticosteriod. The primary therapy for severe persistent asthma includes inhaled steroids at higher doses plus a long acting inhaled β2-agonist twice daily. Any available medications including oral steroid may be added to control asthma symptoms. Once control of asthma is achieved and maintained for at least 3 months, a gradual reduction of the maintenance therapy should be tried.