KAAACI Evidence-Based Clinical Practice Guidelines for Chronic Cough in Adults and Children in Korea

Chronic cough is common in the community and causes significant morbidity. Several factors may underlie this problem, but comorbid conditions located at sensory nerve endings that regulate the cough reflex, including rhinitis, rhinosinusitis, asthma, eosinophilic bronchitis, and gastroesophageal reflux disease, are considered important. However, chronic cough is frequently non-specific and accompanied by not easily identifiable causes during the initial evaluation. Therefore, there are unmet needs for developing empirical treatment and practical diagnostic approaches that can be applied in primary clinics. Meanwhile, in referral clinics, a considerable proportion of adult patients with chronic cough are unexplained or refractory to conventional treatment. The present clinical practice guidelines aim to address major clinical questions regarding empirical treatment, practical diagnostic tools for non-specific chronic cough, and available therapeutic options for chronic wet cough in children and unexplained chronic cough in adults in Korea.

Lung Function Reference Values in Healthy Korean Children / 소아알레르기및호흡기학회지

PURPOSE: Appropriate reference values are needed for assessment of pulmonary function during childhood. We performed pulmonary function test with simple computerized spirometry to establish reference values of air flow rates in healthy Korean children. METHODS: We examined 1,317 children aged 6 to 15 years at their schools by standardized method during May, 2001. The children with poor cooperation, respiratory symptom, and chronic disease were excluded. Regression analysis was applied for FVC, FEV1, PEF, FEF25-75% predicted from sex, age, standing height, weight, and body surface area. RESULTS: In 1,317 children(Male : 716, Female : 601), the distribution of height was from 106.7 cm to 173.5 cm, weight was from 16.5 kg to 75.5 kg. We could get regression equations and determinant coefficients between anthropometric parameters and air flow rates. In both sexes, height showed very close correlation with lung function variables, and FEV1 showed very close correlation with all anthropometric parameters. Reference values of pulmonary function test were generally higher in boys than in girls. CONCLUSION: After performing the pulmonary function test in healthy Korean children, we report their normal values of air flow rates and regression equations for the predicted values. Among anthropometric parameters, height showed most close correlation with lung function variables in both sexes.

A Model of Game Program for Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: The increased prevalence of childhood asthma in Korea from 3.4% in 1964 to 15% in 1995 might be very important for morbidity and mortality in children. Recognition of this led to consider the necessity of new management strategies emphasizing patient education. We developed the educational program including asthma-specific play game called 'Malgunsum asthma game' to improve the child's interest and evaluated its educational effect. METHOD: Twenty asthmatic children between the age seven to fifteen were attended Malgunsum Asthma Camp. The Children were randomly assigned to 5 groups, and each player had to move the horse by answering the questions on the card. The first one who reaches the goal wins the game. RESULTS: All the children well followed the play rule and were interested to the game. CONCLUSION: This educational game model will achieve better control of asthma by leading the patients to understand the nature of asthma, how to identify and control the aggravating factors, how to recognize symptoms and appropriate steps for asthma, and the importance of daily maintenance therapy with anti-inflammatory medications.

Allergen Patterns using MAST cla Test in Korean pediatric patients / 대한임상병리학회지

BACKGROUND: The MAST CLA test is known to have almost the same sensitivity and specificity as the skin prick test for diagnosing allergic diseases. We report the types of allergens causing allergic diseases in Korean pediatric patients and re-evaluate the positive cut-off level used in Korea. METHODS: The MAST CLA tests were done on patients, ages less than 14-years, who visited the allergy clinic in the pediatric department from May 1999 to September 2000. We separated the patients into 2 age groups, one group of less than 3 years and dependent on milk feeding and another group of older than 3 years. RESULTS: Among 599 patients, 353 patients were male, 246 patients were female. 261 patients had at least one positive allergen-specific IgE antibody in the allergy disease group. The overall positive rate was 63.0% and 61.3% in the male and female groups, respectively among the allergy diseases group. The order of allergic origin frequencies was; milk, egg whites, D. farinae, D. pteronyssinus, and house dust. But patients who were less than 3 years of age and dependent on milk feeding, the order of allergen frequencies changed to milk, egg whites, and soybeans. By changing the positive cut-off from class 2 to class 1, the positive rates for allergen-specific IgE increased from 34.4% to 62.3%. Class 1 positive results showed good clinical correlations. CONCLUSIONS: Allergen origins for patients under 3 years of age and those of older groups were different. By changing the positive cut-off from class 2 to class 1, the detection rate for allergens increased which also showed good clinical correlation with symptoms. Allergen origin should be defined by the MAST CLA test for prompt therapy.

Transplacental transfer and age-related levels of serum IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae types 14 and 19 in Korea

Little is known about the prevalence of naturally acquired IgG antibodies to the capsular polysaccharides of Streptococcus pneumoniae (pneumococcal IgG) in Korea. In the present study, we investigated transplacental transfer and age-related levels of pneumococcal IgG to provide background seroepidemiologic data for S. pneumoniae in Korea. One hundred thirty eight sera were assayed by ELISA for IgG to pneumococcal polysaccharide capsular serotypes 14 and 19, the predominant serotypes for under 15 yr of age in Korea. The subjects were divided into 7 subgroups according to age. The cord/maternal geometric mean titer of pneumococcal were 4.47+/-5.88/5.21 +/- 5.88 for serotype 14, and 4.68 +/- 5.55/6.55 +/- 6.92 for serotype 1 9 (mean +/- standard deviation, microg/mL). After birth, the geometric mean titers of pneumococcal IgG for serotypes 14 and 19 expressed in microg/mL were 1.18+/-2.12 and 1.41+/-2.17 in the 0-6 months group, 0.27+/-0.19 and 0.69+/-0.93 in 7-12 months, 0.21+/-0.22 and 0.64+/-1.32 in 1-2 yr, 0.69+/-0.78 and 2.65+/-2.46 in 3-6 yr, 2.52+/-2.72 and 8.29+/-4.24 in 7-10 yr, respectively. In conclusion, reduced transplacental transfer and very low serum concentrations of pneumococcal IgG may contribute to the susceptibility of neonates, infants, and young children to S. pneumoniae infection.

Usefulness of Pasma Atrial Natriuretic Peptide Concentration in the Diagnosis of Patent Ductus Arteriosus in Preterm Infants

PURPOSE: Diagnosis of a hemodynamically significant patent ductus arteriosus(PDA) that should be treated is difficult to determine by clinical and echocardiographic examinations. The aim of this study was to clarify the interrelationship of plasma atrial natriuretic peptide(ANP) concentrations and clinical signs or echocardiographic signs of PDA in preterm infants and use plasma ANP concentrations as a diagnostic indicator of a hemodynamically significant PDA. METHODS: Twenty-four preterm infants who were born at Guro Hospital, Korea Medical Center were evaluated on the 3rd day after birth. Clinical signs(cardiovascular dysfunction score 3) and echocardiographic signs[magnitude of left-to-right shunt across a PDA and left atrium(LA): Ao ratio] of a PDA and plasma ANP concentrations were measured. RESULTS: Plasma ANP concentrations and LA/Ao ratios of preterm infants with hemodynamically significant PDA were significantly higher than those of preterm infants without hemodynamically significant PDA. Plasma ANP concentrations were related to the magnitude of the left- to-right shunt across a PDA and LA: Ao ratio. Plasma ANP concentrations of LA/Ao of more than 1.3 were significantly higher than that of LA/Ao of less than 1.3. CONCLUSION: In preterm infants, high plasma ANP concentration may be a useful predictive indicator of a hemodynarnically significant PDA. Measurement of plasma ANP concentration may play a role in deciding the need for and timing of medical or surgical management of preterm infants with PDA.

The Use of Ultrasonography in the Suprapubic Bladder Aspiration in Neonates

PURPOSE: Suprapubic bladder aspiration (SBA) of urine is an acceptable method to obtain sterile urine in the newborn infants. But the main problem with this technique is the low success rate of the procedure. We undertook a randomized, prospective study to determine whether a portable ultrasound examination could improve the success rate of SBA in the newborns. METHODS: In the ultrasound group, 46 newborns underwent SBA if ultrasound revealed sufficient urine (10x20 mm) in the bladder. In the control group, 32 newborns underwent SBA without an ultrasound examination. After each attempt, the number of needle punctures, volume of urine obtained and any complications of the procedures were recorded. RESULTS: 1) Success rate of SBA in this study was 91.3% (42/46) in the ultrasound group compared with 68.8% (22/32) in the control group (P<0.05). The mean number of punctures in the ultrasound group was less than in the control group (P<0.001). 2) The mean number of punctures and the frequency of hematuria were less in the success group of SBA (P<0.05). CONCLUSION: Portable ultrasonography can improve the success rate of SBA and reduce the number of passes and complications.

Clinical Efficiency of Cardiac Troponin T for Myocardial Damage in Neonatal Asphyxia

PURPOSE: The aim of this study was to evaluate the clinical efficiency of cardiac troponin T(cTnT) in detecting myocardial damage in neonatal asphyxia and to compare the diagnostic value of cTnT with creatine kinase MB(CK-MB). METHODS: Sixty-three neonates were enrolled in this study, consisting of 27 asphyxiated infants(asphyxiated group; 1-min or 5-min Apgar score0.05), whereas CK-MB in group II it was higher than in group I (P0.2 microgram/L). Ten of them(83%) had a tricuspid insufficiency of moderate or severe degree. CONCLUSION: cTnT is a more heart-specific serodiagnostic marker than other markers in asphyxiated neonates with suspected myocardial damage.

A Study of the Comparison of Uitrasonography with Radiography to Localize the Umbilical Venous Catheter in the Neonate

PURPOSE: Incorrect umbilical venous catheter(UVC) position results in an increased incidence of complications and rnisleading pressure measurements. Most modern catheters are radiopaque and are easily seen on plain film radiographs but the exact relation of the catheter tip to vascular anatomic landmarks is not available. We assessed the ability of ultrasonography to locate the tip of UVC. And we described the relationship between the locations of the tip of UVC on the ultrasonography and the anatomical landmark seen on the radiography. METHODS: From February 1997 to June 1997, 40 newborns admitted to NICU at Guro Hospital, Korea University, and required UVC insertion for clinical care. UVC position was checked by anteroposterior and cross table lateral radiography. And then ultrasonographic assessment was performed using Hewlett Packard Sonos-1000(Hewlett Packard, UK) with a 5 MHz transducer. The ultrasonographic examinations were documented on hard copy and compared with current plain film radiographs. The sensitivity, specificity, positive predictive value, negative predictive value for the radiography as a test to detect properly positioned UVC were calculated. RESULTS: 1) In 23 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8-T10), but ultrasonographic examination showed that 3 UVCs were malpositioned(false positive value 13%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 76.9%, specificity of 78.6%, positive predictive value of 87% and negative predictive value of 64.7%. 2) In 13 of 40 newborns the UVCs were properly positioned by anteroposterior radiography (T8- T9), ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 0%). Detection of properly located UVC by anteroposterior radiography had a sensitivity of 50%, specificity of 100%, positive predictive value of 100% and negative predictive value of 51.9%. 3) In 18 of 40 newborns the UVCs were properly positioned by cross table lateral radio- graphy(less than 7mm between diaphragm and tip of UVC), but ultrasonographic examination showed that all UVCs were positioned in RA and IVC(false positive value 10.5%). Detection of properly located UVC by cross table lateral radiography had a sensitivity of 69.2%, specificity of 100%, positive predictive value of 100%, negative predictive value of 63.6%. CONCLUSION: Ultrasonographic catheter localization is a noninvasive technique that uses no ionizing radiation and has no known deterimental side effects, and allows direct visualization of the pertinent vascular anatomy and provides more information than traditional radiography. Use of ultrasonographic guidance at the time of UVC insertion allows the catheter position to be immediately adjusted, with confirmation of the amended position, obviating the need for repeated radiological evaluations. When ultrasonography is unavailable, proper placement of UVC can be estimated by use of radiography to position the tip of UVC between the eighth and ninth thoracic vertebral body by anteroposterior radiography and less than 7mm above or below the diaphragm by cross table lateral radiography.

A Case of Dexamethasone induced Hypertrophic Cardiomyopathy in Neonate with Bronchopulmonary Dysplasia

Although hypertrophic cardiomyopathy is uncommon in infant and children, we have experienced a case of dexamethasone induced hypertrophic cardiomyopathy in preterm baby who had bronchopulmonary dysplasia. This patient had hyaline membrane disease. Therefore, he received prolonged mechanical ventilation that resulted in bronchopulmonary dysplasia. After we carried out dexamethasone therapy for 7 days, hypertrophic cardiomyopathy appeared in his echocardiographic finding. We discontinued dexamethasone and then, hypertrophic cardiomyopathy improved. We report this case with the review of the associated literatures.

A Model of Education Program for Childhood Asthma / 소아알레르기및호흡기학회지

PURPOSE: The size of the burden placed on all concerned, the chronicity of the disorder, and the importance of patient compliance in optimal management make asthma an excellent target for the development of patient education programs. Despite the usefulness and the need of the asthma education programs, there is no asthma education programs developed in Korea. In order to develop the education programs for childhood asthma, we offer a model for educating parents, as the first step. METHODS: Most1y, adult education programs consist of 3 components-planning, implication, evaluation. At first, we are going to p1an the asthma education programs for parents of the patients. 2O Volunteers in mothers will be gathered in one c1ass. The curiculum is made of four 1-hour sessions. During the each session, mothers wi1l be taught about the asthma, discuss the shared experiences and practice the skins. RESULTS: This model consists of 4 sessions such as the definition of asthma, the treatment-medicines and correct use of inhalation devices, prevention and the management of acute episodes. CONCLUSIONS: Use of this education model wi1l achieve better control of childhood asthma by leading the parents and patients to participate actively in their asthma treatment. The effects of this program will be assessed by a formal objective evaluation using a pretest, posttest experimental research design.

Changes of Measles Specific IgG after Active Immunization of Measles in Korean Children

PURPOSE: Despite preventive measures, measles outbreaks ocurred in 1989, 1990 and 1994 in Korea. Especially, the proportion of immunized school aged children and adolescents was increased, and the reason was, in our opinion, primary and secondary vaccine failure after measles immunization. In this context, we attempted to evaluate the changes of measles specific IgG levels in various age groups of immunized children. METHODS: From Jun. 1. 1994 to Mar. 31. 1995, the sera were collected from immunized children aged 1.5 to 12 years who had no history of natural measles. We measured the measles specific IgG using enzyme linked immunosorbent assay (ELISA: SIATM Measles IgG Kit, SIGMA Co. St Louis, Mo). RESULTS: The seropositivity of immunized children aged 1.5 to 12 years was 86.1% and 11 year old age group showed lowest level, 66.0%. As children were getting older, the measles antibody level decreased significantly( r=-0.2264, p<0.001 ). CONCLUSIONS: Above results partially explain the reasons for recent measles occurrences in immunized children and suggest that it is necessary to modify the current immunization schedule of measles in Korea.