Usefulness of Percutaneous Oxygen Saturation Monitoring as a Predictor of Deterioration of Lung Function in Korean Children with Asthma / 소아알레르기및호흡기학회지

PURPOSE:Our study was designed to verify the correlation between the level of percutaneous arterial oxygen saturation (SpO2) and forced expiratory volume in 1 second (FEV1) and to classify the severity according to SpO2 level when asthma exacerbation is developed. METHODS:We performed the methacholine bronchial provocation tests with monitoring SpO2 on 350 children who visited the pediatric allergy clinic with chronic cough or recurrent wheezing from August 2006 to August 2008. RESULTS:There was a significant correlation between FEV1%fall and SpO2 (r=-0.814, P< 0.01). The mean value of SpO2 was 95.80%+/-1.2% when decrement of FEV1 was 20%. It was 92.3%+/-0.81% when FEV1 decreased by 40%. CONCLUSION:Monitoring SpO2 is a convenient and reliable objective method to determine an appropriate therapeutic option when the pulmonary function test or arteial blood gas analysis is not available in children with asthma. We suggest less than 96% of SpO2 for the moderate attack, less than 92% for the severe attack, as the criteria for the severity of asthma exacerbations in Korea, which is higher than those suggested by GINA guideline or Japanese guidelines.

The Relationship between Wheezing during Methacholine Bronchial Challenge and the Severity of Acute Asthma Exacerbation in Asthmatic Children / 소아알레르기및호흡기학회지

PURPOSE:Global Initiatives for Asthma (GINA guideline) 2005 suggests that the pitch and intensity of wheezing as the determinating factor for the severity of asthma exacerbation. However, there have not yet been sufficient data to support the correlation between wheezing and the severity of asthma exacerbation. This study was aimed to estimate the relationship between wheezing threshold and the level of forced expiratory volume in 1 second (FEV1). METHODS:Among 370 pediatric patients who visited Inha University Hospital between May 2005 and June 2006, who underwent the methacholine bronchial challenge tests in order to diagnose asthma, 228 patients with PC20 less than 16 mg/mL were examined. Medical history, physical examination, skin prick test, eosinophil count and total IgE level in peripheral blood, and nasal smear for eosinophil count were performed. RESULTS:Among the 228 patients 127 (55.7%) showed wheezing during the methacholine challenge test. Among the patient with wheezing 82 patients (36%) showed more than 20% fall of FEV1, and the other, 45 patients (19.7%), showed less than 20% FEV1%fall. One hundred one patients (43.3 %) did not show any wheezing until the %fall of FEV1 was below 20%. The geometric mean (range of 1SD) [2.29 (0.86-6.13) mg/mL] of methacholine PC20 of the 127 patients with wheezing was significantly lower than that [4.11 (1.82-9.24) mg/mL] of the 101 patients without wheezing (P<0.001). The geometric mean (range of 1SD) of methacholine PC20 in the 143 patients with positive skin prick test results was 2.57 (0.97-6.81) mg/mL, which was significantly lower than that of the 37 patients with negative results [3.69 (1.57-8.66) mg/mL] (P<0.001). CONCLUSION:We could learn that most wheezing patients showed more than 20% fall of FEV1. Therefore, it is suggested that the asthmatic children with wheezing were regarded and treated as moderate or more severe state

Comparison between adverse effects of low and usual doses of intravenous aminophylline / 소아과

PURPOSE: Some patients develop side effects from theophylline even at low serum concentrations. We designed a prospective study to evaluate the side effects of theophylline. METHODS: A Prospective, controlled trial study was conducted. The low-dose group received an intravenous continuous aminophylline dose of 5 mg/kg/day on the first day and subsequently 10 mg/kg/day on the following two days. The usual-dose group received 10 mg/kg/day for three days and the control group received normal saline for three days. Heart rate, respiratory rate, serum concentration of theophylline, and four adverse events (irritability, sleep disturbance, jitter, and vomiting) were checked at the time of admission and at 2, 12, 24, 48, and 72 h after the start of aminophylline infusions. RESULTS: Nine patients out of 37 in the low-dose group and six of 21 in the usual-dose group dropped out because of uncontrolled irritability. The serum concentrations of theophylline in dropouts (3.68+/-1.93 ig/mL) and participants (4.47+/-2.45 ig/mL) were not significantly different. Irritability was a more frequent side effect in the usual-dose group at 12 h, but there was no difference between the low-dose and usual-dose groups in terms of vomiting, sleep disturbance, and jitter. Most of the severe adverse effects were observed in children below two years of age. CONCLUSION: Some patients dropped out regardless of the initiating aminophylline dose, especially patients under the age of two years.

A Case of Acute Viral Myositis

Diffuse myalgia is common in transient systemic viral infections but overt myositis, with weakness and signs of muscle inflammation, rarely accompanies viral infection in chidren. We describe a 8-year-old boy with severe myalgia and tenderness in both lower extremities, whose unusual skeletal muscle uptake on Technetium-methylene diphosphate bone scan helped to diagnosis of myositis. Clinical course, muscle-derived enzyme studies(AST, ALT, LD, CK), electromyogram findings, histopathologic findings obtained from left gastrocnemius muscle biopsy and serologic studies for enteroviral antibodies (enterovirus type 71 and Coxsackie B4 neutralization antibody titer 1:128 respectively) were all compatible with acute viral myositis.