[Respiratory problems in children after severe pneumonia]. / Problemy oddechowe u dzieci po przebytym zapaleniu pluc o ciezkim przebiegu.

In the course of complicated pneumonia in children diffuse inflammatory infiltrations with the risk of durable destruction of lung parenchyma are confirmed clinically and radiologically. The aim of the study was an evaluation of the general health state and respiratory problems in 55 children who had been earlier hospitalized for pneumonia with signs of localized changes and severe symptoms. The evaluation was done 2-10 years after the onset of the disease. In 89.1% of children a planned treatment was continued after hospital discharge. The period of recovery lasted over 6 weeks in 50.8% of examined children, and it was shorter than 2 weeks only in 23.6% of children. The relapses of the lower respiratory tract inflammation occurred in 43.6% of children in the form of bronchitis and in 9.1% of children a recurrent pneumonia was diagnosed. Only 12.7% of children needed subsequent hospitalization for respiratory problems. In 34.5% of children a limitation of physical activity was noted. 40 children underwent a functional examination of the respiratory system. In this group 35% of children ventilation problems of restrictive character were stated, whereas in 17.5% spirometry revealed bronchial obstruction. Presented results suggest the necessity of the specialistIc care of children after severe pneumonia including the monitoring of clinical and spirometric parameters of respiratory function and adequate rehabilitation.

[Inhaled glucocorticosteroids--distribution, stability, therapy]. / Glikokortykosteroidy wziewne--rozpraszanie, stabilnosc, terapia.

In this paper the basic methods of aerosol generation--ultrasonic and pneumatic and problems resulting from their use have been discussed. Nebulisation of the inhaled steroids has been presented together with metered dose inhalers (MDI) and dry powder inhalers (DPI). Special attention has been payed to the role of lung volume chambers (spacers). In the tables the review of steroid preparations and their dosage has been displayed.

[Levels of eosinophil cationic protein in serum of infants with wheezy bronchitis]. / Stezenie eozynofilowego bialka kationowego w surowicy niemowlat chorych na obturacyjne zapalenia oskrzeli.

Wheezy bronchitis is one of the most important problems in pediatric pneumonology. Characteristic of bronchial inflammatory response during acute episode of wheezy bronchitis is not well known. The aim of our study was to examine eosinophil activation marker--eosinophil cationic protein(s-ECP) in infants with wheezy bronchitis. The study group consisted of 69 infants. Mean s-ECP level was 12.51 ug/l. Increased concentration was found in 13 children (18.8%). s-ECP level depended on age (the lowest value in the first three month of life), severity of symptoms and atopic status (higher value in case of severe course of disease and in group with higher IgE level)). There was no difference in s-ECP value between group of children presenting recurrent symptoms and children without respiratory problems in follow-up observation. However in group with frequent episodes of wheezing results of ECP level on first examination were higher than in group with only one or two episodes. Our observation suggests that in infants suffering from wheezy bronchitis eosinophils are activated and s-ECP correlate with severity of symptoms and atopic predisposition.

[Use of a video questionnaire for assessment of asthma prevalence in school children as part of the ISAAC epidemiological study]. / Zastosowanie video-kwestionariusza w ocenie czestosci wystepowania astmy oskrzelowej u dzieci szkolnych w badaniach epidemiologicznych ISAAC.

The aim of this publication is the comparison of the data characterizing asthma prevalence obtained from standardized questionnaire (SQ) and video-questionnaire (VQ) used in epidemiological study ISAAC--Poznan. Number of positive answers to questions concerning wheezing ever, current wheezing, night symptoms were lower in VQ. The percentage of children reporting exercise induced asthma didn't differ in both methods. Severe asthma attacks were reported more frequently in VQ. VQ may eliminate the differences in perception and interpretation of asthma symptoms, but presentation of severe symptoms leads to underestimation of asthma problem.

[Stability of inhaled drugs as a requisite for safe therapy as for example, with nebulised glucocorticosteroids]. / Stabilnosc leków inhalacyjnych warunkiem bezpieczenstwa terapii na przykladzie kortykosteroidów wziewnych.

In inhalation therapy preservation of the stability of an aerosolized drug molecule while nebulisation is an important factor determining its clinical efficacy and safety. The influence of nebulisation with employment of ultrasonic and jet methods using compressed air and oxygen as aerosol carriers on the stability of inhaled hydrocortisone hemisuccinate, budesonide and flunisolide was investigated. Collected aerosol samples were analyzed using thin layer chromatography and compared with standard solution samples in UV-wavelength chi = 254 nm. The appearance of additional fluorescence exctinction points by ultrasonic and air jet methods produced hydrocortisone hemisuccinate aerosol samples and by an ultrasonic method produced budesonide aerosol sample were observed. This could provide evidence for affecting stability and appearance of desintegration products of hydrocortisone hemisuccinate and budesonide while nebulisation using aforementioned methods. In the context of the obtained results the stability of a flunisolide molecule remains unaffected. Furthermore, the process of steroids solution condensation on the membrane of the nebuliser and in inhalation vessel were seen. The phenomena of molecule desintegration and solution condensation as well stated while nebulisation lead to reduction of the inhaled steroid dose accessible for a patient.

[Prevalence of allergic diseases in schoolchildren in Krakow and Poznan (based on a standardized ISAAC questionnaire)]. / Wystepowanie chorób alergicznych u dzieci szkolnych w Krakowie i Poznaniu (na podstawie badan ankietowych ISAAC).

The study population included children aged 6-7 and 13-14 years from primary schools in Kraków (2302 and 2967 children respectively) and Poznan (3132 and 4069 children respectively). The prevalence was assessed using ISAAC questionnaire. In younger age group the number of children with diagnosed asthma and presenting asthma symptoms was significantly higher in Kraków than in Poznan. In older age group higher percentage was observed in Kraków in relation to wheeze ever and nocturnal cough during last year. Pupils from Kraków had symptoms of allergic rhinitis and were diagnosed as allergic rhinitis more frequently than from Poznan. Symptoms suggestive for skin allergy were more often observed in Kraków, but the differences were significant in relation to symptoms during last year in both age groups and in relation to symptoms ever in older age group. Our study revealed discrepancy between the prevalence of symptoms of asthma and allergic rhinitis and the prevalence of established diagnosis.

[Activation of T lymphocytes and severity of atopic bronchial asthma in children]. / Aktywacja limfocytów T a ciezkosc atopowej astmy oskrzelowej u dzieci.

Recent studies point out to the role of activated T lymphocytes in the pathogenesis of bronchial asthma. We analyzed (1) T subpopulations and (2) expression of the cell surface activation markers (the light chain of interleukin-2 receptor (IL-2R) and HLA-DR antigen) in the peripheral blood of 36 children with stable atopic asthma and 10 non-atopic control subjects. Flow cytometry and double phenotyping with monoclonal antibodies conjugated with fluorescein and phycoerythrin were used. The results of these studies were correlated to the degree of asthma severity. We found no differences between the two evaluated subgroups (severe asthma--AC and moderate asthma--AU) in the percentage of T cells with CD3 and CD4 antigen. In the severe asthma subgroup there were the following differences as compared with those from control subjects: decrease of the percentage of CD8+ lymphocytes (p < 0.01) and the increase of activated cells expressing IL-2R (p < 0.001) and HLA-DR (p < 0.001). Differences in the expression of activation markers were more pronounced in the CD4+ subpopulation (CD4+/IL-2R, p < 0.001 and CD4+/HLA-DR+, p < 0.001), while they were less visible, but still significant, in the CD8+ cells (CD8+/IL-2R+, p < 0.01 and CD8+/HLA-DR+, p < 0.05). When comparing the results in severe asthma subgroup with those in moderate asthma, significant elevation was found in CD4+/IL-2R+ (p < 0.03), CD4+/HLA-DR+ (p < 0.05) and CD8+/IL-2R+ (p < 0.03) double positive cells. These observations may indicate a role of activated T lymphocytes, CD4+ and CD8+, in the pathogenesis of atopic bronchial asthma in children and existence of prolonged activation factors in chronic severe asthma.

[Studies of microbiological contamination of ultrasonic apparatus used in pediatric aerosol therapy]. / Badania zanieczyszczen mikrobiologicznych aparatury ultradzwiekowej stosowanej w aerozoloterapii pediatrycznej.

It was found that inflating tube is most rarely contaminated with microorganisms during the use of ultrasonic inhalator TUR USI 70. Glass cylinder is contaminated more frequently whereas a diaphragm, aerosol preparation, inhaling mask and a pipe joining it with the device are contaminated most frequently. Sporadic contamination of the inflating tube indicate an efficient work of air filters while frequent contamination of the diaphragm, aerosol preparation and glass cylinder prove that the contamination is caused by a coupling fluid. It was also found that ultrasound exerts a destructive effect on microorganisms in the aerosol preparation. The investigations have shown that the inhaling mask and tubes joining it with the device should be changed before each use while the other parts of an inhalator and aerosol preparation may be changed once per 15 inhalations. It was also noted that disinfection of different parts of the device by a 2% aqueous glutaric aldehyde (30 minutes at room temperature) is efficient in about 95%.