Serum ECP taken in the acute episode of bronchial obstruction can predict the development of bronchial asthma in young children.

For the early institution of anti-asthma treatment, reliable markers distinguishing the children with asthma from children with virus-associated wheeze are needed. Serum eosinophilic cationic protein (ECP) has been suggested as a marker correlating with the intensity of eosinophilic inflammation. We have studied 27 children (age 3 to 35 months) admitted with acute bronchial obstruction. Each child had been followed for 12 months after the first episode and then assigned to one of two groups (asthma or non-asthma) based on the clinical course. Serum ECP (s-ECP) was taken at the acute episode and again at least 6 months later, when the child was completely symptom-free. Serum ECP was analyzed using the Pharmacia CAP ECP FEIA immunofluorescence system. Mean s-ECP during the acute episode was 26.5 micrograms/L (5.5-69) in the asthma group (n = 14) and 9.7 (5.2-17 micrograms/L) in the non-asthmatics (n = 13), p < 0.01. There was no difference in the s-ECP analyzed during the symptom-free period. Elevated values of serum ECP taken during, but not outside, the acute episodes of bronchial obstruction may be helpful in predicting the development of bronchial asthma in young children with acute obstructive episodes.

[Bronchial hyperreactivity in pediatric and adolescent asthmatics and healthy children]. / Zkusenosti s vysetrováním bronchiální hyperreaktivity u detských a mladistvých astmatiku a zdravých detí.

The investigation of bronchial hyperreactivity (b.h.) represents the basic diagnostic test in asthmatics. In 515 asymptomatic pediatric and adolescent asthmatics (age 6-23 years) divided into various subgroups according to the study purposes, b.h. as an induced airway obstruction was assessed after inhalations of a single dose of acetylcholine (3 mg), histamine (3 mg), hypotonic and hypertonic solutions with jet nebulizer. B.h. was also studied following inhalations of distilled and mineral water, physiologic solution with ultrasonic nebulizer, and 5 min. free running outdoors. The induced airway obstruction was assessed by parameters measured from maximum expiratory flow-volume curve. The most potent stimuli were the inhaled acetylcholine (3 mg) and 5 min. free running outdoors. By the latter two tests similar incidence and magnitude of b.h. were revealed in our asthmatics without airway obstruction as well as with a mild obstruction (MEF50 and MEF25 below lower limits of predicted before both tests). For both tests (acetylcholine and 5 min. free running), recommended in practice, were given the expected limits of lung function parameters before starting the tests. The values of the parameters before the onset of provocation tests were unreliable predictors of the induced airway obstruction in our asthmatics. B. h. was also assessed in 426 healthy 9-years old children by inhalation of 1% carbachol (mean dose: 2.57 +/- 0.7 mg). Various lung function parameters showed different incidence of b.h. in the latter children. Both values of one- second vital capacity and respiratory resistance (interruption technique) revealed b.h. in 46% of our healthy children (decline of parameters more than 20%). Other parameters measured, except peak expiratory flow, proved b.h. more frequently. In the article the problems of respiratory resistance measured by interruption technique and higher incidence of b.h. in the studied healthy children are outlined.

[Gastroesophageal reflux as the basis of recurrent and chronic respiratory diseases]. / Gastroezofageální reflux jako podklad recidivujících a chronických respiracních onemocnení.

Among many causes of relapsing and chronic respiratory diseases in children the authors revealed gastrooesophageal reflux (GER) in 53 of 106 examined children, i.e. in 50%. Therefore examination of GER was included in routine examinations of all children admitted on account of the following diseases: laryngitis rec., bronchitis rec., bronchitis obstructiva rec., pneumonia rec., bronchiectasy, bronchitis deformans, asthma bronchiale. GER was detected in 208 children aged 6 months to 15 years. All children were subjected to an X-ray examination by contrast substance and to sonography of the cardia. In clinically serious cases manometric and pH metric examinations were made. When GER was detected the authors recommended conservative treatment: postural position, restricted fluid intake before going to bed, elimination of cocoa and chocolate, antacids. A favourable effect of conservative treatment in the course of 1-2 years was recorded in 60 of 76 children, who attended check-up examinations, i. e. in 79%. In children where serious complaints persisted, in particular rec. pneumonia, the development of deforming bronchitis and bronchiectasy or dyspnoic attacks, the authors indicated after completion of examinations and agreement with surgeons, a surgical approach. Fundoplication was performed in 22 children, i. e. in 10% of the patients where GER was revealed.

Ultrastructure of bronchial submucosal glands in children with chronic respiratory diseases.

The ultrastructure of bronchial submucosal glands in 4 children with chronic respiratory diseases was studied. Based on their ultrastructure the glandular secretory cells were divided into four categories: 1. mucous cells packed with large electron-lucent coalescing granules with fibrogranular matrix, 2. mucous-like cells with abundant granular endoplasmic reticulum and fewer smaller electron-lucent granules, 3. serous cells containing small to moderately large membrane-bound electron-dense granules with homogenous matrix and prominent granular endoplasmic reticulum, 4. sero-mucous cells similar to the serous ones but containing granules of either serous or mucous morphology. In our patients the mucous and mucous-like cells prevailed, forming 54.6%-100% of the glands' secretory area. Only in 2 children all four types of secretory cells were detected. Signs of pathological alteration were discovered in secretory cells of all patients. The system of intra- and interlobular ducts was lined by tall mucous cells.

Effects of 90% oxygen exposure on the ultrastructure of the tracheal epithelium in rabbits.

Numerous signs of pathological alteration were induced in the pseudostratified ciliated epithelium by a 2-hour exposure to 90% oxygen. The ciliary border injury was especially conspicuous, the mean number of cilia in a given area was significantly (p less than 0.005) reduced and morphological signs of impaired self-cleaning ability were revealed. Ciliated cells were severely injured showing apical blebbing and swelling of cell organelles. The reaction of goblet cells to exposure to O2 was rapid discharge of mucus, but the mechanism of mucus evacuation was not substantially influenced. At the ultrastructural level, only a mild effect of humidification of the oxygen was observed.

Ultrastructure of the bronchial epithelium in three children with asthma.

The ultrastructure of the bronchial epithelium of three asthmatic girls was studied from material obtained during bronchoscopy. In all patients the large bronchi were lined with an altered pseudostratified ciliated epithelium having a severely damaged ciliary border. Injury to the ciliated cells was manifested by apical bleb formation, destruction of free kinocilia, pathological ciliogenesis, dilation of the spaces of the endoplasmic reticulum and Golgi complex, an increase in the number of vacuoles and lysosomes, and the appearance of altered mitochondria. The most outstanding feature of the epithelium was the marked hyperplasia of the goblet cells with the development of intraepithelial mucous glands. The mucous elements of the epithelium had discharged their mucus. Further, there were signs of mucus cell injury and degeneration. Squamous metaplasia of the pseudostratified epithelium was not observed.