Psychosocial characteristics of asthma.

The objective of this study was to compare psychosocial characteristics of children with asthma and children with bronchial hyperreactivity with those of normal children. A population-based study of 2634 children (mean age, 10 years) was carried out. Pulmonary function tests of children were performed in children before and after cold air hyperventilation challenge to determine bronchial hyperreactivity. Parental assessment of children's behavior was evaluated with 15 questions about school/learning habits, level of activity, communication/affection, and sleeping patterns. A factor analysis was performed and the factor loading adjusted for confounders compared in the different groups. Asthmatic children sleep less well than normal and hyperreactive children (p < 0.001). Unexpectedly, however, all other single items did not differ significantly. As a result of the factorial analysis we obtained two factors. On the first factor, measuring school behavior and learning, there was a small difference between asthmatic and normal children, which could not be found on the second factor indicating activity and communication. We conclude that psychosocial differences of asthmatic children are less remarkable than expected. As a result of the examination of the hyperreactive children it is likely that asthmatic children are influenced more by secondary psychosocial factors than by any primary effect of asthmatic disease.

Pertussis infection and allergic sensitization.

BACKGROUND: The immunogenic activity of B. pertussis infection has been described in various laboratory, animal, and clinical studies. There is, however, no information on the impact of pertussis on allergies in the total population. OBJECTIVE: To compare the prevalence of allergic sensitization and allergic rhinitis in children with and without previous pertussis infection. METHODS: A population-based, cross-sectional study was carried out on 13,937 10-year-old children in the western (Munich and Southern Bavaria) and eastern parts of Germany (Leipzig and the region around Halle). A total of 11,969 questionnaires (85.9%) given to the parents were collected. Data from 9,484 German children (questionnaire and skin prick tests with six different allergens) were analyzed. RESULTS: Pertussis was much more common in the western than in the eastern part of Germany. The adjusted odds ratio for any allergic sensitization after pertussis was only slightly increased in western Germany with 1.3 (95% confidence limits 1.2 to 1.5) and in eastern Germany with 1.5, (1.2 to 1.8) but not for allergic rhinitis with 1.0 (0.7 to 1.4) and in Eastern Germany 1.3 (0.8 to 1.9). CONCLUSIONS: Infection with pertussis seems to have only a weak influence on allergic sensitization and does not explain the observed differences in allergic sensitization between western and eastern Germany.

Bronchial hyperreactivity and history of wheezing in children.

UNLABELLED: The objective of this analysis was to determine the relationship between wheezing at different age groups in children and the prevalence of bronchial hyperreactivity at the age of 10. A population-based cross-sectional study was conducted in Leipzig and the region around Halle in Germany. Of 3105 10-year-old children, 2658 questionnaires (85.6%) were returned. In addition 2279 (73.4%) pulmonary function tests were performed before and after cold air challenge. 658 children (24.8%) had recurrent wheezing during their lifetime. In 579 children the individual time course could be evaluated (46 children with and 533 without a physician-confirmed diagnosis of asthma). Wheezing began most frequently in the 1st year of life (44.1% of all wheezing children) with the highest annual prevalence in the 3rd year (71.0% of all wheezing children). Wheezing which started in the first 2 years of life, had disappeared in most of the children by the age of 10. However, if wheezing began later than the 3rd year it was more persisting. Bronchial hyperreactivity measured after cold air challenge was higher in the group with recurrent wheezing (24.1%) than in the group without wheezing (18.8%, P = 0.004). CONCLUSION: Wheezing is a very common symptom in childhood and only partly associated with later bronchial hyperreactivity. On the other hand, asthma is often not diagnosed despite bronchial hyperreactivity and many years of wheezing.

Skin test reactivity and number of siblings.

OBJECTIVE: To investigate the relation between skin test reactivity in children and number of siblings. DESIGN: Cross sectional survey among schoolchildren aged 9-11 years. Skin prick tests in the children and self completion of written questionnaire by their parents. SUBJECTS: 5030 children in Munich and 2623 children in Leipzig and Halle, Germany. MAIN OUTCOME MEASURES: Atopic status assessed by skin prick tests. RESULTS: After possible confounders were controlled for, the prevalence of atopic sensitisation decreased linearly with increasing number of siblings (odds ratio = 0.96 for one sibling, 0.67 for five or more siblings; P = 0.005). In atopic children the severity of the skin test reaction as assessed by the weal size was not associated with the number of siblings. CONCLUSIONS: Factors directly or indirectly related to the number of siblings may decrease the susceptibility of children to become atopic. Thus, declining family size may in part contribute to the increased prevalence of atopic diseases reported in Western countries over the past few decades.

Prevalence of asthma and atopy in two areas of West and East Germany.

The German reunification offers a unique opportunity to study the impact of environmental factors on the development of childhood respiratory and allergic disorders in ethnically similar populations. We investigated the prevalence of asthma, hay fever, atopy, and bronchial hyperresponsiveness (BHR) in 9- to 11-year old children in West Germany (n = 5,030) and East Germany (n = 2,623). A self-administered questionnaire was distributed to the parents. Children underwent cold air challenge and allergy skin prick tests. Atopic sensitization was considerably more frequent in West German children than in their peers in East Germany (36.7% versus 18.2%; odds ratio [OR] = 2.6, p < 0.0001). The prevalence of current asthma and hay fever was significantly higher in West Germany when compared with that in East Germany (5.9% versus 3.9%; OR = 1.5, p < 0.0001 and 8.6% versus 2.7%; OR = 3.4, p < 0.0001, respectively). Bronchitis, however, was more prevalent in East Germany than in the western part of the country. The prevalence of BHR as assessed by cold air challenge was higher in West Germany compared with that in East Germany (8.3% versus 5.5%, OR = 1.6, p < 0.001). Logistic regression showed that the West German study area was no longer a significant independent determinant of asthma once sensitization to mites, cats, and pollen was taken into account. We conclude that sensitization to aeroallergens is strikingly more frequent in West Germany than in East Germany and this may explain the differences in the prevalence of asthma and hay fever between the two parts of the country.

The production of saliva of patients with juvenile chronic arthritis (JCA).

About 12-16 p.c. of the patients with JCA had a reduced saliva production. These were older than twelve years or belonged to the systemic form of JCA. The reduced saliva production is clinically not discernible. Enteral deviation or disturbances are observed with rheumatic arthritis. Various examinators have found a Sicca syndrome at about 6-12 p.c. of patients suffering from rheumatic arthritis (1, 2, 3). The mostly retrospective examinations do not allow a direct comparison. Up to now the Sicca syndrome has rarely been observed with the Juvenile Chronic Arthritis. This investigation is to present the quantitative production of saliva of JCA patients.

[Atopic skeletal retardation as a possible cause for short stature and thoracic deformity in children with asthma]. / Die atopische Skelettretardierung als eine mögliche Ursache für Kleinwuchs und Brustkorbdeformierung asthmakranker Kinder.

Deformities of the chest occur not only in asthmatics suffering from severe attacks, but also in those having a mild form of the disease. It also occurs in children with atopic dermatitis and in members of atopic families without concomitant bronchial asthma. This observation and the fact that asthmatic children tend towards hyposomia, has prompted auxological investigations of asthmatic children. It was of interest to see whether asthma itself or the atopic disposition is responsible for disturbances of growth and development. The investigation was carried out as a cross-sectional study involving 173 asthmatic boys aged 1 1/2-18 years. The programme included among other things age, bone age, bone maturity difference (BMD: difference age minus bone age) height, type and severity of asthma (measured by means of scope of therapy). The rate of hyposomia (height < mean -2 SD) amounted in the whole group to 4.7 per cent. It rose in the extrinsic asthmatics to 6.6 per cent. This corresponds with a rise of two or three times the normal rate. 11.6 per cent of the probands showed a skeletal retardation of more than 2 years. The degree of BMD showed a significant dependence on age and type of asthma but not on the duration of the disease, severity or glucocorticoid therapy. Skeletal retardation cannot, therefore, be regarded as a direct consequence of bronchial asthma, whereas the significantly different averages of BMD in extrinsic and intrinsic asthmatics point to an atopic genesis, hence it might be possible to speak of an atopic retardation of the skeleton.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of bronchial asthma on growth and physical development]. / Der Einfluss des Asthma bronchiale auf Wachstum und körperliche Entwicklung.

Radiologic bone measurements for determination of the skeletal maturation were conducted in 243 children with bronchial asthma. The authors describe marked retardation of skeletal maturation as a general phenomenon of the atopic asthma. The grade of retardation is greater in atopics than in non-atopic asthmatics. The grade of quantitative response to allergic tests is significantly correlated with the extent of retardation of the skeletal maturation. It is discussed that in addition to asthma, eczema and allergic rhinitis the retardation of the skeletal bone maturation could be a further original manifestation of atopia.

[Radiation dosage of premature infants caused by roentgen imaging of the thorax]. / Strahlenbelastung Frühgeborener durch Röntgenaufnahmen des Thorax.

The X-ray pictures of the thorax from premature infants must be prepared by conditions of neonatal intensive care. For this X-ray pictures are available very often single-puls generators only. The radiation exposure is dependent prominently on the type of the generator. The radiation exposure was compared between single-puls generators and 6-puls generators. The dosimetry was performed with CaF2-thermoluminescent dosimeters. The results of measurement demonstrated: In the radiation fields the radiation exposure is considerable higher by the single-puls generators than by the 6-puls generators. The indication to X-ray pictures of the thorax from premature infants under conditions of bed-side with single-puls generators must be very accuratly.

[Significance of bronchial branching anomalies for recurrent and chronic nonspecific diseases of the respiratory organs in children]. / Bedeutung bronchialer Verzweigungsanomalien für die rezidivierenden und chronischen unspezifischen Erkrankungen der Atemorgane bei Kindern.

About the question, whether anomalies in the branching of the bronchial tree are in causative connection with chronic nonspecific lung diseases of children, in the literature different opinions are to be read. Among about 2000 patients bronchographically examined we found 136 bronchial branching anomalies of different degrees. Seventy of them we examined about 5 years later. It is shown that isolated simple anomalies are of no consequence to the lung disease. However, branching anomalies associated with anomalies or malformations of the lung or their blood vessels have the meaning of a real disease.

[Experiences using acylureido-penicillins (azlocillin, mezlocillin) in pediatrics]. / Erfahrungen mit Acylureido-Penicillinen (Azlocillin-Mezlocillin) in der Pädiatrie.

The acylureidopenicillins azlocillin and mezlocillin cover a broad spectrum of bacteria, including gramnegative and grampositive species as well as anaerobes. Azlocillin is especially active against P. aeruginosa. Mezlocillin has a good activity against Klebsiella. Both antibiotics inhibit Hemophilus, N. meningitidis and D. pneumoniae in low concentrations. Clinical and kinetic studies were made in more than 300 pediatric patients. Elimination-constant halflife, distribution volume and area under the curve were determined to propose dosage recommendations. Concentrations of azlocillin (44) and mezlocillin (77) were measured in the bronchial secretions. Up to hour 5 after i.v. injection a wide range of concentration values were observed. Azlocillin was found in the meconium in different concentrations after a single injection into the newborn. Mezlocillin diffused into the CSF even in uninflamed meninges, 3 h after injection the mean concentrations were 5.5 mg/l. 39 patients, 35 of them infected by P. aeruginosa, were treated by azlocillin. Urinary tract infections, wound infections and dacryocystitis were cured with one exception. Less convincing were the results in complicated bronchopulmonary diseases. The clinical efficacy of mezlocillin was similar. In a group of 59 patients there were only 3 without effect and some with improvement again in complicated pulmonary diseases. Side effects worth to be mentioned were not seen. In 2 patients the azlocillin injection caused nausea. Mezlocillin led to some minor transitory elevations of the transaminases and dyspepsia in some patients.

[Air pollution and prevalence of nonspecific respiratory diseases in childhood]. / Luftverunreinigung und Prävalenz unspezifischer Erkrankungen der Atemorgane im Kindesalter.

The difficulties of defining chronic nonspecific lung diseases (CNSLD) and covering patients with these diseases are discussed. The comparison of the results of epidemiologic investigation from different investigators is full of problems. In extensive epidemiologic investigations a remarkable parallelism was found between the prevalence of CNSLD and the degree of air pollution. Furthermore the influence of climatic factors such as average annual temperature, air humidity, wind velocity, especially in reference to the content of SO2 and sedimentation dust could be stated. For the influence of microclimate on the morbidity rate the habits of smoking in the family and heating were found to be important.

[The value of the quantitative acetylcholine-test for the estimate of the bronchial reactivity (author's transl)]. / Der Wert des quantitativen Acetylcholintests für die Beurteilung der bronchialen Reagibilität.

By the quantitative acetylcholine-test, described in details, the threshold amount of acetylcholine is determined, which after inhalation is able to provoke bronchial obstruction just measureable. By double-determinations nearly identical results are obtained. Errors may result from the patient's non-cooperation, especially in young children and from unexact dosage of acetylcholine by the nebulizer. There exists a circadian periodicity of bronchial reactivity having its climax in the night an the early morning. Therefore the test should be performed always at the same hour in the morning.

[Respiratory diseases of children in an early age as a cause of absenteeism of the mothers from their working place and economical losses caused herewith (author's transl)]. / Zur volkswirtschaftlichen Bedeutung des Arbeitsausfalls berufstätiger Nütter infolge von Erkrankungen der Atemorgane ihrer Kinder im Krippen- und Kindergartenalter.

Acute respiratory diseases of children are the most important factor in all institutions for children before school age. Pediatrics and preventive medicine have here hard to work against many medical social and economic problems. Till now, we did not know exactly, how great is the financial loss and reduction of produced goods, if working woman have as mothers to stay at home to take care for their ill children. Therefore during a whole year (Sept. 1976/Aug. 1977) in the town Thale all children in creeches and other children's institutions before school age were registered. In this period a number of 2 134 days resulted from 120 mothers, obliged to stay at home by an acute respiratory disease of their children. This means a loss of 1 182 102.90 M. For 93 single mothers, 18 065.71 M are to add to this amount payed by insurance. All preventive and therapeutic measures against such respiratory diseases in an early children's age have therefore to be intensified.