Exercise-induced asthma in asthmatic children. Predisposing factors.

BACKGROUND: Exercise-induced bronchoconstriction (EIB) has a high prevalence in children with asthma, and this is a common problem, even in case of controlled asthma, because of the high levels of physical activity in the childhood. OBJECTIVES: The aim of our study was to identify factors associated with the development of EIB in children with controlled asthma. METHODS: We studied children evaluated for asthma. A personal and familiar history was collected from each patient to estimate asthma severity, precipitating factors, exercise ability, immunotherapy treatment and atopic familiar disorders. Skin prick tests for inhalant allergens, pulmonary function tests (PFTs) and exercise challenge test (ECT) measurements were realized in every patient. We used the Chi Squared test to compare qualitative variables, the Student's-t test for quantitative variables and a logistic regression analysis to estimate the independent effect of the variables. RESULTS: We evaluated 132 asthmatic patients. Eighty-two, 6 to 14 years old (average 110 +/- 36.9 months), were included in the study. Forty one have coughing or wheezing with exercise at least three months ago, in addition to a positive ECT; 9 of these children had solitary EIB (group A), and 32 (group B) had controlled chronic asthma, 27 intermittent and 5 moderately persistent. Forty one controlled asthmatic children, 39 intermittent, 1 mildly persistent and 1 moderately persistent (group C) had a good tolerance for exercise with a negative ECT. No differences were found in familiar history, asthma severity or evolution time in B vs C group. We found that 35 patients (42,68 %) patients were sensitized to indoor allergens: 24 (58,53 %) were patients suffering EIB and 11 (26,8 %) allowed to group C. Precipitating factors of asthma were in group B: respiratory infections in 19 cases, pollen in 20 and in 10 indoor allergens exposure. In group C: 14 patients had asthmatic symptoms with viral respiratory infections, 32 with pollen and 2 with indoor allergens exposure. A patient from group A had allergy rhinitis after exposure to cats. Allergy to indoor allergens demonstrated an direct association to EIB suffering (p = 0,026). Twenty six patients with allergic asthma followed pollen immunotherapy treatment, 7 of group B (33,3 %) and 19 (59,3 %) of group C. This treatment was inversely associated with EIB suffering (p = 0,048). A logistic regression analysis confirmed the independence of both variables as predisposing and protecting factors in EIB suffering. CONCLUSIONS: Allergy to indoor allergens might be considered a risk factor for EIB. Immunotherapy treatment could be a protective factor against the development of EIB in children with allergic asthma.

[Dermatomyositis in children: clinical course of 9 cases]. / Dermatomiositis infantil: evolución clínica de nueve casos.

Eight cases of dermatomyositis and one of polymyositis were studies among five male and four female patients. All had criteria definitive of the disease. All nine patients were give prednisone; six of them responded favorably to treatment and after discontinuing still remain asymptomatic. Three male patients have had a worse response to therapy, two of them deceased and the third still remains symptomatic, but very slowly improving after fourteen months with steroids and cyclophosphamide. These three patients have had chronic cutaneous vasculitic ulcers and this is a sign of bad prognosis. Both deceased patients exhibited important visceral complications (digestive and pulmonary). A more aggressive therapy has been suggested in these forms of worse clinical evolutions, including use of immunosuppressors.

[Pathology of the phagocytic mononuclear system. Apropos of 4 cases]. / Patología del sistema mononuclear fagocítico. A propósito de cuatro observaciones.

Four patients, with disorders belonging to mononuclear phagocyte system diseases are described: a case of malignant histiocytosis; one of Weber-Christians disease and two siblings affected by familiar erythrophagocytic lymphohistiocytosis. An attempt is made to update classification of this group of diseases previously known as reticulosis, reticulohistiocytosis, reticuloendotheliosis, etcetera.

[Mucolipidosis. biologic characteristics (author's transl)]. / Características biológicas de las mucolipidosis II y III.

Mucolipidosis II is a severe inherited lysosomal storage disease characterized by profound psychomotor retardation, severe Hurler-like skeletal changes and normal urinary mucopolysaccharide excretion. Mucolipidosis II is a related disorder distinguished by its milder course, milder to absent mental retardation and survival to adult life. Cultivated fibroblasts from patients with both of these disorders display large inclusions on phase microscopy and reduced levels of many acid hydrolases. However, culture medium fibroblasts out the body fluids of affected patients show enormously elevated levels of these hydrolases. The lysosomal enzyme activities in serum, leukocytes, fibroblasts extracts and culture medium from seven patients with mucolipidosis II are similar to those found in four cases of mucolipidosis III. The findings of excessive excretion of sialyl-oligosaccharide in urine and of increased level of sialic acid compounds in cultured fibroblasts associated with a sialidase deficiency in leukocytes, fibroblasts and serum are discussed.

[Two cases of secondary amyloidosis (author's transl)]. / Dos casos de amiloidósis en la infancia.

Two cases of secondary amyloidosis are presented. Both cases presented as nephrotic syndrome and were confirmed by biopsy dying two years later of the appearance of proteinuria. Incidence and characteristics of amyloidosis in infancy is commented.

[Three cases of mucolipidosis type III (author's transl)]. / Sialidosis tipo II o mucolipidosis III. A propósito de tres observaciones.

Three cases of mucolipidosis type III in three siblins ranging in age from 4 to 10 years are reported. One of them was severely involved; the other two in a lesser degree. The enzymatic studies performed are exposed, together with a discussion and interpretation of the findings. The concepts regarding the group of metabolic diseases among which mucolipidosis is nowadays included are reviewed. Some characteristics of the enzymatic disorder, origin of the disease, are finally commented.