The effects of meteorological factors and Alternaria spore concentrations on children sensitised to Alternaria

Background: Alternaria is the most important fungal species belonging to the class Deuteromycetes which causes allergic respiratory diseases. The fungus pattern often shows a pronounced seasonal periodicity and with fluctuations related to meteorological conditions. In this study, we aimed to investigate the effect of outdoor Alternaria spore concentrations on monthly lung function tests, symptoms, and medication scores in children sensitised only to Alternaria. Additionally, we planned to determine the Alternaria spores of the outdoor environment in Adana, with special respect to their relationships with meteorological conditions and their seasonal changes. Methods: Twenty-five patients with a clinical diagnosis of asthma and/or rhinitis sensitised only to Alternaria were enrolled in the prospective study. Meteorological data and outdoor samples of airborne fungi were obtained between November 2006 and October 2007. Results: The outdoor Alternaria spore concentrations were significantly correlated with the monthly average temperature (r=0.626, p=0.03) and monthly average barometric pressure (r= -0.613, p=0.03). Similarly, the outdoor Alternaria spore concentrations were significantly correlated with mean monthly asthma medication score (r=0.599, p=0.04), value monthly PEF (r= -0.737, p=0.006), value monthly FEF25–75% (r= -0.914, p=0.0001) and, variation in PEF (r=0.901, p=0.0001). Conclusions: The atmospheric concentration of Alternaria spores are markedly affected by meteorological factors such as air temperatures and barometric pressures. In hypersensitive patients, Alternaria spores can induce decreases in respiratory functions and development of allergic symptoms between May and September, being especially more influential in August

The effects of meteorological factors and Alternaria spore concentrations on children sensitised to Alternaria.

BACKGROUND: Alternaria is the most important fungal species belonging to the class Deuteromycetes which causes allergic respiratory diseases. The fungus pattern often shows a pronounced seasonal periodicity and with fluctuations related to meteorological conditions. In this study, we aimed to investigate the effect of outdoor Alternaria spore concentrations on monthly lung function tests, symptoms, and medication scores in children sensitised only to Alternaria. Additionally, we planned to determine the Alternaria spores of the outdoor environment in Adana, with special respect to their relationships with meteorological conditions and their seasonal changes. METHODS: Twenty-five patients with a clinical diagnosis of asthma and/or rhinitis sensitised only to Alternaria were enrolled in the prospective study. Meteorological data and outdoor samples of airborne fungi were obtained between November 2006 and October 2007. RESULTS: The outdoor Alternaria spore concentrations were significantly correlated with the monthly average temperature (r=0.626, p=0.03) and monthly average barometric pressure (r=-0.613, p=0.03). Similarly, the outdoor Alternaria spore concentrations were significantly correlated with mean monthly asthma medication score (r=0.599, p=0.04), value monthly PEF (r=-0.737, p=0.006), value monthly FEF25-75% (r=-0.914, p=0.0001) and, variation in PEF (r=0.901, p=0.0001). CONCLUSIONS: The atmospheric concentration of Alternaria spores are markedly affected by meteorological factors such as air temperatures and barometric pressures. In hypersensitive patients, Alternaria spores can induce decreases in respiratory functions and development of allergic symptoms between May and September, being especially more influential in August.

The WHO global alliance against chronic respiratory diseases in Turkey (GARD Turkey).

In order to prevent and control non-communicable diseases (NCDs), the 61st World Health Assembly has endorsed an NCD action plan (WHA resolution 61.14). A package for essential NCDs including chronic respiratory diseases (CRDs) has also been developed. The Global Alliance against Chronic Respiratory Diseases (GARD) is a new but rapidly developing voluntary alliance that is assisting World Health Organization (WHO) in the task of addressing NCDs at country level. The GARD approach was initiated in 2006. GARD Turkey is the first comprehensive programme developed by a government with all stakeholders of the country. This paper provides a summary of indicators of the prevalence and severity of chronic respiratory diseases in Turkey and the formation of GARD Turkey.

The effects of long term use of inhaled corticosteroids on linear growth, adrenal function and bone mineral density in children

In this study we aimed to investigate the long term effects of inhaled steroids on linear growth, adranal function and bone mineral density. Thirty children with moderate asthma were randomly divided into two groups.Fifteen children (8 boys, 7 girls mean age; 10.6 ± 2.1) were treated with budesonide (group 1), and 15 (9 boys, 6 girls, mean age; 9.6 ± 2.4). with fluticasone propionate (group 2). Control group included 30 children. Anthropometric assesment, symptom and medication scores, pulmonary functions, bone mineral density, serum and urine cortisol levels and ACTH stimulation test were evaluated at the beginning of the study and after one year period. Symptom and medication scores, pulmonary functions improved significantly in both groups (p < 0.05). The mean annual growth was similar in group 1 and 2 and control group. Bone mineral density was comperable with control group at the beginning of the study and after one year. Mean serum cortisol level diminished at the end of the therapy but no significant differences were found between the initial and end values in respect to urine cortisol levels and cortisole/creatinin ratio. Of three groups ACTH stimulation test revealed that there were no significant difference between stdy and control groups. In conclusion, although we did not observed any side effects of inhaled corticosteroids we suggest that children treated with inhaled corticosteroids for a long time should be followed closely with respect to side effects

El presente estudio tuvo como objetivo investigar los efectos a largo plazo de los esteroides inhalados sobre el crecimiento lineal, la función adrenal y la densidad mineral ósea. Treinta niños con asma moderada se distribuyeron aleatoriamente en dos grupos: 15 de ellos (8 niños y 7 niñas, con una media de edad de 10,6 ± 2,1 años) se trataron con budesonida (grupo 1), y los otros 15 (9 niños y 6 niñas, con una media de edad de 9,6 ± 2,4 años) con propionato de fluticasona (grupo 2). El grupo de control constaba de 30 niños. Se realizó una exploración antropométrica, una puntuación de los síntomas y la medicación, análisis de la función pulmonar, de la densidad mineral ósea y del nivel de cortisol en sangre y orina, así como pruebas de estimulación de ACTH, tanto al principio del estudio como tras un período de un año. La puntuación de los síntomas y la medicación y la función pulmonar mejoraron significativamente en ambos grupos (p < 0,05). El crecimiento medio anual fue similar en los grupos 1, 2 y el de control. La densidad mineral ósea fue comparable con la del grupo de control en el inicio del estudio y al cabo de un año. El nivel medio de cortisol en sangre descendió al final de tratamiento, pero no se observaron diferencias significativas entre los valores iniciales y finales con respecto al nivel de cortisol en la orina y la proporción entre cortisol y creatinina. La prueba de estimulación de ACTH no reveló diferencias significativas entre los grupos de estudio y el de control. En conclusión, aunque no observamos ningún efecto secundario de los corticosteroides inhalados, sugerimos el control meticuloso de los posibles efectos secundarios en los niños tratados con estos fármacos de forma prolongada

Pneumomediastinum and pneumopericardium: unusual and rare complications of asthma in a 4 years old girl

We describe a 4-year-old girl with asthma who presented with pneumomediastinum, pneumopericardium and subcutaneous emphysema. She was admitted to our hospital with dyspnea, chest pain, palpitation and cough of two days duration. She had attacks of cough, dyspnea and wheezing from two years of age, but she did not have a diagnosis of asthma previously. She was dyspneic and had subcutaneous emphysema in the neck, axilla and thorax. In the skin prick test (Center Lab. USA) she had positive reaction to Dermatophagoides pteronyssinus, Dermatophagoides farinae, mold mix, tree mix and grass mix. Pulmonary function tests could not be performed. In the chest X-ray air was seen in mediastinum and subcutaneous area and the epicardium was surrounded completely with air. She was treated successfully with inhaled salbutamol and budesonide. Radiological signs of pneumopericardium and pneumomediastinum disappeared completely in ten days period. In the light of this case we want to mention that early diagnosis and treatment of asthma should be done to prevent serious complication of asthma (AU)

Describimos el caso de una niña de 4 años de edad que se presentó con un neumomediastino, neumopericardio y enfisema subcutáneo. Fue ingresada en nuestro hospital con disnea, dolor torácico, palpitación y tos de 2 días de duración. La paciente experimentaba crisis de tos, disnea y sibilancias desde los 2 años de edad, pero previamente no se había establecido un diagnóstico de asma. La paciente se encontraba disneica y se apreció un enfisema subcutáneo en el cuello, axila y tórax. En la prueba de prick test (Center Lab, EE.UU.) presentó una reacción positiva a Dermatophagoides pteronyssinus, Dermatophagoides farinae, una mezcla de mohos, una mezcla de pólenes de árboles y una mezcla de hierbas silvestres. No pudieron llevarse a cabo pruebas de función pulmonar. En la radiografía de tórax se identificó aire en el mediastino y área subcutánea y el pericardio estaba ocupado por completo por aire. Fue tratada satisfactoriamente con salbutamol y budesonida inhalados. Los signos radiológicos de neumopericardio y de neumomedias tino desaparecieron por completo en un período de 10 días. A la luz de este caso, deseamos destacar que para prevenir las complicaciones de gravedad del asma es preciso establecer un diagnóstico precoz de asma e instituir de inmediato un tratamiento (AU)

The effects of daily pulmonary rehabilitation program at home on childhood asthma.

OBJECTIVE: the aim of this study is to investigate the efficacy of pulmonary rehabilitation program in children with asthma. PATIENTS AND METHOD: twenty eight children with mild persistent or moderate asthma were included into a double blind, randomised study. Sixteen children (9 girls, 7 boys) with the mean age of 10.8 +/- 2.3 were assigned to receive pulmonary rehabilitation program with their parents for 30 days (group I). Control group included 12 children (6 girls, 6 boys ) with the mean age of 10.2 +/- 2.4 (group II). Symptom and medication scores quality of life index and pulmonary function tests were evaluated in rehabilitation and control group in the beginning of the study and after the one month period. RESULTS: the groups did not differ on all parameters before the study (p > 0. 05). Statistically significant decrease were found in symptom and medication scores in rehabilitation group (p < 0.05) and quality of life index was increased significantly in the same group (p < 0.05). Pulmonary function measures also significantly improved including vital capacity, forced vital capacity, FEV1, PEF and FEF25-75 in the rehabilitation group (p < 0.05). The best improvement were seen in FEF25-75 (10.09% increase) and PEF (7.81% increase) values. In control group no statistically significant differences were found in all parameters. CONCLUSION: in this study it was shown that daily pulmonary rehabilitation at home could improve quality of life and pulmonary functions. So pulmonary rehabilitation should be placed as a component of management in childhood asthma.

The effects of daily pulmonary rehabilitation program at home on childhood asthma

Objective: the aim of this study is to investigate the efficacy of pulmonary rehabilitation program in children with asthma. Patients and method: twenty eight children with mild persistent or moderate asthma were included into a double blind, randomised study. Sixteen children (9 girls , 7 boys) with the mean age of 10.8 ± 2.3 were assigned to receive pulmonary rehabilitation program with their parents for 30 days (group I). Control group included 12 children (6 girls, 6 boys ) with the mean age of 10.2 ± 2.4 (group II). Symptom and medication scores quality of life index and pulmonary function tests were evaluated in rehabilitation and control group in the beginning of the study and after the one month period. Results: the groups did not differ on all parameters before the study (p > 0.05). Statistically significant decrease were found in symptom and medication scores in rehabilitation group (p < 0.05) and quality of life index was increased significantly in the same group (p < 0.05). Pulmonary function measures also significantly improved including vital capacity, forced vital capacity, FEV1, PEF and FEF25-75 in the rehabilitation group (p < 0.05). The best improvement were seen in FEF25-75 (10.09% increase) and PEF (7.81% increase) values. In control group no statistically significant differences were found in all parameters. Conclusion: in this study it was shown that daily pulmonary rehabilitation at home could improve quality of life and pulmonary functions. So pulmonary rehabilitation should be placed as a component of management in childhood asthma (AU)

Objetivos: el objetivo de este estudio fue investigar la eficacia de un programa de rehabilitación pulmonar para niños asmáticos.Pacientes y método: veintiocho niños con asma leve persistente o moderada fueron incluidos en un estudio aleatorio doble ciego. Dieciséis niños (9 chicas y 7 chicos, edad media 10,8 ñ 2,3 años) fueron incluidos en un programa de rehabilitación pulmonar de 30 días de duración que realizaron con sus padres (grupo I). El grupo control incluyó 12 niños (6 chicas y 6 chicos, edad media 10,2 ñ 2,4 años) (grupo II). Se evaluaron las puntuaciones por síntomas y el consumo de fármacos, el índice de la calidad de vida y las pruebas de función pulmonar en los grupos de rehabilitación y control al principio del estudio y después de un intervalo de un mes.Resultados: antes del estudio no se encontró ninguna diferencia entre grupos en los parámetros (p > 0,05). Después de un mes de rehabilitación, se encontró una disminución estadísticamente significativa en las puntuaciones por síntomas y consumo de fármacos (p < 0,05) y un índice de calidad de vida significativamente mayor (p < 0,05). Las mediciones de función pulmonar también mejoraron significativamente, incluyendo la capacidad vital, capacidad vital forzada, FEV1, PEF y FEF25-75 en el grupo de rehabilitación (p < 0,05). La máxima mejoría se constató en los valores del FEF25-75 (un incremento del 10,09 por ciento) y PEF (un incremento del 7,81 por ciento). No se observó ningún cambio estadísticamente significativo en los parámetros del grupo control.Conclusión: este estudio ha demostrado que un programa de rehabilitación pulmonar diaria en el domicilio puede mejorar la calidad de vida y función pulmonar. Por lo tanto, la rehabilitación pulmonar debería incluirse en el tratamiento del asma infantil. (AU)