Japanese pediatric guideline for the treatment and management of bronchial asthma 2012.

A new version of the Japanese pediatric guideline for the treatment and management of bronchial asthma was published in Japanese at the end of 2011. The guideline sets the pragmatic goal for clinicians treating childhood asthma as maintaining a "well-controlled level" for an extended period in which the child patient can lead a trouble-free daily life, not forgetting the ultimate goal of obtaining remission and/or cure. Important factors in the attainment of the pragmatic goal are: (i) appropriate use of anti-inflammatory drugs; (ii) elimination of environmental risk factors; and (iii) educational and enlightening activities for the patient and caregivers regarding adequate asthma management in daily life. The well-controlled level refers to a symptom-free state in which no transient coughs, wheezing, dyspnea or other symptoms associated with bronchial asthma are present, even for a short period of time. As was the case in the previous versions of the guideline, asthmatic children younger than 2 years of age are defined as infantile asthma patients. Special attention is paid to these patients in the new guideline: they often have rapid exacerbation and easily present chronic asthmatic conditions after the disease is established.

[A case of lupus anticoagulant hypoprothrombinemia syndrome following adenovirus gastroenteritis and mycoplasma pneumonia].

We describe a previously healthy 9-year-old girl who had multiple purpura several days after acute adenovirus gastroenteritis and mycoplasma pneumonia. Initial laboratory evaluation revealed a prolonged prothrombin time (PT) and APTT, low complement levels (C4, CH50), and positive immune complex (C1q) in her serum. Platelet count, fibrinogen, and other routine blood chemistry tests were normal. The prolonged APTT was not corrected by mixture of the patient's plus normal plasma. Clotting activities of factors II, V, VIII, IX, X, XI, and XII reduced. Further examinations revealed the presence of lupus anticoagulant (LA), phosphatidylserine-dependent anti-prothrombin antibodies (aPS/PT), and anticardiolipin antibodies. Mycoplasma pneumonia was treated by minocycline and the patient's skin lesions disappeared spontaneously within a week. During follow-up, she showed no other bleeding symptoms, and no signs of SLE or other autoimmune diseases. Four weeks after admission to our hospital, blood coagulation tests and serum complements normalized. Clotting activities of factors and antiphospholipid antibodies were not detected, half year later. The bleeding in this case was associated with acquired hypoprothrombinemia caused by antiphospholipid antibodies following acute adenovirus gastroenteritis and mycoplasma pneumonia.

Hospitalizations associated with pandemic influenza A (H1N1) 2009 in asthmatic children in Japan.

BACKGROUND: The pandemic influenza A (H1N1) 2009 [pdm (H1N1) 2009] spread through the world in 2009, producing a serious epidemic in Japan. Since it was suggested early that asthma is a risk factor for an increased severity of the infection, the Japanese Society of Pediatric Allergy and Clinical Immunology (JSPACI) organized a working group for countermeasures, and investigated asthmatic children admitted to the hospitals for pdm (H1N1) 2009 infection. METHODS: An appeal was made on the home page of the JSPACI to medical practitioners to input clinical information about asthmatic and non-asthmatic children (0-19 years) admitted to the hospital with pdm (H1N1) 2009 infection. RESULTS: A total of 862 children (390 with asthma, and 472 without asthma) from 61 medical centers were registered, and the data of 333 asthmatic children and 388 non-asthmatic children in all were entered in the analyses. The mean age was 7.4 ± 2.9 years in the asthma group and 6.9 ± 3.8 years in the non-asthma group. The percentage of children admitted for respiratory symptoms was significantly higher in the asthma group than in the non-asthma group (p < 0.001). There was no significant difference in the frequency of admission to the ICU or need for mechanical ventilation support between the two groups. No definite trend was detected in the relationship between the severity of asthma and the intensity of asthma attack. Antiviral drugs were administered within 24 hours in about 85% of the patients in both groups. CONCLUSIONS: Asthma may not be a risk factor for severe pdm (H1N1) 2009 infection in children.

Japanese pediatric guidelines for the treatment and management of bronchial asthma 2008.

Abstract The fourth version of the Japanese Pediatric Guidelines for the Treatment and Management of Bronchial Asthma 2008 (JPGL 2008) was published by the Japanese Society of Pediatric Allergy and Clinical Immunology in December 2008. In JPGL 2008, the recommendations were revised on the basis of the JPGL 2005. The JPGL 2008 is different to the Global Initiative for Asthma guideline in that it contains the following items: a classification system of asthma severity; recommendations for long-term management organized by age; a special mention of infantile asthma; and an emphasis on prevention and early intervention. Here we show a summary of the JPGL 2008 revising our previous report concerning JPGL 2005.

[Sudden asthma death: etiology and prevention].

The duration of the last lethal asthma attack in children was short and their asthma deaths were unexpected and abrupt in many cases by the annual reports of the committee on asthma death in children of the Japanese Society of Pediatric Allergy and Clinical Immunology. In adult asthma death, sudden death type died in three hours 29.3%, unstable sudden aggravation type 16.2% and status asthmatics was only 21.2% by the national wide study in Japan. The severity of asthma prior to asthma death; in children mild was 26%, moderate 30%, severe 43% and in adult, mild was 9.3%, moderate 41.4% and severe 49.2%. Asthma deaths during sports were also discussed. In adolescent and young adult, asthma was one of the main causes of sudden death. Prevention of sudden asthma death was discussed.

A case-control study of asthma death and life-threatening attack: their possible relationship with prescribed drug therapy in Japan.

Sales of inhaled beta2-agonist bronchodilators may be related to the increase in asthma deaths. The aim of this study is to find whether prescribed drug therapy was associated with the increased risk of death from asthma and life-threatening attacks (LTA). The "case" group comprised those under 35 years of age who expired or experienced LTA from January 1994 through December 1996. For each case, an age and sex matched control was selected from asthma patients. Hospital records were reviewed to obtain information on the prescribed drug therapy and clinical asthma severity for the cases and controls. Bivariate analysis with conditional logistic regression models for matched data sets were used to estimate the severity-adjusted odds ratios for each asthma medication. Twenty-four fatal cases and 54 LTA cases were observed. The crude odds ratio of clinical severity (OR=9.33, 95%CI:2.84-30.7) was larger than unity and with statistical significance. After adjusting for clinical severity, the odds ratios computed for all beta2-agonists delivered by metered dose inhaler (MDI) increased (OR=2.08, 95%CI:0.78-5.50) from that of crude analysis. Among those subjects under 20 years of age, the clinical severity-adjusted odds ratio for the use of all beta2-agonists by MDI (OR=3.67, 95%CI:0.77-17.5) was higher than that of all subjects. The prescription of B2-agonists by MDI increased the risk of asthma death after taking clinical severity into account. Although not statistically significant, our results suggested that beta2-agonists administered by a MDI might have increased the risk of asthma death and LTA in Japan because the magnitude of the effect was similar to that reported in other countries.