The Value of Induced Sputum in the Diagnosis and Management of Children with Bronchial Asthma.

BACKGROUND: Induced sputum in children with bronchial asthma represents a non-invasive method of bronchial inflammation assessment. The main objective of our study was to analyze the cellularity of sputum in patients with bronchial asthma according to the level of disease control and the controlling therapy (with/without inhaled glucocorticoids). The second objective was to establish the correlation between sputum cellularity and other indirect parameters used to evidence bronchial inflammation (exhaled nitric oxide) and obstruction (forced expiratory volume in 1 second). METHODS: The study included children with bronchial asthma that were assessed clinically (physical exam, questionnaire on the control of bronchial asthma in children) and by medical tests (induced sputum, exhaled nitric oxide, spirometry). RESULTS: In patients with partially controlled asthma and those with uncontrolled asthma, the eosinophils percentage in the sputum was higher than in patients with controlled asthma (19.8±26.4% respectively 9.2±20.5% versus 4.5±14.6%, p<0.001). Higher percentage of neutrophils in the sputum was found in the partially controlled and uncontrolled asthma than in the controlled asthma (43.9±20.1% respectively 51.6±38.3% versus 35±19.7%, p=0.009). We also evidenced a direct and statistically significant correlation between the exhaled nitric oxide and the neutrophils percentage in the sputum (r=0.67, p=0.0003). Also, an indirect, moderate to good correlation (r=-0.56, p=0.005) was evidenced between the values of the forced expiratory volume in 1 second and the high eosinophils percentage in the sputum. CONCLUSIONS: In partially controlled and uncontrolled bronchial asthma the eosinophils and neutrophils count in the sputum is significantly higher than in patients with controlled asthma. There is an indirect correlation between the high eosinophils count in the sputum and the forced expiratory volume in 1 second, as well as a direct correlation between the neutrophils count and the exhaled nitric oxide, suggesting that induced sputum should be used in combination with other indirect parameters for the evidence of bronchial inflammation.

The role of exhaled nitric oxide assessment in children with bronchial asthma.

BACKGROUND: Exhaled nitric oxide (eNO) assessment in children with bronchial asthma (BA) is an easy and non-invasive test that provides informations on the presence of bronchial inflammation. METHODS: The study included 110 children aged between 5-18 years with a diagnosis of BA. The patients were assessed clinically (objective examination, questionnaire regarding the disease control) and by medical tests (exhaled breath analysis for nitric oxide, induced sputum, spirometry). RESULTS: Of the 33 patients with non-atopic BA, 9 (27.27%) presented normal eNO values, and 24 (72.72%) had higher than normal levels. There were 26 patients with controlled BA, 59 with partially controlled BA and 25 with uncontrolled BA, the levels of eNO demonstrating the existence of the statistically significant differences between the mean values of the variables obtained in the studied groups (p=0.003). Increased individual values were more frequently noted in patients with an exacerbation of asthma in the last month (70% vs 56.6%), but the differences were not statistically significant. Of the 77 patients with atopic BA, 35 (45.45%) had normal eNO, while 42 (54.54%) had increased values. The normal values of the eNO were most frequently noted in patients undergoing treatment with inhaled glucocorticoids (IGC). Patients with low percent of eosinophils in sputum had increased eNO values (p=0.03). CONCLUSIONS: The investigation of the airways by measuring the eNO levels is a useful method of assessing bronchial inflammation in children with bronchial asthma, in order to establish the disease responsiveness and therapy.

Clinical, imaging and cystometric findings of voiding dysfunction in children.

UNLABELLED: The AIM of the study was to validate some of the imaging criteria for voiding dysfunction in children. MATERIAL AND METHODS: The study included a number of 55 children with voiding dysfunction symptoms. They were investigated clinically as well as through imaging techniques: renourinary ultrasound, voiding cystourethrography and cystometry. RESULTS: The most common symptoms were urgency (87.3%), increased frequency (81.8%), and daytime urinary incontinence (76.3%). Ultrasound scans detected a reduced bladder capacity in 65.5% patients. The voiding cystourethrography detected bladder trabeculations (58.2%) and spinning top urethra (63.6%). Cystometric recordings indicated overactive bladder in 70.9% patients. Reduced bladder capacity detected by ultrasound associated with trabeculated bladder and spinning top urethra detected by voiding cystourethrography in a patient with specific symptoms may suggest an overactive bladder. In CONCLUSION, voiding dysfunction in child can be diagnosed by minimal or non-invasive methods.

Epidemiological survey 6 years apart: increased prevalence of asthma and other allergic diseases in schoolchildren aged 13-14 years in cluj-napoca, romania (based on isaac questionnaire).

BACKGROUND: The prevalence of asthma and allergy has increased during recent decades. OBJECTIVE: We investigate the prevalence of asthma and other allergic diseases in children aged 13-14 years and we evaluate the trend of prevalence after an interval of 6 years. MATERIAL AND METHODS: We used a core questionnaire designed by the International Study of Asthma and Allergy in Children. In 1991, the questionnaire was administered to 2,866 children from a Romanian city and during 2001 to 1,657 children from the same area. RESULTS: The prevalence of asthma increased from 3.3% in 1995 to 5.5% in 2001 (p<0.001). In 1995, 4.3% of children reported asthma-related symptoms, significantly fewer than the percentage 6 years later (13.6%; p<0.00001). Similar results were obtained with regard to allergic rhinitis (13.6% versus 20%; p<0.00001) and eczema (11.5% versus 16.2%; p=0.00015). As far as gender differences are concerned, in the first stage of study all three allergic disorders were found to occur more frequently in females. In the study undertaken in 2001, females proved to have a higher prevalence of asthma (p=0.226), but a lower prevalence for allergic rhinitis (p=0.121) and eczema (p=0.064). CONCLUSIONS: The prevalence of asthma and allergy increased significantly during the past 6 years.

[Relationship between asthma and obesity in school age students]. / Relatia dintre astm si obezitate la copiii de vârsta scolara.

BACKGROUND: Obesity and asthma are both public health problems with an increasing prevalence all over the world. The association between asthma and obesity was studied and proved in some papers, although the pathogenic pathway between them is not exactly known. The aim of this study was to examine the relationship between obesity and asthma by measuring the prevalence of obesity in asthmatic children compared with a control population. METHODS: Two groups of children aged between 7 and 18 years were studied: one group of asthmatic children and a control group, with the same age and sex with the first group. The differences between the two groups regarding the BMI were calculated, obesity being defined as a body mass index greater than the 95th percentile. RESULTS: A number of 200 children with asthma and 200 children in the control group were studied. The mean age was 10.49 years. 61.5% of children were boys. No significant difference was observed in the two groups regarding the percentage of overweight and obese children, except in the group of 7-10 years, where there is a greater percentage of children with overweight in the asthmatic group (23.3% vs 1% in the control group, p = 0.045). CONCLUSION: Obesity does not constitute, therefore, a risk factor for asthma and does not contribute to the severity of the disease.

The long-term evolution of chronic hepatitis B acquired in childhood.

UNLABELLED: The AIM of this study was to assess the long-term evolution of chronic hepatitis B acquired in childhood. METHODS: The study was carried out in 2007 - 2008 on a group of 77 adult patients who were diagnosed with chronic hepatitis B in childhood. The actual assessment included epidemiological, clinical, biological and virological data, ultrasound examination in all patients and liver histology in 3 patients. RESULTS: From the 77 patients, 69 were HBeAg positive and the other 8 patients were anti-HBe positive when the diagnosis was made in their childhood. Thirty-seven patients from the HBeAg positive group and 2 patients from the anti-HBe group had been treated in childhood with IFN-alpha and the other 38 patients remained untreated (32 patients with HBeAg positive and 6 patients anti-HBe positive). Overall, 78.26% seroconverted to anti-HBe (87.50% untreated and 70.27% of patients treated with IFN). After a median follow-up period of 13 years, 36 patients from the HBeAg positive group (48.65% of treated patients and 56.25% of untreated ones) became inactive carriers. Seroconversion to anti-HBs, in the HBeAg positive group, occurred in 10.14% of cases (8.1% in treated patients) without statistical significance. Three patients from the whole group developed cirrhosis but none developed hepatocellular carcinoma. CONCLUSION: The long-term outcome in our patients with CHB acquired in childhood did not differ between treated and untreated patients.

[The effects on growth velocity of inhaled corticosteroids therapy in children with asthma]. / Efectele glucocorticosteroizilor inhalatori administrati de durata asupra velocitatii cresterii la copiii cu astm bronsic persistent.

INTRODUCTION: Studies have demonstrated growth suppressive effects in case of use of inhaled corticosteroids therapy. OBJECTIVE: To assess growth velocity during 12 months of inhaled corticosteroids therapy in children with persistent asthma. METHODS: Measurements of height were performed in the study group including 109 children with mild and moderately severe, persistent asthma, after 12 month with low or medium doses of either beclomethasone dipropionate or fluticasone propionate. The results were compared with a control group including 71 children with asthma treated with montelukast or cromones. RESULTS: There were statistically significant differences between study group and controls concerning the growth velocity after 3 months of inhaled glucocorticoid therapy (GSI). CONCLUSIONS: The velocity of growth was decreased in the study group compared to controls after 3 months of treatment, but the differences become unsignificant after 12 months of therapy.

[Quality of life in children with bronchial asthma and allergic rhinitis]. / Calitatea vietii la copilul cu astm bronsic si rinita alergica.

The quality of life is a subjective parameter that evaluates the impact of asthma on daily life of the child. The authors evaluated the evolution of the quality of life score in children with persistent asthma and analyzed the impact of association of allergic rhinitis on this parameter. The evaluation of the quality of life was based on a questionnaire with 23 items (PAQLQ), which was applied on 54 children with asthma (35 of them having rhinitis allergic associated to asthma). The quality of life score was evaluated initial and every 3 months, during one year. At the end of the study the authors revealed the improvement of the quality of life score in 87% of children, with significant improvement of the scores for symptoms, activities and emotions (p=0.002). There were no significant differences between the 19 patients with only asthma as compared with the 35 patients that had both asthma and allergic rhinitis either at the beginning of the study (p = 0,19) or after 12 months of follow-up (p = 0,34). In conclusion, allergic rhinitis is frequently associated with asthma in children, but its impact on the quality of life is not significant.

[Askin tumor. Consideration on a case]. / Tumora askin. Consideratii pe marginea unui caz.

The authors present the case of a male patient of 9 years of age admitted for thoracic pain. The clinical evaluation and the imaging exams (chest X-ray, ultrasonography exam of the chest and thoracic computer tomography) reveal a tumor of the thoracic wall. The child was referred to the surgery. It was revealed an invasive tumoral mass of bone origin. At the pathological exam the tumor presented an aspect of Askin tumor. The authors discuss the theoretical aspects correlated with the diagnosis of Askin tumor, based on the presented case.

Pharmacokinetic interaction between fluoxetine and metoclopramide in healthy volunteers.

The pharmacokinetic interaction of fluoxetine with metoclopramide in healthy volunteers was evaluated. A dose of 20 mg metoclopramide in combination with 60 mg fluoxetine was administered to 24 healthy male volunteers in a two treatment study design, separated by 8 days in which the fluoxetine alone was administered as a single p.o. dose daily. Plasma concentrations of metoclopramide were determined during a 24 h period following drug administration. Metoclopramide plasma concentrations were determined by a validated HPLC method. Pharmacokinetic parameters of metoclopramide were calculated using non-compartmental analysis. In the two periods of treatment, the mean peak plasma concentrations (Cmax) were 44.02 ng/ml (metoclopramide alone) and 62.72 ng/ml (metoclopramide after pre-treatment with fluoxetine). The times taken to reach Cmax and tmax, were 1.15 h and 1.06 h, respectively. The total areas under the curve (AUC(0-infinity)) were 312.61 ng.h/ml and 590.62 ng.h/ml, respectively. The half-life values (t1/2) were 5.52 h and 8.47 h. Statistically significant differences were observed for both AUC(0-infinity) and t1/2 of metoclopramide when administered alone or after 8 days treatment with fluoxetine. The experimental data demonstrate the pharmacokinetic interaction between fluoxetine and metoclopramide and suggest that the observed interaction may be clinically significant, but its relevance has to be confirmed.

No effect of short term ranitidine intake on diclofenac pharmacokinetics.

The pharmacokinetics of diclofenac sodium in healthy volunteers was evaluated to determine if previously repeated doses of ranitidine inhibited the metabolism of the non-steroidal anti-inflammatory drug. Diclofenac sodium 50 mg (tablets) in combination with ranitidine 150 mg (tablets) were administered to 14 healthy human volunteers in a two treatment study design, separated by 5 days in which the ranitidine alone was administrated in single p.o. doses twice daily. Plasma concentrations of diclofenac were determined during a 12 hour period following drug administration. Diclofenac plasma concentrations were determined by a validated RP-HPLC method. Pharmacokinetic parameters were calculated with compartmental and non-compartmental analysis. In the two periods of treatments, the mean peak plasma concentrations Cmax were 1503.9 ng/ml (diclofenac alone) and 1742.5 ng/ml (diclofenac and ranitidine). The time taken to reach the peak, Tmax, was 0.85 hrs, and 0.82 hrs, respectively. The areas under the curve (AUC0-6) were 1479.9 ng x hr/ml and 1650.3 ng x hr/ml, respectively. Statistically insignificant difference was observed in these pharmaco-kinetic parameters of diclofenac sodium when administered alone or after 5 days of treatment with ranitidine. The experimental data did not suggest any consistent effects of ranitidine upon the pharmacokinetics of diclofenac sodium.

Pharmacokinetic interaction study between ranitidine and metoclopramide.

The pharmacokinetics of metoclopramide in healthy volunteers was evaluated to determine if previously repeated doses of ranitidine inhibit the metabolism of the gastrointestinal prokinetic drug. Metoclopramide 20 mg (tablets) in combination with ranitidine 150 mg (tablets) were administered to 14 healthy human volunteers in a two treatment study design, separated by 5 days in which the ranitidine alone was administrated in single p.o. doses twice daily. Plasma concentrations of metoclopramide were determined during a 24 hour period following drug administration. Metoclopramide plasma concentrations were determined by a validated RP-HPLC method. Pharmacokinetic parameters were calculated with compartmental and non-compartmental analysis. In the two periods of treatments, the mean peak plasma concentrations Cmax were 44 ng/ml (metoclopramide alone) and 49.2 ng/ml (metoclopramide and ranitidine). The time taken to reach the peak, Tmax, was 1.15 hrs, and 1.21 hrs, respectively. The total areas under the curve (AUC) was 314.3 ng.hr/ml and 354.06 ng.hr/ml, respectively. The half-life (T 1/2) was 5.6 hr and 6.7 hr. A statistically significant difference was observed for both AUC and half-life of metoclopramide when administered alone or after 5 days of treatment with ranitidine. The experimental data proved the pharmacokinetic interaction between ranitidine of metoclopramide, and suggest monitoring adverse effects in patients.

[Effectiveness of antireflux therapy in asthmatic children with gastroesophageal reflux disease]. / Eficienta terapiei antireflux la copiii astmatici cu boala de reflux gastroesofagian.

There is an increased interest within literature regarding the relationship between gastro-esophageal reflux disease and asthma. The study was performed to assess the efficiency of antireflux therapy in asthmatic children. In a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years) the pulmonary function tests were made by means of spirometry in those patients in which reflux disease was diagnosed by means of 24h esophageal pH-monitoring and upper digestive endoscopy. All these patients were reevaluated by means of spirometry 3 months after the antireflux therapy with ranitidine and cisapride added to antiasthmatic therapy. Three months later the results showed a significant decrease in frequency of asthma exacerbations from 3.18 +/- 4.86 to 0.45 +/- 0.80 (p = 0.016). There is also a significant increase of FEV1 (p = 0.04) and of FEV1/FVC (p = 0.018) in asthmatic patients with reflux disease and a positive symptomatic index, and of FEV1/FVC (p = 0.002) in all asthmatic children with abnormal gastro-esophageal reflux respectively. In conclusion, by adding antireflux therapy in asthmatic children there is a significant improvement in clinical and some of functional parameters.

[Induced sputum--means for detecting bronchial inflammation in children with atopic bronchial asthma and treatment monitoring]. / Sputa indusa--metoda de evidentiere a inflamatiei bronsice la copiii cu astm bronsic atopic si de monitorizare a tratamentului.

Induced sputum is a very recent technique for exploration of bronchial inflammation in asthma. Since 1992, it has significantly improved as a method and as clinical and fundamental research tool for asthma. It is currently recognized that this method is well tolerated and can be used in all asthma patients, except those with FEV1 less than 11. Eosinophilic activation in asthma can be very well highlighted by cellular and biochemical analysis of expectoration. Thus, biologic arguments can be added to clinical signs in asthma exacerbations. Clinical evolution under corticosteroids can be biologically proved by this technique. Sputum analysis is useful also for differential diagnosis, sometimes difficult, between asthma and COPD.

[Gastroesophageal reflux in asthmatic children: prevalence and pathogenic role]. / Refluxul gastro-esofagian patologic la copii cu astm bronsic: prevalenta si rol patogenetic.

The relationship of gastroesophageal reflux disease and asthma is controversial. This study was performed to assess the prevalence of pathologic gastroesophageal reflux and its effect on pulmonary function tests in asthmatic children. The following study protocol was performed in a group of asthmatic children (n = 34, 22 male, age range: 2, 5-17 years): diagnosis of pathologic gastroesophageal reflux by means of 24h esophageal pH-monitoring; diagnosis of reflux esophagitis by means of upper digestive endoscopy and pulmonary function tests by means of spirometry. The results show a high prevalence (87%) of pathologic gastroesophageal reflux in asthmatic children. Additionally, there is an inverse correlation (r = -0.67) between the severity of pathologic gastroesophageal reflux and FEV1/FVC. In conclusion, there is a high prevalence of pathologic gastro-esophageal reflux in asthmatic children, contributing to asthma severity.

[The effectiveness of montelukast in recurrent post-bronchiolitis wheezing]. / Eficienta Montelukastului în wheezingul recurent post bronsiolitic.

Some studies showed increased levels of leukotrienes in the nasopharyngeal secretions in children with wheezing secondary to viral infections, leading to therapeutical attempts with leukotriene receptor inhibitors in infants and small children with recurrent wheezing. This is a double blind randomized study for evaluating the efficacy of montelukast in infants and small children. In the study group (20 children) treated with montelukast, 5 mg/day for 3 months, the frequency of bronchial obstruction episodes in the 6 months following the start of therapy was significantly lower (p = 0.001) than the 6 months before treatment (1.25 +/- 1.41 versus 3.79 +/- 2.41). In the control group (18 children) treated with placebo, the frequency of the bronchial obstruction episodes decreased (from 3.04 +/- 1 to 2.41 +/- 1.5) in the two analyzed periods, but the differences were not statistically significant (p = 0.067). The differences between the two groups are present also after excluding the children with atopy. The results suggest the beneficial role of leukotriene receptor antagonists in improving the symptoms of patients with recurrent post-bronchiolitis wheezing.