Asthma knowledge of pediatrician in China has increased significantly,but different views still exist in the diagnosis and management of childhood asthma,especially young children asthma.The Global Initiative for Asthma (GINA) guidelines has been playing an important role in the diagnosis and prevention of childhood asthma in China.In review of the current problems in the field of asthma,GINA committee revised its guideline last year,which was innovative,practicable and involved in many aspects of asthma,and updated in 2015.This article focuses on the new opinions in the 2014-2015 GINA guideline and problems not resolved.

Viral infections affect wheezing and asthma.Wheezing illnesses are usually viral in origin in children.The recurrent wheezing is associated with childhood asthma.There are some new evidences proving that rhinovirus(RV)is closely associated with asthma in children.This review discusses age distribution,epidemic season and risk factors of RV in the wheezing children.It also reviews the relationship between RV infection and asthma,clinical laboratory examination and treatment.

In recent years, the prevalence of allergic rhinitis in children had increased significantly.After a period of time, some children developed into bronchial asthma on the basis of allergic rhinitis, while others did not.To clarify the risk factors of bronchial asthma in children with allergic rhinitis and take early intervention measures are of great significance to the prevention and treatment of bronchial asthma.This article reviews the roles on asthma development of genetics, allergen exposure, types of rhinitis, passive smoking, respiratory infections, early use of antibiotics, and intervention treatment.

Breath Tests ; Child, Preschool ; Exhalation ; Humans ; Nitric Oxide ; analysis

Objective To investigate the distribution of measured value and the expected value of spirometry parameters in healthy children aged 5-14 years old in Beijing,and to provide evidence for clinical interpretation precisely.Methods Four hundred healthy children (198 boys and 202 girls) aged 5 to 14 years from the kindergartens and the primary schools in Beijing were selected as subjects.All of the parameters were measured by using Jaeger Masterscreen spirometry machine(Germany).Pulmonary function parameters including forced vital capacity(FVC),forced expiatory volume in 1 second (FEV1),FEV1/FVC,peak expiratory flow(PEF),forced expiratory flow at 50% of vital capacity(FEF50),forced expiratory flow at 75% of vital capacity(FEF75),and the maximal midexpiratory flow(MMEF) were collected for analysis.The expected values of the 7 parameters above were calculated according to Zapletal prediction equations(4-18 years old).The measured value vs.the expected value was calculated.Results Children aged 5 to 12 years had similar height and weight between boys and girls,and the differences were not significant(all P>0.05);while boys were taller and heavier than girls in 13-<14 years old group and 14 years old group,and the diffe-rences were significant(t=3.35,2.05,5.99,2.67;all P<0.05).The mean measured value vs.the expected value of PEF,FVC,FEV1,FEV1/FVC of children in different gender and age groups ranged between 105.0%-114.7%,95.4%-106.8%,104.6%-115.4% and 105.8%-112.6%,respectively.The mean measured value vs.the expected value of small airway function parameters FEF50,FEF75,MMEF was as follows respectively:79.7%-103.7%,70.2%-110.5%,and 81.6%-114.7%.The low limit of normal(LLN) measured value vs.the expected value of the 7 pulmonary function parameters was as follows:PEF 85.0%,FVC 84.7%,FEV1 92.4%,FEV1/FVC 98.4%,FEF50 67.7%,FEF75 60.1%,and MMEF 71.0%.Conclusions The pulmonary function parameters of the healthy children in Beijing are higher than those of the Zapletal prediction.The measured value vs.the expected value of FEV1 92.4%,FEV1/FVC 98.4%,PEF 85.0%,FVC 84.7%,FEF50 67.7%,FEF75 60.1%,and MMEF 71.0% can be used as LLN in 5-14 years old children.

Objective To understand the causes and the ratio of cause constituents in children with chronic cough in Beijing. Methods Patients with chronic cough treated at respiratory clinic of the Children' s Hospital Affiliated to Capital Institute of Pediatrics from May 2009 to April 2011 were included in this study. Etiologic diagnostic procedure suggested for children by the Subspecialty Group of Respiratory Diseases,the Society of Pediatrics,Chinese Medical Association in 2008 was implemented to manage the patients. After three - month follow - up,the etiological data was analyzed. Results Totally 213 patients with chronic cough aged 1. 1 to 14. 0 years old were enrolled,inclu-ding 40 cases(18. 8% )aged≤3 years old,134 cases(62. 9% )aged ﹥ 3 to 6 years old,and 39 cases(18. 3% ) aged ﹥ 6 years old. The majority of patients with positive allergen tests were sensitized to inhaled allergens. One child had positive result in 24 - hour esophageal pH monitoring,but his cough didn't respond well to the specific treatment for gastroesophageal reflux,so he wasn't diagnosed as gastroesophageal reflux cough. The 4 leading causes of the 213 pa-tients with chronic cough were cough variant asthma(CVA)in 92 cases(43. 2% ),CVA associated with upper airway cough syndrome(UACS)in 57 cases(26. 8% ),UACS in 28 cases(13. 2% ),respiratory infection and post - infec-tion cough(PIC)in 26 cases(12. 2% ),while other causes were found in 8 cases(3. 7% ),and unknown etiology in 2 cases(0. 9% ). The incidence of CVA ranked top 1 in all the 3 age groups,followed by PIC in ≤3 years old group, while CVA associated with UACS in the other 2 age groups. Conclusions CVA,CVA associated with UACS,UACS and PIC were the 4 leading causes for children with chronic cough in Beijing. Children in different age groups had dif-ferent constituents ratio of causes of chronic cough.

Abstrsct:Objective To analyze the correlation of hyponatremia with chronic heart failure (CHF) and the prognostic analysis of CHF. Methods Patients with CHF (n=507) and healthy adult (n=212) were included in this study. The general data of the two groups were analysed. The index which was statistically significant was indicated as independent variables. Multivariate logistic analysis was used to analysis the correlation between serum sodium and CHF. The relationship between serum sodium and the prognosis of CHF include mortality and rate of readmission were included in follow-up study. The prognostic correlation of serum sodium with BNP (brain natriuretic peptide), heart failure with preserved ejection fraction (HFpEF, LVEF≥0.45) and heart failure with reduced ejection fraction (HFrEF, LVEF<0.45) were all analyzed. Results In?dicators such as sex, smoking history showed no statistical significance between two groups (P>0.05) while other indicators like age, hemoglobin, serum sodium presents statistical significance (P < 0.05). Serum sodium is the protective factor for CHF. Brain natriuretic peptide (BNP) concentration in hyponatremia group is significantly higher than that in normal serum sodium group (P<0.05). HFpEF and HFrEF were of no significant difference in these two groups. For patients with CHF, the mortality in hyponatremia group is significantly higher than that in normal serum sodium group (P<0.05), but readmission rates were not significantly different (P>0.05);While for patients with HFpEF, the mortality and the readmission rates were both significantly different (P<0.05). Conclusion Serum sodium is the protective factor in CHF, the patients with hypona?tremia have higher readmission rate and death rate in HFpEF background.

Objective To analyze the differences in clinical characteristics and risk factors in patients with diastolic heart failure and systolic heart failure. Methods A total of 2 088 patients with heart failure were divided into two groups, diastolic heart failure group (EF≥0.45,n=1 356) and systolic heart failure group (EF<0.45,n=732), according to ejection fraction (EF). The clinical features and related factors affecting the two types of heart failure were compared between two groups. Results There were higher age, higher proportion of women and higher proportion of hypertensive patients in dia?stolic heart failure group than those of systolic heart failure group, but lower rates of hypoalbuminemia, anemia, renal insuffi?ciency and hyperuricimia. There was higher incidence of functional class I and II in diastolic heart failure group. And com?pared with systolic heart failure group, there were higher levels of systolic blood pressure, albumin, prealbumin, cholesterol, sodium and serum chloride in diastolic heart failure group, but lower levels of heart rates, creatinine, blood uric acid, potassi?um and brain natriuretic peptide. Compared with systolic heart failure group, there were lower left ventricular end diastolic volume (LVEDV) and left ventricular end systolic volume (LVESV) in diastolic heart failure group. And there were lower RAS blocker andβ-blocker usage, higher statin usage in diastolic heart failure group. Logistic regression analysis showed that gender and hypertension were significantly correlated with diastolic heart failure, and hypoalbuminemia and hyper?uricimia were significantly correlated with systolic heart failure. Conclusion Our results show that there are differences in clinical features and risk factors in patients with diastolic heart failure and systolic heart failure. We should take the differ?ent treatment and prevention programs for the two kinds of heart failures.

Objective To investigate the condition and the related influence factors of small airway function in controlled bronchial asthmatic children.Methods Children diagnosed with bronchial asthma controlled,aged 5-14 years old without gender limitation were consecutively enrolled.Survey questionnaire including asthma symptoms in the past one month and medication usage were conducted.Physical condition and lung function were examined.Results A total of 255 patients were included in this study,and 224 patients had normal small airway function in which the level of forced expiratory flow at 50％ of forced vital capacity(FVC) exhaled (FEF50),forced expiratory flow at 75％ of FVC exhaled(FEF75),maximal mid-expiratory flow(MMEF) was 87.9％ (77.0％,97.2％),73.8％ (65.6％,93.5％),and 84.9％ (76.4％,97.5％) of the predicted value,respectively.Thirty-one patients had small airway dysfunction,accounting for 12.2％ (31/255 cases),and the level of FEF50,FEF75,MMEF were 62.8％ (59.9％,65.5％),51.9％ (46.6％,55.5％),and 62.7％ (57.2％,64.4％) of the predicted value,in which FEF75 had shown more decrease than others.In small airway dysfunction group,10 patients had conducted bronchodilation testing,and improvement rate of FEF50,FEF75 and MMEF were 41.1％,47.5％ and 41.3％,and all 10 cases (100.0％) returned to normal level.No significant difference was found in gender,body mass index,atopy,disease duration,drug usage between 2 groups (all P ＞ 0.05).Conclusion In 5-14 controlled asthmatic children,12.2％ have small airway dysfunction with a certain degree of reversibility.Gender,body mass index,atopy,disease duration,drug usage are not influencing factors.

OBJECTIVETo compare the changes of diagnosis, treatment and control of 0-14 years old urban asthma children during 10 years.

METHODThe questionnaires were given to diagnosed asthmatic children during the national epidemiological survey of asthma in children in 2000 and 2010 to understand the diagnosis and treatment of asthma and the status of the disease control. Children with asthma of a total of 36 cities were involved in this study, and the diagnosed asthma children in recent 2 years were 6,128 and 8 174, separately. Data were stored using epi-info software by double entry, V19.0 of SPSS was used to do the statistical analysis , χ(2) test was used.

RESULTThe proportion of correct diagnosis of asthma before investigation in 2010 was 64.6%, while it was 70.7% in 2010, which showed a significant increase (χ(2) = 59.3, P < 0.01). Diagnosis rate of asthma onset within 1 year was separately 50.8% and 78.6% in 2000 and 2010. The early diagnostic rate was significantly higher in 2010 than that in 2000 (χ(2) = 817.7, P < 0.01). In 2000 and 2010 children with asthma medication in the use of inhaled corticosteroids was 36.3% and 61.7%, it increased by 0.7 times in 2010 (χ(2) = 907.5, P < 0.01). Systemic corticosteroids utilization rate was separately 74.2% and 39.1% (χ(2) = 1 730.6, P < 0.01). Beta 2 agonists utilization rate was separately 71.8% and 73.4%, showing a slight rise (χ(2) = 4.3, P < 0.05). Antibiotics usage was separately 97.4% and 76.0%, compared to a decrease of 21.4% (χ(2) = 1 274.2, P < 0.01). In the survey of 2000 and 2010, children with acute asthma attacks within recent 1 year were separately 86.3% and 77.0% (χ(2) = 194.0, P<0.01), hospitalizations for asthma attack were separately 54.0% and 47.3% (χ(2) = 61.7, P < 0.01), rate of absence from school due to asthma less than 10 days was separately 47.5% and 71.4% (χ(2) = 682.6, P < 0.01).

CONCLUSIONThe rates of correct diagnosis and early diagnosis of asthma in urban Chinese children within 1 year had a significant increase compared with a decade ago. Inhaled corticosteroids therapy had increased by 0.7 times than before while systemic corticosteroids utilization rate significantly decreased. Antibiotics usage had a decrease of 22.0% but they were still overused. Asthma control was significantly improved, but acute exacerbations and hospitalizations of asthma children still accounts for a large proportion although they both had a great improvement.

Adrenal Cortex Hormones ; Airway Obstruction ; Anti-Asthmatic Agents ; Anti-Bacterial Agents ; Asian Continental Ancestry Group ; Asthma ; Child ; China ; Hospitalization ; Humans ; Immunosuppressive Agents ; Surveys and Questionnaires ; Urban Population