Objective: In Japan, beta 2 agonist (BA) has an indication for acute bronchitis with airway obstruction. To investigate BA prescribing practices for children whose diagnosis were acute bronchitis without asthma in Japan, a database study and interviews with pediatricians were conducted.
Design: Database study
Methods: We conducted a database study. Using the Japan Medical Data Center database, medical receipts of about 100,000 children younger than 18 years old were obtained between 2005 and 2008. First we identified all the new incidences (362,287 cases) of upper respiratory tract infection, influenza, or acute bronchitis. Outcome measure was prescription of BA within 21 days of the incidence. We calculated the prescription proportions of BA for the asthma group (41,064 cases) and the non-asthma group (321,223 cases). We then interviewed 10 pediatricians to elucidate the reason why they prescribe BA for patients.
Results: The proportion of children prescribed BA at least once a year in 3-5 years old was 49.9 %. Among 3-5 year olds with acute bronchitis, the BA prescription proportions in the asthma group (58.6%) was nearly as high as that in the non-asthma group (56.6%). Although BA prescription proportions in the asthma group decreased annually with the exception of 0-2 years old, those in the non-asthma group remain unchanged. Based on the interview study, we found interpretations of airway obstruction for acute bronchitis without asthma were broadly-divided into 2 types: the effect of inducing bronchospasm and the effect of producing large amounts of secretions in the airways.
Conclusion: In this study, it was revealed that pediatric patients with acute bronchitis were commonly prescribed BA in Japan. To promote an appropriate use of BA, prescriptions of BA to non-asthma pediatric patients should be carefully watched. (Jpn J Pharmacoepidemiol 2012; 17(1): 1-12)

BACKGROUND: Severe asthmatics are thought to have severer rhinitis than mild asthmatics. A pale nasal mucosa is a typical clinical finding in subjects with severe allergic rhinitis. OBJECTIVE: The aim of this study was to investigate whether a pale nasal mucosa affects airflow limitations in the upper and lower airways in asthmatic children. METHODS: Rhinomanometry, nasal scraping, and spirometry were performed in 54 asthmatic children (median age, 10 years). The nasal mucosa was evaluated by an otolaryngologist. Thirty-seven patients were treated with inhaled corticosteroids, and 11 patients were treated with intranasal corticosteroids. RESULTS: Subjects with a pale nasal mucosa (n = 23) exhibited a lower nasal airflow (p < 0.05) and a larger number of nasal eosinophils (p < 0.05) in the upper airway as well as lower pulmonary functional parameters (p < 0.05 for all comparisons), i.e., the forced vital capacity (FVC), the forced expiratory volume in 1 second, and the peak expiratory flow, compared with the subjects who exhibited a normal or pinkish mucosa (n = 31). No significant difference in the forced expiratory flow between 25%–75% of the FVC, regarded as indicating the peripheral airway, was observed between the 2 groups. CONCLUSION: A pale nasal mucosa may be a predictor of eosinophil infiltration of the nasal mucosa and central airway limitations in asthmatic children. When allergists observe a pale nasal mucosa in asthmatic children, they should consider the possibility of airflow limitations in not only the upper airway, but also the lower airway.
Adrenal Cortex Hormones ; Asthma ; Child ; Eosinophils ; Forced Expiratory Volume ; Humans ; Mucous Membrane ; Nasal Mucosa ; Nasal Obstruction ; Rhinitis ; Rhinitis, Allergic ; Rhinomanometry ; Spirometry ; Vital Capacity

OBJECTIVES: We investigated whether asthma attacks in asthmatic children were caused by short-term exposure to particulate matter(PM)2.5. METHODS: Subjects were 411 patients who received inhalation therapy in National Fukuoka Hospital, from March to May 2013. All subjects were outpatients. We surveyed the air quality measurement results in the stations closest to the address of the patients. Data were used from the City of Fukuoka website data on air pollution. We carried out a case-crossover study and compared PM2.5 concentration between 7 days after asthma attack occurred and the day asthma attack occurred and 1, 2 and 3 days before asthma attack occurred. RESULTS: Highest hourly concentration of the day (OR 1.013, 95%CI 1.000–1.025) showed a significant association with 1 day before PM2.5 concentration statistically. And 0–1 year-old infants were more vulnerable to the highest concentration of 1 day before PM2.5 concentration(P < 0.05). Average concentration of NO2 and O3 and asthma attack also showed a significant association. CONCLUSIONS: Maximal daily PM2.5 concentrations within 24 hours prior to the attack affect asthma exacerbation. 0–1 year-old infants are particularly vulnerable to PM2.5 concentration. Asthma exacerbation is aggravated by NO2 and O3 concentration on the day of the asthma attack.
Air Pollution ; Asthma* ; Child* ; Humans ; Infant ; Japan* ; Outpatients ; Respiratory Therapy

BACKGROUND: In view of the increasing prevalence of food allergies, there has been an associated increase in frequency of situations requiring an emergency response for anaphylaxis at the home, childcare facilities and educational institutions. OBJECTIVE: To clarify the situation of adrenaline auto-injector administration in nursery/kindergarten/school, we carried out a questionnaire survey on pediatric physicians in Western Japan. METHODS: In 2015, self-reported questionnaires were mailed to 421 physicians who are members of the West Japan Research Society Pediatric Clinical Allergy and Shikoku Research Society Pediatric Clinical Allergy. RESULTS: The response rate was 44% (185 physicians) where 160 physicians had a prescription registration for the adrenaline auto-injector. In the past year, 1,330 patients were prescribed the adrenaline auto-injector where 83 patients (6% of the prescribed patients) actually administered the adrenaline auto-injector, of which 14 patients (17% of the administered patients) self-administered the adrenaline auto-injector. “Guardians” at the nursery/kindergarten and elementary school were found to have administered the adrenaline auto-injector the most. Among 117 adrenaline auto-injector prescription-registered physicians, 79% had experienced nonadministration of adrenaline auto-injector at nursery/kindergarten/school when anaphylaxis has occurred. The most frequent reason cited for not administering the adrenaline auto-injector was “hesitation about the timing of administration.” CONCLUSION: If the adrenaline auto-injector was administered after the guardian arrived at the nursery/kindergarten/school, it may lead to delayed treatment of anaphylaxis in which symptoms develop in minutes. Education and cooperation among physicians and nursery/kindergarten/school staff will reduce the number of children suffering unfortunate outcomes due to anaphylaxis.
Anaphylaxis ; Child ; Education ; Emergencies ; Epinephrine ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Japan ; Nurseries ; Postal Service ; Prescriptions ; Prevalence

BACKGROUND: Studies on the adverse effects of Asian dust (AD) on respiratory function in children are scarce. The objective of this study was to examine the association between AD and respiratory function by measuring peak expiratory flow rates (PEFRs) in asthmatic children. METHODS: The study was carried out from March to May from 2014 through 2016. One hundred ten children with bronchial asthma were recruited from four hospitals in the Goto Islands and south Nagasaki area in Nagasaki prefecture. The parents were asked to record their children's PEFRs every morning/evening and clinical symptoms in an asthma diary. AD was assessed from light detection and ranging data, and a linear mixed-effects model was used to estimate the effects of AD on daily PEFR. Time-stratified case-crossover analyses were performed to examine the association between AD and asthma attacks defined by reduction levels in PEFR. RESULTS: AD was detected on 11 days in the Goto Islands, and on 23 days in the south Nagasaki area. After adjusting for age, sex, temperature, and daily oxidants, we found a consistent association between AD and a 1.1% to 1.7% decrease in PEFR in the mornings and a 0.7% to 1.3% decrease in the evenings at a lag of 0 to 5 days. AD was not associated with the number of asthma attacks, respiratory symptoms, or other symptoms at any lag days examined. CONCLUSIONS Exposure to AD was associated with reduced PEFR, although the effects were not large enough to induce clinically apparent symptoms, in clinically well-controlled asthmatic children.