PURPOSE: The incidence of endobronchial tuberculosis in children is unknown, due to the inconsistent implementation of bronchoscopy in pediatric patients with pulmonary tuberculosis. In this study, our aim was to determine the incidence and clinical course of endobronchial tuberculosis in children. METHODS: We performed a retrospective chart review of patients less than 18 years of age, who was diagnosed with endobronchial tuberculosis via fiberoptic bronchoscopy. RESULTS: Out of the 101 patients with pulmonary tuberculosis, 16 patients had endobronchial tuberculosis. The median age at diagnosis was 11.2 years (range, 5 months to 16.1 years). Tuberculin skin test was positive in 9 cases (56.2%), and 6 patients (37.5%) had a history of household contact with tuberculosis. Consolidation lesion was common in the simple chest radiographs of patients with endobronchial tuberculosis. According to the bronchoscopic finding, actively caseating type was most common (43.8%). Nine of the 16 patients of endobronchial tuberculosis progressed to bronchial obstruction and 4 patients underwent pneumonectomy or lobectomy. Fibrostenotic and tumorous type tend to progress to endobronchial obstruction compared with actively caseating type. CONCLUSION: The incidence of endobronchial tuberculosis in pediatric pulmonary tuberculosis was 15.8%. Early detection and effective treatment of endobronchial tuberculosis are important to decrease the secondary complication, such as bronchial obstruction.
Bronchoscopy ; Child ; Family Characteristics ; Humans ; Incidence ; Pneumonectomy ; Retrospective Studies ; Skin Tests ; Thorax ; Tuberculin ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: Tracheostomy is used to aid airway management in perdiatric respiratory care. This study was designed to review causes and outcomes of pediatric tracheostomy. METHODS: We performed a retrospective chart review of 153 patients, less than 18 years of age, who underwent tracheostomy between January 1995 and July 2010. Age at tracheostomy, indications, durations, complications and mortality were evaluated. RESULTS: Subglottic stenosis (19%) was the most common indication for tracheostomy. The median age at tracheostomy was 1.3 years (range, 22 days to 17.8 years). Seventy-three (47.7%) tracheostomies were performed in children under 1 year of age. Respiratory diseases were significantly more prevalent in patients under 1 year of age, while neuromuscular disease were more frequently found in patients older than 1 year (P=0.013). Stoma or tracheal granuloma formation (36.6%) was the most common complication of pediatric tracheostomy. Decannulation was accomplished in 61 (39.9%) patients with median cannulation time of 141 days (range, 1 to 2,529 days). Overall mortality rate was 10.5% (n=16), but only one patient (0.7%) died from tracheostomy-related complications. CONCLUSION: Respiratory diseases, such as subglottic stenosis and neuromuscular disease, are the main cause of pediatric tracheostomy. Although complications, like stoma or tracheal granuloma formation occur, tracheostomy in children is a safe way to aid airway management.
Airway Management ; Catheterization ; Child ; Constriction, Pathologic ; Granuloma ; Humans ; Neuromuscular Diseases ; Retrospective Studies ; Tracheostomy

PURPOSE: Fractional exhaled nitric oxide (FeNO) has been widely reported as a marker for airway inflammationin, and FeNO have shown increased levels in the non-asthmatic patients with other atopy related diseases, such as rhinitis. Bronchial hyperresponsiveness is a characteristic feature of asthma, which is often associated with airway inflammationin allergic rhinitis. It has been suggested that asthma is associated with rhinitis, which is a link between the upper and the lower airways, beyond allergy associated inflammation in the respiratory tract. To evaluate the usefulness of FeNO measurement, as a risk factor of allergic and nonallergic rhinitis in children with asthma. METHODS: Fifty-three children included in this study were diagnosed as asthma from April through August 2005 in the Department of Pediatrics, Kyung Hee University School of Medicine. They conducted FeNO monitoring, total eosinophil count and serum immunoglobulin E at that time. We put a question to the participants' parents about the doctor diagnosed participants' manifestations (sneezing, nasal congestion, nasal itching, rhinorrhea), via a telephone interview survey or at the outpatient department in July 2011. Statistical analyses were performed using IBM SPSS ver. 18.0. RESULTS: The overall prevalence of rhinitis, among the 53 children, was 67.9%. The means of FeNO differed significantly between the two groups, being higher in children who have rhinitis symptoms and lower in asymptomatic children. (mean+/-SD, 29.4+/-24.6 to 13.6+/-11.8 parts per billion; P=0.003; T-test) CONCLUSION: To take the measurement of FeNO value in asthmatics may be a tool in the predictor of the causes of rhinitis.
Aluminum Hydroxide ; Asthma ; Carbonates ; Child ; Eosinophils ; Estrogens, Conjugated (USP) ; Humans ; Hypersensitivity ; Immunoglobulin E ; Immunoglobulins ; Inflammation ; Interviews as Topic ; Nitric Oxide ; Outpatients ; Parents ; Pediatrics ; Prevalence ; Pruritus ; Respiratory System ; Rhinitis ; Rhinitis, Allergic, Perennial ; Risk Factors

PURPOSE: Preschoolers complete forced expiration in a short time, sometimes more quickly than in 1 second, and therefore the importance of forced expiatory volume in 0.75 seconds (FEV0.75) or forced expiatory volume in 0.5 seconds (FEV0.5) has been raised. The purpose of this study is to evaluate the clinical usefulness of DeltaFEV0.75 and DeltaFEV0.5. METHODS: We analyzed 401 subjects of an asthma group, and 150 subjects of a control group under 7 years of age. RESULTS: DeltaFEV1, DeltaFEV0.75 and DeltaFEV0.5 values of the asthma group were significantly higher than those of the control group, respectively (P<0.0001). DeltaFEV1 (0.60; 95% confidence interval [CI], 0.57 to 0.62), DeltaFEV0.75 (0.61; 0.58 to 0.65), and DeltaFEV0.5 (0.60; 0.56 to 0.64) showed no significant difference in the diagnostic ability of asthma when airway reversibility is defined as DeltaFEVt> or =12%. Cutoff values for asthma were 8.6% in DeltaFEV1, 7.9% in DeltaFEV0.75 and 14.2% in DeltaFEV0.5. DeltaFEV0.75 (0.91; 0.88 to 0.94) showed significantly higher area under curve (AUC) than DeltaFEV0.5 (0.77; 0.73 to 0.82) when stratified by 12%, in predicting airway reversibility defined as DeltaFEV1> or =12%. Cutoff values were 12.3% in DeltaFEV0.75, and 13.4% in DeltaFEV0.5. When airway reversibility is defined as DeltaFEV1> or =8.6%, DeltaFEV0.75 (0.90; 0.87 to 0.92) also showed significantly higher AUC than DeltaFEV0.5 (0.79; 0.75 to 0.82), and Cutoff values were 8.4% in DeltaFEV0.75, and 11.3% in DeltaFEV0.5. CONCLUSION: DeltaFEV0.75 or DeltaFEV0.5 can be a means to replace DeltaFEV1 for diagnosis of asthma and assessment of airway reversibility in preschool children.
Area Under Curve ; Asthma ; Child, Preschool ; Forced Expiratory Volume ; Humans ; Spirometry

PURPOSE: To evaluate the clinical characteristics and radiologic patterns of adolescents with pulmonary tuberculosis (TB), and to assess whether they are related with primary TB or reactive TB. METHODS: Among the enrolled patients who were diagnosed with pulmonary TB from March 2000 to May 2011, 36 with plain radiography and/or chest computed tomography (CT) were reviewed. We reviewed retrospectively their medical charts to collect clinical data and past history. Among these 36 patients, plain radiography of the 36 patients and chest CT of the 34 patients were retrospectively evaluated. RESULTS: The patients consisted of 18 males and 18 females, and their median age was 14 years old. The most common clinical presentation was cough and fever. Half of them had chronic cough for more than two weeks. Ten patients had history of close contact with adult patients with active pulmonary TB: 7 patients with their parents, 2 patients with friends, 1 patient with their grandmother. The most frequent pattern of plain radiography was pleural effusion (16/36). In the chest CT findings, all cases showed parenchymal lesions and lymphadenopathy. In addition, 91% of the cases showed acinar nodules. The pattern of pleural effusion revealed associated ipsilateral pleural lymph node and subpleural nodule. Rim enhancement and calcification of the lymph node demonstrated 9% (3/34) and 12% (4/34), respectively. Only two of them showed typical hilar lymphadenopathy in chest X ray and CT. CONCLUSION: The radiologic findings of adolescents with pulmonary TB show patterns for rather reactive than primary TB. For diagnosis of adolescent pulmonary TB, chest CT is more helpful than that of plain radiography.
Adolescent ; Adult ; Cough ; Female ; Fever ; Friends ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Male ; Parents ; Pleural Effusion ; Retrospective Studies ; Thorax ; Tuberculosis ; Tuberculosis, Pulmonary

PURPOSE: In this study, we attempted to analyze the effectiveness of the atopic dermatitis camp for primary school students in the Seoul area. METHODS: Seoul city's atopy camp 2010 was conducted 10 times from May 22nd to October 24th for primary school students at an atopy friendly school and their parents. A total of 374 atopic dermatitis patients participated in the camp and questionnaires for 363 were analyzed, except 11 participants who had left several questions unanswered. In a 3-month follow-up survey, 167 participants out of 374 responded to the mailing questionnaire to evaluate the efficiency of the camp. The response rate was 44.7%. RESULTS: Satisfaction with the educational program of the camp was higher for lower grade students than for higher grade students.(P<0.001) Before camp, higher grade students (P<0.001) or students with severe symptoms were more knowledgeable of atopic dermatitis.(P<0.01) After the camp, the higher the grade, the more the knowledge the student had about atopic dermatitis.(P<0.001) Three months after the camp, there was positive change in the lifestyle of atopic dermatitis patients.(P<0.001) CONCLUSION: Knowledge on atopic dermatitis increased and the lifestyle of atopic dermatitis patients was improved due to the camp. Consequently, Seoul city's atopy camp can be utilized as a method to improve the quality of life of atopic dermatitis patients and their family. And Seoul city's atopy camp is expected to be a model for atopy camps in other local communities.
Dermatitis, Atopic ; Follow-Up Studies ; Humans ; Life Style ; Parents ; Patient Education as Topic ; Postal Service ; Quality of Life ; Surveys and Questionnaires

PURPOSE: The aim of study was to identify the predictors of severe asthma exacerbation with influenza A (H1N1) infection so that intensive care could be initiated immediately. METHODS: Patients were diagnosed influenza A (H1N1), using a real-time reverse transcriptase polymerase chain reaction (RT-PCR) from the nasal aspirates in St. Mary's Medical Center, Busan, Korea, between September, 2009 and February, 2010. Medical records were retrospectively reviewed to collect data. Data were analyzed in two groups by severity of asthma exacerbation. The groups were severe groups and mild-moderate. Statistical analysis was performed by SPSS ver. 12.0. RESULTS: A total of 1,054 children were diagnosed influenza A (H1N1) infection. Of 1,054, 318 (30.1%) were hospitalized. There were 200 boys (62.9%) and median age was 5.0 years (0.1 to 18.0 years). Among hospitalized, 25.2% (80/318) were diagnosed asthma exacerbation. Among 80 patients, 16 (20.0%) were severe group. and 64 (80.0%) were mild-moderate. High leukocyte counts, neutrophil counts, and C-reactive protein (P<0.05) in serum had a greater risk for severe asthma exacerbation. Age, gender, early antiviral medication, gastrointestinal or neurological cosymptoms, allergic family history, sinusitis in water's view, total immunoglobulin E, Dermatophagoides pteronyssinus, Dermatophagoides farinae, mycoplasma coinfection, eosinophil and fever duration (P> or =0.05) were not reliable predictors. CONCLUSION: Among who had influenza A (H1N1) infection with asthma-like symptoms, patients who had not been managed asthma before, had high leukocyte, neutrophil, and C-reactive protein in serum, are likely to progress severe asthma exacerbation.
Asthma ; C-Reactive Protein ; Child ; Coinfection ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Eosinophils ; Fever ; Humans ; Immunoglobulin E ; Immunoglobulins ; Influenza A virus ; Influenza, Human ; Critical Care ; Korea ; Leukocyte Count ; Leukocytes ; Medical Records ; Mycoplasma ; Neutrophils ; Retrospective Studies ; Reverse Transcriptase Polymerase Chain Reaction ; Seasons ; Sinusitis

PURPOSE: The prevalence of allergic rhinitis is rapidly increasing and results in relatively high socio-economic burden on their family and community. However, studies on the economic burden of pediatric allergic rhinitis in Korea are limited. Therefore, we conducted this study to investigate the impact of pediatric allergic rhinitis on economic burden. METHODS: Two hundred sixty two children with allergic rhinitis were enrolled in 6 secondary or tertiary medical centers in Seoul from July to September, 2008. We collected data of the economic burden of allergic rhinitis (direct medical costs, direct nonmedical costs, and indirect costs) by face to face questionnaire survey. We compared the economic burden according to the severity and the duration of allergic rhinitis. RESULTS: The mean age of subjects was 6.54 years, and male were 174 (66.4%). Direct medical costs (10,000 Korean Won/yr) were 177.75, and direct nonmedical costs were 57.92. Although, there was no statistical significance, direct medical costs showed increasing trends in severe allergic rhinitis.(P=0.053) In addition, direct medical costs were positively correlated with duration of allergic rhinitis.(R=0.195, P=0.002). About 17% of the parents who care the allergic rhinitis children experienced the work absence due to their child's illness. CONCLUSION: The economic burdens of allergic rhinitis were positively correlated with the severity and duration of illness. Particularly costs for alternative medicine including oriental medicine were related with severity and duration allergic rhinitis. Therefore, special efforts for education with evidence based treatment strategy are necessary to decrease the economic burden of allergic rhinitis.
Child ; Complementary Therapies ; Humans ; Korea ; Male ; Medicine, East Asian Traditional ; Parents ; Prevalence ; Surveys and Questionnaires ; Rhinitis ; Rhinitis, Allergic, Perennial

Asthma is a complex and heterogeneous disease, which is comprised of seperate phenotypes sharing common characteristics, such as airway inflammation, bronchial hyperresponsiveness and variable airflow limitation. Traditionally, asthma phenotypes have been described by combinations of clinical characteristics, according to the expert's recommendation, but they are now focusing on the pathobiologic mechanisms often using exploratory statistical methods. Several phenotypes and endotypes have been suggested by biased or unbiased phenotyping approaches. However, more detailed studies are still needed. In the future, more integrated large-scaled consortium of cohorts, including clinical information, genetics, molecular biology, and experiments will promote to understand the pathobiologic mechanisms of asthma phenotypes for the personalized therapy.
Asthma ; Bias (Epidemiology) ; Biology ; Cluster Analysis ; Cohort Studies ; Humans ; Inflammation ; Molecular Biology ; Phenotype

No abstract available.
Dermatitis, Atopic