OBJECTIVES: To investigate the influencing factors for asthma management and asthma control level in children. METHODS: A total of 202 children with a confirmed diagnosis of asthma were enrolled. The questionnaire of asthma control level and family management was used to investigate the influencing factors for asthma control level and the indicators of family management. The awareness of childhood asthma and its management was analyzed among the parents, as well as the influence on asthma control level in children, and the association between them was analyzed. RESULTS: Compared with the non-complete control group, the complete control group had significantly longer course of asthma and treatment time (P<0.05). The proportions of asthma attacks ≥3 times and aerosol treatment for asthma attacks >3 times in one year in the complete control group were significantly lower than those in the non-complete control group (P<0.05). The complete control group had a significantly lower proportion of children with frequent respiratory infection, wheezing during respiratory infection, or a family history of allergic diseases (P<0.05). The parents in the complete control group had significantly stronger awareness of short-term escalation to asthma medication after respiratory infection and significantly enhanced management of maintenance medication (P<0.05). Compared with the complete control group, the non-complete control group had a significantly higher proportion of children with abnormal pulmonary function at the initial stage (P<0.05). The level of asthma control in children was associated with short-term escalation to asthma medication during respiratory infection and initial lung function (P<0.05). CONCLUSIONS The level of asthma control in children is closely associated with the severity of asthma and the comprehensive management of childhood asthma. Early treatment and family management, especially escalation to asthma medication during the early stage of respiratory infection, are of great importance in asthma control. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(1): 73-79.
Child ; Humans ; Asthma/diagnosis* ; Hypersensitivity/diagnosis* ; Lung ; Respiratory Tract Infections ; Parents ; Respiratory Sounds

In Korea, there are two descrite pollen seasons: a tree pollen season and a weed pollen season. In order to investigate the incidence of sensitization to the major pollens and to evaluate is clinical significance in respriatory allergic disease, skin prick tests were performed using 7 species of Korean pollen extracts (K-P extracts) and specific IgE was measured by the Phadebas radioallergosorbent test (RAST) in patients with positive skin prick tests. Of the 317 patients with respiratory allergic diseases 73 patients (23.0%) were skin prick test positive to one or more K-P extracts and the positive reactions to individual pollens were as follows: 14.2% (45/317) positive to sagebrush 10.4% to ragweed, 5.0% to grass, 4.1% to oak, 3.8% to alder, 1.9% to poplar; and 0% to pine. The 30-39yr old group manifested the highest skin test positivity 36.7%. There was no difference in the skin reactivity according to the patient's sex and the kinds of allergic disease. Also there was no relationship between birth season and skin test positivity. The agreement between the results of the skin prick test with K-P and commercially prepared Bencard's pollen extracts (B-P extracts) was good. There were good correlations between the strongly positive skin prick test and a posivite RAST and also between a netative skin prick test and a negative RAST. From this study, it can be concluded that overall sensitization rate of respiratory allergy patients to K-P exstracts was 23.0%, and that weed pollens such as sagebrush and ragweed were major pollens.
Female ; Human ; Korea ; Male ; Pollen/adverse effects* ; Radioallergosorbent Test ; Respiratory Hypersensitivity/diagnosis ; Respiratory Hypersensitivity/epidemiology* ; Skin Tests

The diagnosis of anaphylaxis is often based on reported symptoms which may not be accurate and lead to major psychosocial and financial impacts. We describe two adult patients who were diagnosed as having recurrent anaphylaxis witnessed by multiple physicians based on recurrent laryngeal symptoms. The claimed cause was foods in one and drugs in the other. We questioned the diagnosis because of absent documentation of objective findings to support anaphylaxis, and the symptoms occurred during skin testing though the test sites were not reactive. Our initial skin testing with placebos reproduced the symptoms without objective findings. Subsequent skin tests with the suspected allergens were negative yet reproduced the symptoms without objective findings. Disclosing the test results markedly displeased one patient but reassured the other who subsequently tolerated the suspected allergen. In conclusion, these 2 patients' symptoms and evaluation were not supportive of their initial diagnosis of recurrent anaphylaxis. The compatible diagnosis was Munchausen stridor which requires psychiatric evaluation and behavior modification, but often rejected by patients.
Adult ; Allergens ; Anaphylaxis* ; Behavior Therapy ; Diagnosis ; Drug Hypersensitivity ; Food Hypersensitivity ; Humans ; Hypersensitivity ; Placebos ; Respiratory Sounds ; Skin Tests ; Vocal Cord Dysfunction

PURPOSE: Exercise-induced bronchoconstriction (EIB) is common in “high ventilation” athletes, and the Eucapnic Voluntary Hyperpnea (EVH) airway provocation test is the standard EIB screen. Although the EVH test is widely used, the in-test performance in high ventilation athletes as well as the reproducibility of that performance has not been determined. Reproducibility of pre- and post-test spirometry and self-reported atopy/cough was also examined. METHODS: High ventilation athletes (competitive swimmers; n=11, 5 males) completed an atopy/cough questionnaire and EVH testing (operator controlled FiCO₂) on 2 consecutive days. RESULTS: Swimmers achieved 85%±9% and 87%±9% of target FEV1 volume on days 1 and 2, respectively, (P=0.45; ICC 0.57 [0.00-0.86]) resulting in a total ventilation of 687 vs 684 L [P=0.89, ICC 0.89 (0.65-0.97]) equating to 83%±8% and 84%±9% of predicted total volume (ICC 0.54 [0.00-0.85]) between days 1 and 2. FiCO₂ required to maintain eucapnic conditions was 2.5%. Pre-test FEV1 was less on day 2 (P=0.04; ICC >0.90). Day 1 to 2 post-test FEV1 was not different, and 4 swimmers were EIB positive (>10% fall in pre-post FEV1) on day 1 (3 on day 2). CONCLUSIONS: EVH in-test performance is reproducible however required less FiCO₂ than standard protocol and the swimmers under-ventilated by 125 and 139 L/min for days 1 and 2, respectively. How this affects EIB diagnosis remains to be determined; however, our results indicate a post-test FEV1 fall of ≥20% may be recommended as the most consistent diagnostic criterion.
Asthma, Exercise-Induced ; Athletes* ; Bronchoconstriction ; Cough ; Diagnosis ; Humans ; Respiratory Hypersensitivity ; Spirometry ; Swimming ; Ventilation*

There is a growing list of viruses and bacteria associated with wheezing illness and asthma. It is well known that a few of these pathogens are strongly associated with wheezing illness and asthma exacerbations. What is not known is if early childhood infections with these pathogens cause asthma, and, if so, exactly what are the pathophysiologic mechanisms behind its development. The current consensus is respiratory infection works together with allergy to produce the immune and physiologic conditions necessary for asthma diasthesis. One link between respiratory infection and asthma may be the eosinophil, a cell that plays prominently in asthma and allergy, but can also be found in the body in response to infection. In turn, the eosinophil and its associated products may be novel therapeutic targets, or at the very least used to elucidate the complex pathophysiologic pathways of asthma and other respiratory illnesses. Together or separately, they can also be used for diagnosis, treatment and monitoring. The optimal care of a patient must take into consideration not only symptoms, but also the underlying disease mechanisms.
Asthma ; Bacteria ; Consensus ; Diagnosis ; Eosinophil-Derived Neurotoxin ; Eosinophilia ; Eosinophils ; Humans ; Hypersensitivity ; Respiratory Sounds

PURPOSE: Korean Academy of Pediatric Allergy and Respiratory Disease suggested Korea Guideline for Diagnosis and Management of Childhood Asthma(KGDMCA) in 1994 and updated it in 1999. This survey was performed to evaluate the practical efficacy of KGDMCA and to develop appropriate educational interventions of childhood asthma for the Korean Pediatricians. METHODS: One thousand and two hundreds pediatricians were chosen randomly from the address book of Korean Pediatric Society. A questionnaire consisted of 22 multiple choices about childhood asthma and personal data was mailed to each pediatrician. RESULTS: Two hundred and thirty-eight pediatricians(19.8%) completed and returned the questionnaires. History of recurrent wheezing(24.9%) and improvement of wheezing after using bronchodilator(13.1%) were considered as the most important factors for the asthma diagnosis. 65.1% of the respondents used inhaled bronchodilator for the treatment, and 64.0% of users thought it efficient. 46.3% of the respondents used the inhaled corticosteroid. The younger the respondents are, the more they use the inhaled corticosteroid and inhaled bronchodilator(P<0.01). 66.4% of the respondents was already aware of the KGDMCA. 20% of them followed KGDMCA and 72.0% of them used personal guidelines modified from KGDMCA. KGDMCA was significantly preferred in younger pediatricians(4-5th decades, P<0.01). CONCLUSION: Many Korean pediatricians used KGDMCA-modified personal guidelines, but older pediatricians were less familiar with KGDMCA. It is necessary to identify specific areas of misunderstanding about the diagnosis and treatment of asthma, and the continuous, eager education about KGDMCA must be emphasized.
Asthma* ; Diagnosis* ; Education ; Humans ; Hypersensitivity ; Korea ; Postal Service ; Surveys and Questionnaires ; Respiratory Sounds

Chronic cough is a common symptom and the etiology of which can be challenging to diagnose. The key to successful management is to establish a diagnosis and to treat the cause of cough. Asthma, gastro-esophageal reflux, and postnasal drip syndrome have been thought to be most common causes of chronic cough. Various causes such as lung diseases (sarcoidosis, pertussis), obstructive sleep apnea, drug (angiotensin-converting enzyme inhibitor), and psychological status can induce chronic cough. However, many chronic cough patients do not have an identifiable cause. We need to understand the mechanisms underlying central and peripheral sensitization, how they interact with cough triggers and their relationship with the sensations that drive the urge to cough, and the subsequent motor cough response in chronic cough. Heightened cough reflex sensitivity is persistent and their cough is unexplained in many patients. In most patients who visited otorhinolaryngoloy clinics, it is possible to manage a majority of chronic cough patients successfully using a protocol based on presenting symptoms and therapeutic trials for the common causes of cough. However, there are few therapeutic options for patients with unexplained chronic cough. There is a pressing need to understand the physiological basis of unexplained chronic cough and to develop novel antitussive drugs that down regulate cough reflex sensitivity.
Adult* ; Antitussive Agents ; Asthma ; Cough* ; Diagnosis ; Gastroesophageal Reflux ; Humans ; Lung Diseases ; Reflex ; Respiratory Hypersensitivity ; Sensation ; Sleep Apnea, Obstructive

PURPOSE: To observe sequential changes of acute and subacute hypersensitivity pneumonitis in high resolution CT and to correlate the findings with pulmonary function test and bronchoalveolar lavage. MATERIALS AND METHODS: This study includes 11 patients with pathologically (n=10) and clinically(n=1) proved acute and subacute hypersensitivity pneumonitis. The extent of ground glass attenuation and nodules on high resolution CT scan was correlated with pulmonary function test and bronchoalveolar lavage. We also evaluated serial changes of the lesion in high resolution CT scans. RESULTS: The extent of parenchymal abnormalities on high-resolution CT scans were significantly correlated with diffusing capacity (GGA & DLco:r=0.95, p<0.003, Nodule & DLco:r=-0.94, P<.005) and FEV1 (GGA & FEV1: r=-0.57, p<.05, Nodule & FEV1: r=-0.56, P<.05) on pulmonary function test and relatively correlated with total count of cells (GGA & total count of cells: r=0.86, P<.03, Nodule & total count of cells: r=0.71, p<0. 11) on bronchoalveolar lavage. The order in disappearance of abnormal findings were poorly defined centrilobular nodule, ground glass attenuation, and well defined small centrilobular nodule on sequential CT scans. CONCLUSION: The authors conclude that HRCT is useful for diagnosis and follow up evaluation of the acute and subacute hypersensitivity pneumonitis. Quantitative analysis of extent of disease on HRCT is useful for evaluation of clinical status.
Alveolitis, Extrinsic Allergic* ; Bronchoalveolar Lavage* ; Diagnosis ; Follow-Up Studies ; Glass ; Humans ; Hypersensitivity* ; Respiratory Function Tests* ; Tomography, X-Ray Computed

PURPOSE: Ciliary abnormalities of the respiratory system usually accompany recurrent or persistent respiratory diseases such as paranasal sinusitis, bronchiectasis, rhinitis, and/or otitis media, since they cause certain derangements in ciliary cleaning activities. This disease is usually inherited by autosomal recessive trait, but may also be found to be acquired or transient in rare cases after heavy exposure to pollutants, cigarette smoking or severe infection. We performed this study in children with frequently recurrent or persistent respiratory diseases to clarify if the ciliary abnormalities are preceding factors. METHODS: We enrolled 17 children with suspected respiratory ciliary abnormalities. The indications for evaluation of ciliary ultrastructure were recurrent or persistent respiratory infections. Children with immunologic abnormalities were excluded. From August 2000 to July 2003, we performed a biopsy on nasal mucosa and examined the structure of ciliary status by using an electron microscope. RESULTS: Of the subjects, there were seven males and 10 females, aged 2 to 10 years. Out of the 17 subjects, 12 cases of chronic paranasal sinusitis, nine chronic coughs, nine frequent upper respiratory infections, seven cases of recurrent otitis media, four cases of recurrent pneumonia, and four cases of bronchial asthma were found. Out of the 17 cases on which histologic examinations were conducted, four cases showed pathologic findings, including one case of inner dynein arm defect, one of microtubular transposition, one of supernumerous tubules, and one singlet, respectively. CONCLUSION: It is essential for differential diagnosis and effective treatment to identify the abnormalities of ultrastructure of nasal cilia in children with symptoms of frequently recurrent or persistent respiratory diseases, if immunodeficiency or respiratory allergy could be excluded.
Arm ; Asthma ; Biopsy ; Bronchiectasis ; Child* ; Cilia* ; Cough ; Diagnosis, Differential ; Dyneins ; Female ; Humans ; Hypersensitivity ; Male ; Nasal Mucosa ; Otitis Media ; Pneumonia ; Respiratory System ; Respiratory Tract Infections ; Rhinitis ; Sinusitis ; Smoking

PURPOSE: Cough variant asthma may be defined as a presentation of asthma that fulfills all the criteria of asthma, inflammatory process of the airways and airway hyperresponsiveness. Because of the cough is only the manifestation in cough variant asthma especially in children, it may be very difficult to assess by the physical examination and routine spirometry. Airway function may be further evaluated by bronchial provocation, usually with methacholine or exercise, to supprot or exclude the diagnosis of asthma. In children too young to perform pulmonary function tests, a therapeutic trial can serve as a diagnostic tool. In this study we evaluate the effectiveness of inhaled bronchodilator and corticosteroid treatment to the children with cough variant asthma. METHODS: Forth-eight children who visited to our pediatric allergy clinic having a chronic cough more than 3 weeks were enrolled to our study. We defined a children who showed bronchial hyperresponsiveness after exercise challenge as a cough variant asthma. We analyzed the changes of PEFR before and after exercise and treatment for 4 weeks. RESULTS: 1) All the patients with cough variant asthma or sinobronchitis have a night aggravating cough as a sole manifestation. 2) The baseline % predicted PEFR showed within normal range in the study subjects. But there was significant decrease of % perdicted PEFR after execise challenge in the patients with cough variant asthma. 3) There was significant increase of % predicted PEFR after treatment with inhaled bronchodilator and corticosteroid in the patients with cough vatiant asthma. Also it is noted in the patients with sinobronchitis treated with antibiotics. CONCLUSION: We can find significant improvement of clinical manifestation and pulmonary function in the patients with cough variant asthma who treated with inhaled bronchodilator and corticosteoid. Because of many children suffering from chronic cough may have a cough variant asthma, we emphasized that inhaled bron-chodilator and corticosteroid treatment is effective for long-term control of cough variant asthma.
Anti-Bacterial Agents ; Asthma* ; Child ; Cough* ; Diagnosis ; Humans ; Hypersensitivity ; Inhalation* ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Physical Examination ; Reference Values ; Respiratory Function Tests ; Respiratory Therapy* ; Spirometry