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The Relationship between Wheezing during Methacholine Bronchial Challenge and the Severity of Acute Asthma Exacerbation in Asthmatic Children.

Wook NAMKOONG ; Dong Hyun KIM ; Woo Sik JUNG ; Jong Hoon KWAK ; Dae Hyun LIM ; Jeong Hee KIM ; Byong Kwan SON

Pediatric Allergy and Respiratory Disease.2009;19(1):28-37.

PURPOSE:Global Initiatives for Asthma (GINA guideline) 2005 suggests that the pitch and intensity of wheezing as the determinating factor for the severity of asthma exacerbation. However, there have not yet been sufficient data to support the correlation between wheezing and the severity of asthma exacerbation. This study was aimed to estimate the relationship between wheezing threshold and the level of forced expiratory volume in 1 second (FEV1). METHODS:Among 370 pediatric patients who visited Inha University Hospital between May 2005 and June 2006, who underwent the methacholine bronchial challenge tests in order to diagnose asthma, 228 patients with PC20 less than 16 mg/mL were examined. Medical history, physical examination, skin prick test, eosinophil count and total IgE level in peripheral blood, and nasal smear for eosinophil count were performed. RESULTS:Among the 228 patients 127 (55.7%) showed wheezing during the methacholine challenge test. Among the patient with wheezing 82 patients (36%) showed more than 20% fall of FEV1, and the other, 45 patients (19.7%), showed less than 20% FEV1%fall. One hundred one patients (43.3 %) did not show any wheezing until the %fall of FEV1 was below 20%. The geometric mean (range of 1SD) [2.29 (0.86-6.13) mg/mL] of methacholine PC20 of the 127 patients with wheezing was significantly lower than that [4.11 (1.82-9.24) mg/mL] of the 101 patients without wheezing (P<0.001). The geometric mean (range of 1SD) of methacholine PC20 in the 143 patients with positive skin prick test results was 2.57 (0.97-6.81) mg/mL, which was significantly lower than that of the 37 patients with negative results [3.69 (1.57-8.66) mg/mL] (P<0.001). CONCLUSION:We could learn that most wheezing patients showed more than 20% fall of FEV1. Therefore, it is suggested that the asthmatic children with wheezing were regarded and treated as moderate or more severe state
Asthma ; Bronchial Provocation Tests ; Child ; Eosinophils ; Forced Expiratory Volume ; Humans ; Immunoglobulin E ; Methacholine Chloride ; Physical Examination ; Respiratory Sounds ; Skin

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Usefulness of Percutaneous Oxygen Saturation Monitoring as a Predictor of Deterioration of Lung Function in Korean Children with Asthma.

Sung Woo PARK ; Dong Hyun KIM ; Shin young PARK ; Woo Sik JEONG ; Jong Hoon KWAK ; Jeong Hee KIM ; Dae Hyun LIM ; Byung Kwan SON

Pediatric Allergy and Respiratory Disease.2009;19(1):20-27.

PURPOSE:Our study was designed to verify the correlation between the level of percutaneous arterial oxygen saturation (SpO2) and forced expiratory volume in 1 second (FEV1) and to classify the severity according to SpO2 level when asthma exacerbation is developed. METHODS:We performed the methacholine bronchial provocation tests with monitoring SpO2 on 350 children who visited the pediatric allergy clinic with chronic cough or recurrent wheezing from August 2006 to August 2008. RESULTS:There was a significant correlation between FEV1%fall and SpO2 (r=-0.814, P< 0.01). The mean value of SpO2 was 95.80%+/-1.2% when decrement of FEV1 was 20%. It was 92.3%+/-0.81% when FEV1 decreased by 40%. CONCLUSION:Monitoring SpO2 is a convenient and reliable objective method to determine an appropriate therapeutic option when the pulmonary function test or arteial blood gas analysis is not available in children with asthma. We suggest less than 96% of SpO2 for the moderate attack, less than 92% for the severe attack, as the criteria for the severity of asthma exacerbations in Korea, which is higher than those suggested by GINA guideline or Japanese guidelines.
Asian Continental Ancestry Group ; Asthma ; Blood Gas Analysis ; Bronchial Provocation Tests ; Child ; Cough ; Forced Expiratory Volume ; Humans ; Hypersensitivity ; Korea ; Lung ; Methacholine Chloride ; Oxygen ; Respiratory Function Tests ; Respiratory Sounds

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Clinical Features of Human Metapneumovirus and Respiratory Syncytial Virus Infection in Hospitalized Children.

Yu Kyung KIM ; Jin Woo KIM ; Young Sun WEE ; Eun Gyong YOO ; Man Yong HAN

Pediatric Allergy and Respiratory Disease.2009;19(1):12-19.

PURPOSE:To identify the clinical features of human metapneumovirus (hMPV) and the respiratory syncytial virus (RSV) infection in children. METHODS:The participants of our study were 1,104 children who were admitted to Bungdang CHA hospital for lower respiratory infection from August 2006 through July 2007. Nasopharyngeal swabs were taken from the patients, and viruses were identified by RT-PCR. The clinical features of 51 patients with hMPV infection and 138 patients with RSV infection were compared by retrospective review of their medical records. RESULTS:The peak incidence of hMPV infection was noted in April, and that of RSV was noted in November. Both viruses had the highest incidence in patients age <1 year and hMPV infections occurred in 40% and 25% of patients age <6 months, respectively. In the hMPV group, 33.4% of the patients were age > or =2 years, while in the RSV group, 19% were age > or =2 years. In both groups, pneumonia was the most common clinical diagnosis, followed by acute bronchiolitis, acute bronchitis, and asthma. The white blood cell counts were higher in the RSV group, and fever was more frequent on admission in the hMPV group. CONCLUSION:hMPV was the fourth most common virus causing lower respiratory tract infections in children. The clinical features of hMPV infection were similar to those of RSV infection. This study may be helpful for the effective treatment of lower respiratory tract infection in children.
Asthma ; Bronchiolitis ; Bronchitis ; Child ; Fever ; Humans ; Incidence ; Leukocyte Count ; Metapneumovirus ; Pneumonia ; Respiratory Syncytial Viruses ; Respiratory Tract Infections ; Retrospective Studies ; Viruses

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The Association between the Concentration of Pollen and Outbreak of Pollinosis in Childhood.

Jae Won OH ; Im Ju KANG ; Sung Won KIM ; Myung Hee KOOK ; Bong Seong KIM ; Jee Tae CHEONG ; Ha Baik LEE

Pediatric Allergy and Respiratory Disease.2009;19(1):4-11.

Pollinosis is one of the allergic diseases which caused by airborne pollens from allergic plants, such as allergic rhinitis, asthma, and allergic conjunctivitis. The distribution of pollens in the air is fully related to weather condition, especially temperature and humidity, etc. This study is focused on the evaluation of the relation between pollen count and the outbreak of allergic diseases (symptom index) from allergic patients in Korea and this data would be necessary to evaluate Korean own allergy index for pollen forecasting system. Airborne particles carrying allergens were collected daily from nationwide 8 stations (Seoul, Guri, Daejeon, Daegu, Kwangju, Busan, Kangneung, and Jeju) by using 7 days-Burkard sampler (Burkard Manufacturing Co Ltd, Hertfordshire, UK) for 10 year in South Korea (March 1, 2008-October 30, 2008). They were counted and recorded along with the weather factors. Symptom index was evaluated and recorded by calling to allergic patients daily. Airborne pollen has two peak seasons that is May and September in Korea. The peak season for mold was June. There was the tree pollen seasons from the middle of February to late July, then followed during the grasses and weed season from the middle of July to the end of October. Ragweed was one of the most common pollen of autumn in Korea. In skin prick test, Ragweed was the highest sensitization rate (5.9%), followed by Mugwort (5.8%), alder (4.9%), birch (4.8%), oak grasses among the pollen extracts in Korean school aged children. Ragweed pollen counts were gradually increased since 2000. In same period, sensitization rates for airborne pollen, especially weeds in Korean children were increased annually (1999: 4.4%, 2000: 7.1%, 2001: 7.4%, 2002: 8.5%, 2003: 7.7%). There are significantly related between symptom index from allergic patients and allergic pollen concentrations. Sensitization rates for pollens are increased in Korean children with age. There are significantly related between symptom index from allergic patients and allergic pollen concentrations. Risk Grade of pollen for allergy pollen forecast among each allergic plant was established and still remain to confirm it.
Aged ; Allergens ; Alnus ; Ambrosia ; Antigens, Plant ; Artemisia ; Asthma ; Betula ; Child ; Conjunctivitis, Allergic ; Forecasting ; Fungi ; Humans ; Humidity ; Hypersensitivity ; Korea ; Lifting ; Plant Extracts ; Plants ; Poaceae ; Pollen ; Republic of Korea ; Rhinitis ; Rhinitis, Allergic, Perennial ; Rhinitis, Allergic, Seasonal ; Seasons ; Skin ; Weather

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Usefulness of Percutaneous Oxygen Saturation Monitoring as a Predictor of Deterioration of Lung Function in Korean Children with Asthma.

Hai Lee CHUNG

Pediatric Allergy and Respiratory Disease.2009;19(1):1-3.

No abstract available.
Child ; Humans ; Lung ; Oxygen

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IL-4, IFN-gamma, IL-5, IL-12 Production by Peripheral Blood Mononuclear Cells of Moderate Atopic Asthma and Its Relation with Clinical Findings.

Hae Sook KIM ; Eun Mi JUNG ; Moon Sun SHIN ; Do Young SONG ; Im Ju KANG

Pediatric Allergy and Respiratory Disease.2002;12(2):126-135.

PURPOSE: Activation of T helper(Th) cells and secretion of cytokines play a pivotal role in the pathogenesis of asthma. Th2 cells secrete IL-4 and IL-5. IL-4 stimulates IgE production and IL-5 is related with hematopoiesis, chemotaxis and activation of eosinophils. IFN-gamma produced by Th1 cells and IL-12 produced by antigen presenting cells have an inhibitory action on IgE production. We examined the cytokine production by peripheral blood mononuclear cells(PBMCs) of atopic asthmatic children and its relation with clinical findings. METHODS: We measured IL-4, IFN-gamma, IL-5, IL-12 in serum and supernatants of stimulated PBMCs cultures in 32 children with moderate stable asthma and 17 healthy controls. They were compared with number of skin test positive allergens, serum total IgE, peak expiratory flow rate(PEFR), methacholine PD20, sputum eosinophils and eosinophil cationic protein(ECP). RESULTS: No difference in serum cytokines was found between patients and controls, except IL-5. In supernatants of stimulated PBMCs cultures, the concentration of IL-4, IL-5 was significantly increased and IFN-gamma, IL-12 was significantly decreased in patients compared with controls. IL-4 was related with total serum IgE and numbers of skin test positive allergens. IL-5 was related with sputum eosinophils and ECP. The serum total IgE was inversely and PEFR was directly related with IFN-gamma. CONCLUSION: In atopic asthmatics, Th1 cytokines were increased and Th2 were decreased in stimulated PBMCs cultures. IL-4 was related with atopy, IFN-gamma with lung function and IL-5 with airway inflammation.
Allergens ; Antigen-Presenting Cells ; Asthma* ; Chemotaxis ; Child ; Cytokines ; Eosinophils ; Hematopoiesis ; Humans ; Immunoglobulin E ; Inflammation ; Interleukin-12* ; Interleukin-4* ; Interleukin-5* ; Lung ; Methacholine Chloride ; Peak Expiratory Flow Rate ; Skin Tests ; Sputum ; Th1 Cells ; Th2 Cells

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Analysis of Antigen-induced Pulmonary Morphologic Changes in Sensitized Rats.

Sung Won KIM ; Mi Young SUL

Pediatric Allergy and Respiratory Disease.2002;12(2):114-125.

PURPOSE: Challenge of asthmatic patients by means of inhalation of allergens may produce both an early and a late asthmatic reaction. This Study was designed to understand th late-phase asthmatic reaction animal models of asthma and to using facilitate basic pathophysiologic research relevant to this clinical disorder. METHODS: We examined light microscopic and transmission electron microscopic pulmonary morphology of experirnentally allergen-induced asthmatic model of Sprague-Dowley rat to get more precise and time-ordered morphologic changes. The animals were sensitized and induced by ovalbumin with aluminum hydroxide and Pertussis vaccine as adjuvants. RESULTS: The morphologic changes of early reaction were identified in the group sacrificed at 15 minute after induction. The major change was noted in bronchial epithelium revealed as cytologic vacuolization and desquamation into the lumina. There were no identifiable changes in bronchial smooth muscle and no increased infiltration of eosinophils in the lung. The late reaction was identified in the group sacrificed at 4 hours after induction. The major changes were increased infiltration of eosinophils in the bronchial and bronchiolar mucosa and submucosa, increased deposition of collagen beneath the bronchial subepithelial basement membrane, and morphologic changes of bronchial smooth muscle layer. The thickness of the bronchial smooth muscle layer were increased and the smooth muscle cell showed nuclear contraction, increased numbers of mitochondria near the nuclei, irregular distribution of actin filaments in the cytoplasm and focal ballooning of the cytoplasm. Smooth muscle was the most pronounced in the group sacrificed 1 week after induction. The group of sensitization only revealed no identifiable morphologic changes compared with the control group. The group of induction only showed increased infiltration of eosinophils and increased numbers of perinuclear mitochondria in smooth muscle cells, and which features were similar but milder than sensitization and induction group. CONCLUSION: This study will help us to understand time-ordered precise histologic changes of allergic airway inflammation.
Actin Cytoskeleton ; Allergens ; Aluminum Hydroxide ; Animals ; Asthma ; Basement Membrane ; Collagen ; Cytoplasm ; Eosinophils ; Epithelium ; Humans ; Inflammation ; Inhalation ; Lung ; Mitochondria ; Models, Animal ; Mucous Membrane ; Muscle, Smooth ; Myocytes, Smooth Muscle ; Ovalbumin ; Pertussis Vaccine ; Rats*

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Lung Function Reference Values in Healthy Korean Children.

Dai Jin SONG ; Young Na HAN ; Jang Hoon LEE ; Hyung Jin KIM ; Jee Youn LIM ; Dae Hun PEE ; Jae Kyun YOON ; Ji Tae CHOUNG

Pediatric Allergy and Respiratory Disease.2002;12(2):105-113.

PURPOSE: Appropriate reference values are needed for assessment of pulmonary function during childhood. We performed pulmonary function test with simple computerized spirometry to establish reference values of air flow rates in healthy Korean children. METHODS: We examined 1,317 children aged 6 to 15 years at their schools by standardized method during May, 2001. The children with poor cooperation, respiratory symptom, and chronic disease were excluded. Regression analysis was applied for FVC, FEV1, PEF, FEF25-75% predicted from sex, age, standing height, weight, and body surface area. RESULTS: In 1,317 children(Male : 716, Female : 601), the distribution of height was from 106.7 cm to 173.5 cm, weight was from 16.5 kg to 75.5 kg. We could get regression equations and determinant coefficients between anthropometric parameters and air flow rates. In both sexes, height showed very close correlation with lung function variables, and FEV1 showed very close correlation with all anthropometric parameters. Reference values of pulmonary function test were generally higher in boys than in girls. CONCLUSION: After performing the pulmonary function test in healthy Korean children, we report their normal values of air flow rates and regression equations for the predicted values. Among anthropometric parameters, height showed most close correlation with lung function variables in both sexes.
Body Surface Area ; Child* ; Chronic Disease ; Female ; Humans ; Lung* ; Reference Values* ; Respiratory Function Tests ; Spirometry

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Modulation of Eosinophilia and Cytokines of Bronchoalveolar Larvage Fluid(BALF) by CpG Oligodeoxynucleotides(ODN) in a Mouse Model of Established Airway Inflammation.

Ji Sun MOK ; Sung Min CHOI

Pediatric Allergy and Respiratory Disease.2002;12(2):93-104.

PURPOSE: Asthma is an inflammatory disease of the airways that is induced by Th2 cytokines and inhibited by Th1 cytokines. Oligodeoxynucleotides containing a CpG motif(CpG ODN), as potent inducers of Th1 immunity, are considered promising candidates for immune modulation in asthma. In this study we wanted to investigate the effect of CpG ODN on eosinophilia and cytokines of BALF in a mouse model established airway inflammation and the optimal route(systemic vs mucosal) of CpG ODN. We examined the difference of immunologic responses between CpG ODN and corticosteroids. METHODS: Female BALB/c mice, induced pulmonary allergic inflammation, were treated intranasally or intraperitoneally with CpG ODN and Dexamethasone. Allergen-specific antibody responses, cytokines(IL-4, IL-5, IL-12), and eosinophilic inflammation of the airways were investigated on BALF and splenocyte. RESULTS: CpG ODN effectively induced IL-12 and inhibited IL-4 and IL-5 as well as eosinophilic inflammation when CpG ODN was administered intranasally or intraperitoneally with allergen challenge. Therapy with corticosteroides, while effective inhibiting IL-5 generation, did not induced IL-12 in BALF. CONCLUSION: Systemic or mucosal administration of CpG ODN effectively stimulated the production of Th1 cytokines and suppressed eosinophilic airway inflammation in contrast of corticosteroids and control ODN. Thus, CpG ODN vaccination is a potentially useful approach for immunomodulation of established airway inflammation in a mouse model of asthma.
Administration, Mucosal ; Adrenal Cortex Hormones ; Animals ; Antibody Formation ; Asthma ; Cytokines* ; Dexamethasone ; Eosinophilia* ; Eosinophils ; Female ; Humans ; Immunomodulation ; Inflammation* ; Interleukin-12 ; Interleukin-4 ; Interleukin-5 ; Mice* ; Oligodeoxyribonucleotides ; Vaccination

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A 10 Year Follow-up of Childhood Asthma: Potential Risk Factors on Persistence of Nonspecific Bronchial Hyperresponsiveness.

Eun Mi JUNG ; Hae Sook KIM ; Im Ju KANG

Pediatric Allergy and Respiratory Disease.2002;12(2):82-92.

PURPOSE: We studied the change of bronchial hyperresponsiveness(BHR) from childhood to early adulthood and to know the risk factors which influence on the persistence of BHR. METHODS: Seventy two atopic asthma children with nonspecific BHR to methacholine were observed for about 10 years, longitudinally. They were divided into 3 groups depend on the degree of BHR; no BHR group(A group), asymptomatic BHR group(B group), symptomatic BHR group(C group) and compared clinical and atopic findings, inflammation degree of airway, and environmental factors between the groups. RESULTS: In the group A, B, C, the number of subjects were, respectively, 15(20.8%), 19 (26.4%), 38(52.8%). The frequency of group C was higher in the subjects with more severe asthma symptoms and higher BHR at diagnosis. The positive rates of skin prick test to Dp, Df, and pets, serum total IgE, sputum eosinophils, sputum ECP at the time of follow-up were significantly higher in group C. The frequency of subjects with carpets/sofa/bed, pets at home and smokers at the time of follow-up were higher in group B, C. CONCLUSION: Significant number of childhood asthma showed persistent nonspecific BHR in early adulthood. The persistence of nonspecific BHR in early adulthood was related with severity of asthma at diagnosis, laboratory findings and environmental factors at follow up.
Asthma* ; Child ; Clinical Laboratory Techniques ; Diagnosis ; Eosinophils ; Follow-Up Studies* ; Humans ; Immunoglobulin E ; Inflammation ; Methacholine Chloride ; Risk Factors* ; Skin ; Sputum

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