BACKGROUND: Test for Respiratory and Asthma Control in Kids (TRACK) questionnaires were developed and validated in various languages to monitor respiratory control in preschool-aged children. We aimed to assess the reliability and validity of the Korean version of the TRACK questionnaire. METHODS: We administered the linguistically validated TRACK questionnaires to caregivers of asthmatic preschool children on two separate visits 4–6 weeks apart. Each physician graded the level of the guideline-based asthma control, assessed the timing of symptoms, and adjusted the therapeutic level at each visit. RESULTS: A total of 137 children were enrolled in the study. Cronbach's alpha was 0.65 for a questionnaire as a whole. The test-retest reliability was 0.72. The median TRACK scores were significantly different between asthma control status categories, with the lowest scores in children classified as poorly controlled and the highest in the well-controlled group (P < 0.001). They were different among groups classified according to the physician adjusted therapeutic levels, with the lowest values in children prescribed step-up therapy (P < 0.001), and according to the recency of respiratory symptoms (P < 0.001). Finally, the changes in TRACK scores between visits were highest in subjects showing improved control, followed by unchanged, and worsened control. When we applied the traditional cut-off of 80 for a well-controlled condition, a sensitivity of 75.6% and a specificity of 70.9% were calculated. CONCLUSION: The Korean translated version of the TRACK questionnaire is valid and reliable to assess respiratory and asthma control in Korean preschool children with asthma symptoms.
Asthma* ; Caregivers ; Child ; Child, Preschool ; Humans ; Reproducibility of Results* ; Sensitivity and Specificity

PURPOSE: Adherence is a major component of successful medical treatment. However, non-adherence remains a barrier to effective delivery of healthcare worldwide. METHODS: Twenty healthcare facilities (secondary or tertiary hospitals) belonging to the Korean Academy of Pediatric Allergy and Respiratory Diseases (KAPARD) participated. Questionnaires were given to patients currently receiving treatment in the form of inhalant useor oral intake or transdermal patch for mild to moderate asthma. RESULTS: A total of 1,838 patients responded to the questionnaire. Mean age was 5.98 ± 3.79 years (range: 0-18 years). With help from their caregivers, the percentage of patients that answered “taking as prescribed” was 38.04% for inhalant users, 50.09% for oral medication users and 67.42% for transdermal users. Transdermal patch users had significantly greater adherence compared to the other 2 groups (P < 0.001). The 34.15% of inhalant users, 70.33% of oral medication users and 93.00% of transdermal patch users felt that their medication delivery system was “Easy” or “Very easy” to use (P < 0.001). “Method of administration” was deemed to be the most difficult part of the treatment regimen to follow, and 76.7% of patients preferred once-daily administration (i.e., “Frequency of administration”). CONCLUSIONS: Asthma medication adherence in young children was found to be better in the transdermal patch group. This may be due to requiring fewer doses and easy to follow instructions. From an adherence point of view, the transdermal patch seems more useful for long-term asthma control in children compared to oral or inhaled medicine.
Asthma ; Caregivers ; Child ; Delivery of Health Care ; Humans ; Hypersensitivity ; Korea ; Medication Adherence ; Transdermal Patch

PURPOSE: Prenatal maternal stress affects offspring's atopic dermatitis (AD) development, which is thought to be mediated by the oxidative stress. We aimed to evaluate the difference in leukocyte telomere length (LTL), a marker for exposure to oxidative stress, according to the prenatal stress exposure and the later AD development. METHODS: From a birth cohort (the COhort for Childhood Origin of Asthma and allergic diseases) that had displayed a good epidemiologic association between the exposure to prenatal stress and AD development in the offspring, we selected 68 pairs of samples from 4 subject groups based on the level of prenatal maternal stress and later AD development. The LTL was measured from both cord blood and 1-year peripheral blood, and their LTLs were compared between subject groups. Finally, the proportion of AD development was examined in the subject groups that are reclassified based on subjects' exposure to prenatal stress and there LTL. RESULTS: Cord-blood LTL was shorter in prenatally stressed infants than in unstressed ones (P = 0.026), which difference was still significant when subjects became 1 year old (P = 0.008). LTL of cord blood, as well as one of the 1-year peripheral blood, was not different according to later AD development at 1 year (P = 0.915 and 0.174, respectively). Shorter LTL made no increase in the proportion of later AD development in either prenatally high-stressed or low-stressed groups (P = 1.000 and 0.473, respectively). CONCLUSIONS: Cord-blood LTL may reflect subjects' exposure to maternal prenatal stress. However, the LTL shortening is not a risk factor of increasing AD development until the age of 1, and a longer investigation may be necessary for validation. Currently, the results doubt the role of LTL shortening as a marker for risk assessment tool for the prenatal stress associated with AD development in the offspring.
Asthma ; Child ; Cohort Studies ; Dermatitis, Atopic ; Fetal Blood ; Humans ; Infant ; Leukocytes ; Oxidative Stress ; Parturition ; Risk Assessment ; Risk Factors ; Stress, Psychological ; Telomere Shortening ; Telomere

PURPOSE: We aimed to translate the Test for Respiratory and Asthma Control in Kids (TRACK) instrument into Korean, with subsequent linguistic validation. METHODS: The multistep process of forward translation, reconciliation, back-translation, cognitive debriefing, and proofreading of the Korean version of the TRACK was completed. RESULTS: Two bilingual medical personnel independently translated the original English version of the TRACK into Korean one. After moderating the translation into a single reconciled one, 4 other bilingual persons were invited to translate the Korean draft back into an English one. Discrepancies between the original English version and the back-translated one were reviewed, and the need to modify the reconciled Korean draft was discussed. Twenty caregivers of asthmatic children took part in interviews that examine the appropriateness of the Korean version of the TRACK. The feedback from caregivers were then reviewed by a panel of pediatric allergists and reflected in the final Korean version. The document was finally proofread to check the spelling, grammar, layout and formatting. CONCLUSION: Translation and linguistic validation of the Korean version of the TRACK instrument were completed.
Asthma* ; Caregivers ; Child ; Humans ; Linguistics* ; Translations

PURPOSE: We investigated the prevalence of bronchial hyperresponsiveness (BHR) and its associated factors in population-based elementary school children. METHODS: Methacholine bronchial provocation tests were performed on 1,151 elementary school children and BHR was defined as PC20 (provocative concentration of methacholine causing a 20% fall in forced expiratory volume in 1 second [FEV1]) < or =8 mg/mL. We analyzed the prevalence of BHR according to age and sex. The Korean version of International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, skin prick test, pulmonary function test, and blood tests were performed to determine associated factors for BHR. RESULTS: A total of 1,106 students eligible for provocation tests were included in the analysis. The overall prevalence of PC20 < or =8 mg/mL was 11.5% (95% confidence interval, 10.6-13.4) and BHR decreased with age (P-value for trend <0.001). Younger age (adjusted odds ratio [aOR], 0.860; P=0.032), higher blood eosinophil % (aOR, 1.151; P=0.001), lower predictive % of FEV1 (aOR, 0.977; P=0.029), fraction of exhaled nitric oxide (FeNO) > or =25 ppb (aOR, 2.118; P=0.025), and sensitization to mites (aOR, 1.705; P=0.034) were associated with BHR. Preterm birth (aOR, 2.056; P=0.068) showed borderline significance. The associated factors for BHR with atopy were lower body mass index (aOR, 0.838; P=0.005), preterm birth (aOR, 4.361; P=0.003), and FeNO > or =25 ppb (aOR, 2.161; P=0.043). Younger age (aOR, 0.810; P=0.037) and higher blood eosinophil % (aOR, 1.296; P<0.001) were associated with BHR without atopy. CONCLUSION: The prevalence of BHR decreased with age in elementary school children. Younger age, preterm birth, eosinophilia, sensitization to mites, lower lung function, and higher FeNO level were independently associated with BHR.
Asthma ; Body Mass Index ; Bronchial Hyperreactivity ; Bronchial Provocation Tests ; Child* ; Eosinophilia ; Eosinophils ; Forced Expiratory Volume ; Hematologic Tests ; Humans ; Hypersensitivity ; Lung ; Methacholine Chloride ; Mites ; Nitric Oxide ; Odds Ratio ; Premature Birth ; Prevalence* ; Respiratory Function Tests ; Skin ; Surveys and Questionnaires

Asthma is not a homogeneous disease presenting variable clinical features, but a complex disorder consisting of many different disease entities characterized by variable air-flow limitation. To date, there are little effective preventive-strategies for the development of asthma, and it has been emphasized that early identification and intervention are the best ways to reduce the associated morbidities, quality of life, and socioeconomic burden. Predicting the natural course of asthma is still difficult, although various phenotypic approaches and predictive scores are developed and widely used. The present phenotypes and predictive scores may be reliable in the population, but those appear to be unreliable in each individual in real practice. Either undertreatment or overtreatment in childhood asthma is an important issue, because they are associated with poor compliance, increments of socioeconomic burdens, and poor quality of life. There is no doubt about the clinical efficacy of inhaled corticosteroid (ICS) in childhood asthma, but the negative effect of long-term use of ICS on the height is emerging. Therefore general physicians should consider an individualized management using specific phenotypes and endotypes, and regularly re-evaluate the drug-response, level of control, and adherence/compliance to avoid inadequate treatment.
Asthma* ; Child ; Compliance ; Humans ; Phenotype* ; Quality of Life

BACKGROUND: The aims of this study were to compare the cytomorphologic features diagnostic of atypical squamous cells (ASC) in liquid-based preparations (LBPs) and conventional Pap (CP) smears and to cytomorphologically assess the performance of the Cell Scan 1500(TM) in cervical cytology practice. METHODS: Cervicovaginal smears were obtained from 938 women. Two smears were obtained simultaneously from each individual, one for an LBP and the other for a CP smear; the smears were independently examined. ASC was diagnosed in 24 patients, and their samples were cytomorphologically and semiquantitatively analyzed. RESULTS: A total of 24 of the 938 women (2.6%) were diagnosed with ASC by one or both methods. Results from LBPs and CP smears were in agreement in 13 of 24 cases of ASC diagnosis (absolute direct agreement, 54.2%; k<0.20; p-value from chi-square test=0.085). Diagnostic features of ASC in the LBPs included squamous cell atypia and atypical squamous metaplasia. CONCLUSIONS: The cellular features diagnostic of ASC present in one preparation can manifest themselves differently in the other. Changes in individual cells, particularly nuclear changes, are the most reliable features for diagnosing ASC. The Cell Scan 1500(TM) processor is more effective at detecting ASC than are CP smears.
Female ; Humans

PURPOSE: Although CD30 is known to be expressed more on eosinophils undergoing apoptosis, it is still not known how CD30 activation leads to eosinophil apoptosis. In this study, we evaluated whether ligation of CD30 incites apoptosis and investigated whether the mechanisms of CD30 induced eosinophil apoptosis are dependent on caspase activation. METHODS: We drew 90 mL of peripheral blood from healthy donors and then purified eosinophils using a MACS system. Expression of CD30 on eosinophils was measured, and eosinophils were cultured in wells pretreated with anti-CD30 mAb, isotype control immunoglobulin G1, interleukin (IL)-5, and dexamethasone in Roswell Park Memorial Institute 1640 media supplemented with 10% fetal bovine serum. Their rates of apoptosis were then compared using flow cytometry. To evaluate whether caspase-9 is involved in CD30-induced eosinophil apoptosis, the apoptotic rate was evaluated after the addition of caspase-9 inhibitor. The expression of procaspase-9 was also measured using Western blot. RESULTS: Expression of CD30 molecules on eosinophils increased steadily as the culture time lapse. The apoptotic rates of eosinophils cultured in the presence of anti-CD30 mAb were significantly increased to 29.1+/-6.1% and 47.3+/-4.7% compared to 17.1+/-6.7% and 29.4+/-9.2% of the control at 4 and 24 hours, respectively (both P<0.05). The apoptotic rates of eosinophils treated with anti-CD30 mAb were even faster than those of eosinophils treated with dexamethasone, and the mAb also suppressed the IL-5-induced enhancing effect of eosinophil survival. Caspase-9 inhibitor suppressed mAb induced eosinophil apoptosis from 54.8+/-6.9% and 71.5+/-11.6% to 24.5+/-6.0% and 47.8+/-11.4% at 18 and 36 hours, respectively (both P<0.001). We also demonstrated that the expression of procaspase-9 with mAb was diminished compared to that of the control and of IL-5. CONCLUSION: This study showed CD30 activation enhances eosinophil apoptosis, and the effect is mediated by caspase-9 activation.
Apoptosis ; Caspase 9 ; Dexamethasone ; Eosinophils ; Flow Cytometry ; Humans ; Immunoglobulins ; Interleukins ; Ligation ; Tissue Donors

Cystic fibrosis (CF) is an autosomal recessive disease that is very rare in Asians: only a few cases have been reported in Korea. We treated a female infant with CF who had steatorrhea and failure to thrive. Her sweat chloride concentration was 102.0 mM/L. Genetic analysis identified two novel mutations including a splice site mutation (c.1766+2T>C) and a frameshift mutation (c.3908dupA; Asn1303LysfsX6). Pancreatic enzyme replacement and fat-soluble vitamin supplementation enabled the patient to get a catch-up growth. This is the first report of a Korean patient with CF demonstrating pancreatic insufficiency. CF should therefore be considered in the differential diagnosis of infants with steatorrhea and failure to thrive.
Alternative Splicing ; Base Sequence ; Cystic Fibrosis/complications/diagnosis/*genetics ; Cystic Fibrosis Transmembrane Conductance Regulator/*genetics ; Diagnosis, Differential ; Exocrine Pancreatic Insufficiency/complications/diagnosis/*genetics ; Female ; Frameshift Mutation ; Humans ; Infant ; Republic of Korea ; Steatorrhea/diagnosis

To validate the prevalence rate of symptoms of asthma produced by the phase I ISAAC (International Study of Asthma and Allergies in Childhood) study, hypertonic saline challenge test was carried out during the phase II study at a year after the phase I study. For the phase II study, six middle schools from three cities in the phase I study were selected. Finally, 499 children who responded to both studies were analyzed. All subjects were asked to complete the written questionnaire (WQ) first, followed by a video questionnaire (AVQ 3.0) during the phase I study. Of the 499 children, only 19 (3.8%) were positive to the hypertonic saline bronchial challenge test. The degree of agreement between responses to the two corresponding questions "wheezing at rest" and "nocturnal wheeze" in the AVQ 3.0 and WQ were moderate and weak with a Kappa indices of 0.45 and 0.23, respectively. The question on "severe wheeze" in the AVQ 3.0 had the highest Youden's index among the five questions related to asthma symptoms in the previous 12 months, but its specificity was low whereas it 's sensitivity was 1.0. There was no consistency of priority between the two questionnaires in predicting bronchial hyperreactivity in a group of Korean schoolchildren. Therefore we need to develop more appropriate WQ or AVQ to compare the prevalences of asthma to other countries.
Adolescent ; Asthma/diagnosis* ; Asthma/epidemiology ; Asthma/etiology ; Bronchial Hyperreactivity/complications ; Bronchial Hyperreactivity/diagnosis* ; Bronchial Hyperreactivity/epidemiology ; Bronchial Provocation Tests ; Comparative Study ; Female ; Human ; Korea/epidemiology ; Language ; Male ; Prevalence ; Questionnaires* ; Random Allocation ; Respiratory Sounds ; Saline Solution, Hypertonic/diagnostic use ; Sampling Studies ; Videotape Recording ; Writing