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: 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: There is currently no information regarding predisposing factors for chronic and recurrent rhinosinusitis (RS), although these are considered to be multifactorial in origin, and allergic diseases contribute to their pathogenesis. We evaluated the predisposing factors that may be associated with chronic and recurrent RS. METHODS: In this prospective study, we examined patients with RS younger than 13 years of age, diagnosed with RS at six tertiary referral hospitals in Korea between October and December, 2006. Demographic and clinical data related to RS were recorded and analyzed. RESULTS: In total, 296 patients were recruited. Acute RS was the most frequent type: 56.4% of the patients had acute RS. The prevalences of other types of RS, in descending order, were chronic RS (18.9%), subacute RS (13.2%), and recurrent RS (11.5%). Factors associated with recurrent RS were similar to those of chronic RS. Patients with chronic and recurrent RS were significantly older than those with acute and subacute RS. The prevalences of allergic rhinitis, atopy, and asthma were significantly higher in patients with chronic and recurrent RS than those with acute and subacute RS. CONCLUSIONS: An association between atopy and chronic/recurrent RS, compared to acute and subacute RS, suggests a possible causal link.
Aluminum Hydroxide ; Asthma ; Carbonates ; Child ; Humans ; Korea ; Prevalence ; Prospective Studies ; Rhinitis ; Rhinitis, Allergic, Perennial ; Tertiary Care Centers

Primary ciliary dyskinesia is characterized by chronic upper and lower respiratory infections which are caused by the grossly impaired ciliary transport. Since the cilia and neutrophils both utilize microtubular system for their movement, it has been speculated that neutrophil motility such as chemotaxis might be impaired in patients with primary ciliary dyskinesia. Neutrophils were purified from whole blood from 16 patients with primary ciliary dyskinesia and from 15 healthy controls. Chemotactic responses of neutrophils to leukotriene B4 (LTB4), complement 5a (C5a), and formylmethion-ylleucylphenylalanine (fMLP) were examined using the under agarose method. The chemotactic differentials in response to LTB4, C5a, and fMLP in neutrophils from the patient group were significantly lower than the corresponding values in neutrophils from the control group (p<0.05 for all comparisons). The difference in chemotactic index between the two groups was statistically significant for LTB4 and fMLP (p<0.05 for both comparisons), but not for C5a (p=0.20). Neutrophils from patients with primary ciliary dyskinesia showed a decreased chemotactic response as compared with those from normal subjects. It is concluded that the increased frequency of respiratory tract infection in patients with primary ciliary dyskinesia is possibly due to the defective directional migration of neutrophils, as well as to the defective mucociliary clearance of the airways.
Adolescent ; Chemotactic Factors/pharmacology ; Chemotaxis* ; Child ; Cilia/ultrastructure ; Comparative Study ; Complement 5a/pharmacology ; Dose-Response Relationship, Drug ; Dynein ATPase/chemistry ; Human ; Kartagener Syndrome/blood* ; Kartagener Syndrome/classification ; Leukotriene B4/pharmacology ; Male ; N-Formylmethionine Leucyl-Phenylalanine/pharmacology ; Neutrophils/physiology* ; Neutrophils/ultrastructure

PURPOSE: Skin reactivity to different allergens may vary with age, since the degree and type of sensitization may be related not only to genetic factors but also to the intensity and duration of exposure to the allergens. The aim of this study was to evaluate profile of sensitization to airborne allergens according to age in children with allergic asthma. METHODS: We performed skin prick tests with 12 common airborne allergens in children with clinically diagnosed asthma, and analyzed the results of 313 patients with at least one positive response. Patients were arbitrarily divided into four groups, according to their age: group I(3 to 7 yrs; n=80), group II(7 to 10 yrs; n=93), group III(10 to 13 yrs; n=85), and group IV(13 to 17 yrs; n=55). The allergens tested were grouped into 5 classes : house dust mites, cockroach, animal danders, molds, and pollens. Atopy index and class index were calculated as the number of allergens and classes to which responses had been positive, respectively. RESULTS: In all groups, the most common positive allergic reaction was to house dust mites. Positive reactions to cat fur, mugwort, and ragweed among the allergens, and animal danders and pollens among the classes, tended to increase from group I to group IV(P<0.05). Atopy index increased with age(P<0.05). Class index also increased with age(P<0.05). Sensitization to more than one class of allergens occurred in 62.3% of the patients, and the percentage of these polysensitized patients tended to increase from group I to group IV(P<0.05). CONCLUSION: In children with allergic asthma, the positive number of allergens and their classes by skin prick test increased with the age of the patients. This phenomenon was associated with age- related increase in the frequency of polysensitized patients.
Allergens ; Ambrosia ; Animals ; Artemisia ; Asthma* ; Cats ; Child* ; Cockroaches ; Dander ; Fungi ; Humans ; Hypersensitivity ; Mites ; Pollen ; Pyroglyphidae ; Skin Tests ; Skin*

PURPOSE: Airways hyperresponsiveness is a hallmark of asthma. Inhaled corticosteroids improve hyperresponsiveness, but the extent of improvement may vary considerably between patients. This study was designed to determine which patient characteristics predict these differences in response. METHODS: Children with atopic asthma(n=71) received inhaled budesonide(800microgram per day) regularly for 12 weeks, and methacholine PC20 was measured before and after the treatment. Baseline clinical characteristics of children were analyzed with regard to their response to budesonide therapy. RESULTS: The children were divided into high(n=36) and low responder(n=35) on the basis of the median value of the doubling doses(change in PC20). There were no differences observed between the two groups with respect to age, sex, eosinophil counts, and pretreatment FEV1 or methacholine PC20. Among the allergic parameters, serum total IgE was higher in the high responder group than in the low responder group, whereas Dermatophagoides-specific IgE levels or skin test wheal sizes were not different between the two groups. There was a significant correlation between total IgE level and change in PC20. CONCLUSION: Total serum IgE was found to be the most important and single predictor of change in PC20 with inhaled corticosteroids.
Adrenal Cortex Hormones* ; Asthma ; Budesonide ; Child* ; Eosinophils ; Humans ; Immunoglobulin E* ; Methacholine Chloride ; Skin Tests

No abstract available.

PURPOSE: Wilson disease is a hereditary metabolic disorder characterized by an accumulation of copper in tissues which sometimes results in renal problems. This study was performed to evaluate the prevalences of the renal problems in Wilson disease and related risk factors. METHODS: In 31 patients with Wilson disease, we looked for renal problems by history taking, physical examination and laboratory tests such as urinalysis, BUN, serum creatinine, creatinine clearance, 24-hour urine total protein, serum and urine electrolytes, serum and 24-hour urine calcium, phosphorus, uric acid, beta2-microglobulin(beta2-MG) levels and 24-hour urine N-acetyl-beta-glucosaminidase(NAG) excretion. RESULTS: All of the patients were on penicillamine therapy for 4.3+/-3.4 years. None of them had any renal symptoms or signs at the time of this study except one patient who had a history of intermittent puffy face for 6 months. In the laboratory studies, 21 cases(68%) had one or more renal problems. Sixteen cases(52%) had one or more tubular dysfunctions; individually, hypercalciuria, increased excretion of beta2-MG, decreased TRP, increased excretion of NAG were detected in 29%, 19%, 16%, and 10%, respectively. Microscopic hematurias were detected in 8 cases(26%), creatinine clearances(Ccr) were decreased in 4 cases(13%). Two cases(6%) revealed proteinuria. Hematurias were more frequent within 3 years after beginning penicillamine treatment(P<0.05). Though not proven statistically, tubular dysfunctions and proteinurias showed the same trends. Prevalence of the decreased Ccr did not change with the treatment duration. CONCLUSION: In Wilson disease, covert renal problems are relatively common. Tubular dysfunctions are the most frequently observed abnormalities followed by microscopic hematuria, proteinuria, and decreased creatinine clearance in order. Hematuria is more common within 3 years after beginning penicillamine treatment, which is also probable for tubular dysfunctions and proteinuria.
Calcium ; Copper ; Creatinine ; Electrolytes ; Hematuria ; Hepatolenticular Degeneration* ; Humans ; Hypercalciuria ; Penicillamine ; Phosphorus ; Physical Examination ; Prevalence ; Proteinuria ; Risk Factors ; Uric Acid ; Urinalysis

PURPOSE: Skin prick test and determination of allergen-specific IgE antibodies in serum are methods commonly used to diagnose allergies. Several studies indicate that skin test and specific IgE have roughly the same diagnostic precision, although discrepancies exist. The objective of this study was to evaluate the influence of total serum IgE on the relation between skin prick test and allergen-specific IgE antibody. METHODS: We performed skin prick tests using 14 major inhalant allergens and measured total IgE and specific IgE for two major allergens [Dermatophagoides farinae(D.f.) and Dermatophagoides pteronyssinus (D.p.)] in serum of 230 children with atopic asthma. RESULTS: Positivity of skin prick test was 92.2% for D.f., 89.6% for D.p., and 22.6% for cockroach. Allergen/Histamine(A/H) ratio and allergen-specific IgE score showed a positive correlation for D.f.(r=0.39, P<0.01), and for D.p.(r=0.38, P<0.01). Total serum IgE and allergen-specific antibody score showed a positive correlation for D.f.(r=0.50, P<0.01), and for D.p.(r=0.53, P<0.01). There was no correlation between total serum IgE and A/H ratio on skin prick test for the two allergens. However, total serum IgE had the tendency to increase according to the number of positive allergens on skin prick test. At each level of A/H ratio for D.f. and D.p. on skin prick test, patients with high total IgE had higher antigen-specific IgE scores than patients with low total IgE. CONCLUSION: Our results show that the relationship between skin prick test and antigen-specific IgE was influenced by the level of serum total IgE. This indicates that the level of serum total IgE should be taken into account when skin prick test and allergen-specific IgE are compared.
Allergens ; Antibodies ; Asthma* ; Child* ; Cockroaches ; Dermatophagoides farinae ; Dermatophagoides pteronyssinus ; Humans ; Hypersensitivity ; Immunoglobulin E* ; Skin Tests ; Skin*

PURPOSE: The release of histamine from human basophils is controlled by an intrinsic, as yet unidentified, cellular property termed "releasability." We carried out this study to ascertain whether there was any difference in the releasability of basophils from asthmatic children compared to those from normal children. We intended also to clarify the correlation between the releasability and the atopic status of asthma. METHODS: We selected nineteen atopic asthmatic, eighteen nonatopic asthmatic and fourteen normal children for this study. Suspensions of leukocytes were isolated and stimulated with calcium ionophore A23187, anti-IgE and D. pteronyssinus antigen. After incubation, the supernatant was assayed for histamine with an automated fluorometric technique. RESULTS: Basophil histamine release with anti-IgE was different in three groups. Anti-IgE caused significantly more basophil histamine release in asthmatic children than in nomal children. Atopic asthmatic group showed greater basophil histamine release with anti-IgE than nonatopic asthmatic group. D. pteronyssinus antigen caused the significant amount of histamine release only in atopic asthmatic group. CONCLUSIONS: Our data suggests that basophils from asthmatic children are characterized by a specific increase in IgE mediated histamine releasability. The difference of histamine releasability with anti-IgE between atopic and nonatopic asthmatic children may be due to the heterogeneity of IgE bound to cell surface, or may be due to the degree of the basophil activation by cytokines such as IL3. The specific release of histamine with D. pteronyssinus antigen in atopic asthmatic group suggests that the basophil histamine release test can be used to diagnose the causing antigen.
Asthma ; Basophils* ; Calcimycin ; Calcium ; Child* ; Cytokines ; Histamine Release ; Histamine* ; Humans ; Immunoglobulin E ; Leukocytes ; Population Characteristics ; Suspensions