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Paediatric pulmonology and allergology
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Arunas Valiulis, Saulius Rocka, Rokas Tamosauskas, Lina Noreikiene, Izolda Areskiene, Aurimas Motiejunas. The prevalence of bronchial asthma, allergic rhinitis and eczema among schoolchildren in Vilnius (ISAAC study) Thomas Nicolai, Erika von Mutius. Respiratory hypersensitivity and environmental factors: East and West Germany Albinas Naudziunas, Raimundas Aleknavicius. Psychological aspects of the management of asthma in children Göran Wennergren. Impact of viral infection on bronchial hyperresponsiveness Jurgis Bojarskas, Jolanta Kudzyte, Laimute Vaideliene. Allergy among toddler in connection with the family allergy (SPACE study) Magnus Borres, Görel Bråkenheilm, Kristina Irander. How many Swedish teenagers think they have allergic rhinoconjunctivitis and what they do about it Algimantas Vingras, Jovile Vingraite. Causes of cough and it's management Sigitas Dumcius, Vilija Bubnaitiene. Clinical manifestations of cystic fibrosis Petras Kaltenis. Is gentamicine appropriate for the treatment of pneumonia in children? Arunas Valiulis, Jonas Sadauskas, Vanda Kriukiene, Violeta Radziuniene, Nomeda Jokubaitiene, Iveta Skurvydiene. Evaluation of the effectiveness of pneumonia therapy with amoxicillin/acidum clavulanicum in children Ingrid Enander. Antiallergic and anti-inflammatory effects of loratadine Andrew Bush. Recent advances in the management of tuberculosis Abstracts of the IInd International Paediatric Asthma Conference-School |
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The prevalence of bronchial asthma, allergic rhinitis and atopic eczema among schoolchildren in Vilnius (ISAAC study)
Arunas Valiulis, Saulius Rocka, Rokas Tamosauskas, Lina Noreikiene, Izolda Areskiene, Aurimas Motiejunas
The prevalence of allergic diseases increased dramatically in many European as well as other countries. The aim of our study was to determine the prevalence of bronchial asthma, allergic rhinitis and eczema among Vilnius schoolchildren. Epidemiological study was carries out from January to March, 1998. A standardized ISAAC survey protocol was utilized as questionnaire in the study. 1365 younger children and 1838 adolescents were interviewed in 6-7 and 13-14 year age groups, respectively. A positive response to the "wheezing ever" question was obtained in 9.0 perc. of cases in the first group of children and as many as in 17.5 perc. of cases in the second group. A half of these children have had an episode of wheezing during the last year. 2.0 perc. of children in the younger age group and 3.0 perc. of adolescents have had a diagnosis of bronchial asthma. Allergic rhinitis was diagnosed in 2.6 perc. and in 6.1 perc. of 6-7 year age group children and adolescent group, respectively. A diagnosis of eczema was present in 3.6 perc. of cases (6-7 year old children group) and 3.9 perc. of cases (13-14 year old adolescent group). Bronchial asthma was diagnosed in every fifth child while diagnosis of allergic rhinitis was made in every tenth child having objective symptoms of the disease. Atopic eczema was diagnosed in one half of patients presenting with the signs of dermatitis.
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Respiratory hypersensitivity and environmental factors: East and West Germany
Thomas Nicolai, Erika von Mutius
We assessed the prevalence of asthma and allergic disorders in 9-11 year old children in Leipzig and Hale in East Germany, and Munich, West Germany. Both East German cities were heavily polluted due to private coal burning and industrial emissions, whereas Munich has moderate industry but heavy car traffic. All fourth grade pupils in Munich (n=7445) were compared with those in Leipzig, 1990 (n=1429), and Leipzig and Hale, 1991 (n=3105). The prevalence of a hay fever and skin test reactivity to common aeroallergens was considerably higher in West Germany as compared to East Germany. The prevalence of asthma was also higher in the West German study area. However, when atopy was taken into account, there was no longer a significant difference in the prevalence of asthma between the two parts of the country.
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Psychological aspects of the management of asthma in children
Albinas Naudziunas, Raimundas Aleknavicius
Psychogenic pathogenesis, influence of psychosocial factors on etiology and course of children bronchial asthma, psychological peculiarities of patients life, principles of psychological defense have been considered in the article. Psychosocial issues related to asthma mortality and morbidity: depression, anxiety, life crises, family conflict, psychological and social isolation. In stress situations blood concentration of epinephrine and coritcosteroids increase to the level as in the depressive disorders. Cooperation of physician, patient and psychologist is very important for providing of psychological health for asthmatic patients. Asthmatic for psychological defense could use mechanisms of psychological defense: repression, sublimation, regression, projection and other.
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Impact of viral infection on bronchial hyperresponsiveness
Göran Wennergren
Viral respiratory infections play a major role in causing exacerbations of asthma symptoms in both children and adults. RSV, parainfluenza, influenza, adeno- and human rhinovirus infections increase bronchial reactivity. Bronchial hyperreactivity is thought to be mediated via several pathophysiological mechanisms including damage to epithelial cells, inflammation of bronchial mucosa and direct receptor stimulation. Viruses enhance expression of adhesion molecules, production and release of inflammation mediators form mast cells, basophiles, neutrophils, eosionphils and macrophages as well as increasing virus-specific IgE production. Another mechanism is downregulation of b-receptors. The evidence is emerging that chronic persistent infections caused by RSV an adenoviruses are responsible for maintaining bronchial hyperreactivity.
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Allergy among toddlers in connection with the family allergy (SPACE study)
Jurgis Bojarskas, Jolanta Kudzyte, Laimute Vaideliene
With the help of International SPACE study launched in Lithuania we determined that 24.9 perc. of children are at great risk to get ill with various allergic diseases. Specific IgE explored in children's blood revealed that 17.7 perc. of them were allergic to house dust mites. 39.9 perc. of allergic children ever had wheezing and even 31.4 perc. of them had wheezing during the last 12 months. Bronchial asthma was diagnosed for 9 perc. of those children and almost half of them (52.3 perc.) were allergic to house dust mites. Our results confirmed that many children from allergic parents are also allergic. Diagnosis and prevention of allergic diseases from the early childhood are of great importance.
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How many Swedish teenager think they have allergic rhinoconjunctivitis and what they do about it
Magnus Borres, Görel Bråkenhielm, Kristina Irander
A study was made to assess the proportion of 17-year-old students who consider themselves to have allergic rhinoconjunctivitis and to find out how they treat themselves. The study was performed outside the pollen season in 1993 and 1994 and 5938 first-year secondary school students in eight different cities were asked to answer a questionnaire during class. A total of 1458 students (24 perc.) claimed that they suffered from allergic rhinoconjunctivitis after being given a description of the disease. 65 perc. had had symptoms for 3 or more years and most of the sufferers, 71 perc., had had symptoms during the spring and/or summer. In 32 perc. of the sufferers the causative agent was unknown. 76 perc. of the sufferers treated themselves with drugs. The most commonly used drugs for a systemic effect were nonsedating antihistamines and for a local effect, sodium cromoglycate. Of those who used nasal drugs (sodium cromoglycate and/or steroids, n=545), only 14 perc. used them daily, 51 perc. always when having symptoms, and 35 perc. occasionally when having symptoms. The use of over-the counter treatment increased in the following year to 33 perc. (p<0.05). We are concluded that many young people perceive themselves as having allergic rhinoconjunctivitis and that the treatment can be much improved for the group as a whole.
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Causes of cough and it's management
Algimantas Vingras, Jovile Vingraite
Cough is a symptom of many illnesses, both mild and severe, acute and chronic. This article discusses ethiopathogenesis of cough and detailed guidelines for both specific and non-specific treatment of cough. Indications and contraindications of some cough medications (codeine, dextromethorphan, N-acetylcysteine, ambroxol hydorcholoride) are presented. The best way for relieving productive cough is sufficient hydration.
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Clinical manifestations of cystic fibrosis
Sigitas Dumcius, Vilija Bubnaitiene
This study presents data of personal observation of 92 children with cystic fibrosis from 1987 till 1997 in Kaunas university hospital. Age of diagnosis extends from the fist day of life to teenagers. It has been found out that most infants and children (76.1 perc.) at presentation of cystic fibrosis have a mixture of both respiratory and gastrointestinal symptoms though one or other predominates. It is this combination that usually suggests the diagnosis. When either respiratory or gastrointestinal symptoms are present alone (17.4 perc.) or in cases of uncommon modes of presentation (6.5 perc.) including heat prostration, nasal polyposis, sinusitis, the diagnosis was frequently delayed. The earliest symptom is usually a loose cough in association with a presumed viral respiratory infection which fails to clear or clears only incompletely with antibiotics.
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Is gentamicine appropriate for the treatment of pneumonia in children?
Petras Kaltenis
Uncomplicated pneumonia in paediatric in-patients and out-patients sometimes is being treated with gentamicin. Impropriety of such choice has long been shown by many microbiological, pharmacological and clinical studies. The most common causative agents of bacterial pneumonia are Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis and in older children - Mycoplasma pneumoniae. Neither of these organisms is sufficiently and consistently susceptible to gentamicin. Besides that penetration of gentamicin to bronchial secretions is poor and its concentration in sputum is usually about 20 perc. of that in plasma. Toxicity of gentamicin should be kept in mind as well. Finally, there is a wide choice of antibiotics more suitable for treatment of respiratory tract infections, e.g. penicilins and their combinations with beta-lactamase inhibitors, II generation cephalosporins, macrolides. Gentamicin (usually in combination with other antibiotics) could be indicated in severe pneumonia, when there is a great probability of gram-negative bacteria or staphylococci as causative agents.
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Evaluation of the effectiveness of substitutive pneumonia therapy with amoxicillin/acidum clavulanicum in children
Arunas Valiulis, Jonas Sadauskas, Vanda Kriukiene, Violeta Radziuniene, Nomeda Jokubaitiene, Iveta Skurvydiene
This article is devoted to the evaluation of the effectiveness of substitutive intravenous-oral amoxicillin/ac. clavulanicum (Amoksiklav, LEK) vs. cefuroxime therapy for the treatment of bacterial pneumonia in paediatric patients. We investigate 40 children (3 months - 16 years) in not placebo controlled open clinical study. Performing microbiological investigation of the sputum of our patients we found Haemophilus influenzae (25.0 perc. ), Staphylococcus aureus (17.5 perc.), Streptococcus pneumoniae (10.0 perc.) and Klebsiella spp. (5.0 perc.). It was confirmed that monotherapy of bacterial pneumonia with amoxicillin/ac. clavulanicum was as effective as the one with cephalosporin of second generation.
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Antiallergic and anti-inflammatory effects of loratadine
Ingrid Enander
The allergic reaction often consists of an early phase response and a late phase response. It is of major importance that both phases are treated in the allergic patient. Histamine is a major mediator of the allergic reaction. Antihistamines have been used for over six decades to treat a variety of allergic disorders such as allergic rhinitis and urticaria. Loratadine, a second generation antihistamine, has the ability to modulate both the early phase response and a late phase allergic response. It is highly potent and long acting medication that lacks sedation and anticholinergic side effects which are common to older antihistamines. Loratadine and other new generation antihistamine also possess additional antiallergic properties beyond those affected through histamine H1- receptors i.e. inhibition of mast cell degranulation, thereby decreasing inflammatory cell migration. Because factors other than histamine are mediating the allergic reaction, additional effects of loratadine could be of benefit for patients with allergic disorders.
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Recent advances in the management of tuberculosis
Andrew Bush
The majority of cases of tuberculosis can be managed with conventional diagnostic methods and routine triple therapy. Indeed, the greatest advances globally have been in ensuring the proper use of conventional treatment, including the use of directly observed therapy, rather than by any new advance. However, for problem cases, more sophisticated imaging and fibreoptic bronchoscopy, supplemented by the new and powerful techniques of molecular biology, are needed to ensure optimal management. The signs are that tuberculosis will remain a major problem will into the 21st century. The best hope for global control clearly lies in the rigorous application of standard methods of diagnosis and treatment. However, the diagnostic laboratory of the future will rely on more and more sophisticated molecular techniques, which will be cheaper and automated, in particular in the atypical and puzzling cases.
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November, 1998, Vol. I, No. 2 (p. 1-98)
