Inhaled corticosteroid use and asthma hospitalization rates in Japan.

This epidemiological study assessed whether the use of anti-inflammatory drugs, in particular inhaled corticosteroids, affected hospitalization rates for asthma in Japan between 1990 and 2002. Asthma hospitalization rates were calculated from the number of asthma in-patients recorded in governmental surveys. Information concerning use of anti-inflammatory drugs was extracted from the IMS prescription database. Patients were stratified into four age groups: < or = 4 years, 5 - 19 years, 20 - 39 years and 40 - 64 years. Over the study period, the number of prescriptions for inhaled corticosteroids per year increased dramatically and hospitalizations for asthma decreased in all groups except those < or = 4 years of age. Increased use of leukotriene receptor antagonists was also noted in all age groups. The use of anti-inflammatory drugs may have contributed to the observed decrease in asthma hospitalizations. Increased use of inhaled corticosteroids in infants and very young children may help prevent hospitalization in this age group.

[Japanese guideline for treatment and management of childhood asthma and its originality].

Japanese guideline for treatment and management of childhood asthma was published in April, 2000. This is the Japan original guideline. The general and practical asthma treatment in Japan is described. We compared with this guideline and GINA. There is not a difference in the diagnosis and concept of bronchial asthma. This guideline for several Japan original therapies are described. The originality of this guideline is the early use of theophylline. There is not the entry of the use of oral steroid. There are many Japan original therapies such as the isoproterenol continuous inhalation therapy. Also, as for this guideline the education, vaccination and exercise of the patient are written in detail. We hope that this guideline is translated to English and be published.

[The effect of DPT and BCG vaccinations on atopic disorders].

METHODS: To examine the relationship between DPT and BCG vaccinations and development of atopic diseases, we studied on 143 children resident of the island of Kodushima, Tokyo Japan. This study dealt with the entire population of 0-3 years old (82), all of the first graders of the elementary school (31) and all of the first graders of the junior high school (30) on the Island. RESULTS: Among the 82 children aged 0-3, out of the 39 who received DPT vaccination, 10 (25.6%) suffered from bronchial asthma and this ratio was significantly higher than among the children who have not received DPT vaccination (1 in 43, 2.3%), (p < 0.01). This was also the case concerning atopic dermatitis (7 in 39, 18.0% vs 1 in 43, 2.3%) (p < 0.05). The same trend was also observed if three diseases (bronchial asthma, allergic rhinitis and atopic dermatitis) were combined (22 in 39, 56.4% vs 4 in 43, 9.3%) (p < 0.01). As to the context of BCG vaccination, there were no cases with atopic disorders among the tuberculin positive first graders of the elementary school. No such relations, however, were observed among the first graders of the junior high school at all. FINDINGS: From these results, we conclude that DPT vaccination has some effect in the promotion of atopic disorders, while successful BCG vaccination inhibits the development of atopic disorders, although the preventive effect of BCG may not last for many years.

[Examination of theophylline pharmacokinetics during an attack of bronchial asthma in children].

For the purpose of a safe and effective use of theophylline in therapy during an attack of asthma, we have examined the effect of an attack of bronchial asthma on the metabolism of theophylline. We carefully selected cases in which neither theophylline preparations have been administered, nor infectious complications have occurred, nor an attack has been delayed. Aminophylline was intravenously administered to 33 asthmatic children by instillation over 2 hours during an attack of asthma and during a phase of remission, then a concentration of theophylline in blood was determined without further administration of theophylline, and a distribution volume of theophylline, its half-life, its elimination rate and its clearance were calculated. The results obtained are as follows. The volume of distribution of theophylline was 0.572 +/- 0.076 L/kg during and attack while it was 0.458 +/- 0.116 L/kg during a phase of remission. During an attack, the volume of distribution of theophylline increased. The half-life of theophylline was 7.741 +/- 3.313 hr. during an attack while its was 4.710 +/- 1.873 hr. during a phase of remission. During an attack, the half-life of theophylline increased while the elimination rate constant decreased. The clearance of theophylline was 57.4 +/- 20.9 ml/kg/hr. during an attack while it was 78.3 +/- 31.0 mg/kg/hr. during a phase of remission. During an attack, the clearance of theophylline increased. As described above, during an attack, a distribution volume of theophylline increases, its elimination rate constant decreases, and its clearance is prolonged.(ABSTRACT TRUNCATED AT 250 WORDS)

Antidiuretic hormone in acute asthma in children: effects of medication on serum levels and clinical course.

This study of seventeen patients presenting to the emergency room with acute severe asthma determined levels of antidiuretic hormone in serum as well as serum electrolytes and arterial blood gases serially. There was a progressive increase in plasma ADH concentration with severe asthma and ADH levels were substantially higher in those patients with PaCO2's higher than 45 Torr. Patients treated with intravenous aminophylline had a fall in ADH levels while those treated with injectable epinephrine showed an elevation of these levels. As the asthma improved, ADH levels decreased in all patients. In this series of children, sick for not more than 24 hours, serum sodium levels were normal. However, children who have been ill for longer periods than this or who are on prolonged intravenous fluid therapy need close monitoring of serum electrolyte concentrations.

[Studies of specific IgE and IgG antibodies in allergic children. Changes in specific IgE and IgG antibodies to egg white, milk, soybean and mite from children with atopic dermatitis].

Egg, milk, soybean, mite (DF)-specific IgG and IgE antibodies were measured in 276 atopic dermatitis children in whom dietary restrictions had never been done. We recommend cleaning house and bed clothes to decrease number of mites and elimination diet according to clinical symptoms and laboratory findings. After elimination periods (approximately 140 days) the same specific antibodies were examined again. In the patients who improved clinically by elimination of foods, the specific IgG antibodies to the foods decreased significantly. The other patients did not improved clinically suggesting that inadequate elimination diet were done and cleaning house and bed clothes was incomplete and/or other types of allergic reactions might exist.

How to prevent allergic disease. I. Study of specific IgE, IgG, and IgG4 antibodies in serum of pregnant mothers, cord blood, and infants.

We have investigated methods for decreasing the number of allergic patients and have produced the following data. We compared mothers' total IgE levels and allergen-specific IgG and IgG4 levels in 72 paired cases. In mothers with high total IgE, the cord blood levels of IgG and IgG4 specific for egg, milk, and mite allergens were significantly higher than in mothers with low IgE levels. Mothers who took over 200 ml of milk per day showed a statistically higher level of milk-specific IgG antibody. From our studies of IgE, IgG, and IgG4 antibody levels in atopic dermatitis patients, we conclude that specific IgG and IgG4 levels should be considered when eliminating offending foods. Infants with high egg-specific IgG antibody levels in cord blood were statistically more prone to develop allergic disease.

Plasma catecholamine concentrations during a 72-hour aminophylline infusion in children with acute asthma.

To explore the possibility that theophylline may act through adrenomedullary secretion of catecholamines, we examined the time courses of plasma norepinephrine (NE), epinephrine (E), and theophylline concentrations and peak expiratory flow (PEF) in nine children with an acute exacerbation of asthma receiving a 72-hour constant infusion of aminophylline. These measurements were made before (baseline) and at 2, 24, 48, and 72 hours after the infusion began. Plasma theophylline concentrations were kept constant in a near midpoint therapeutic range (mean +/- SEM, 14.1 +/- 1.3 to 16.1 +/- 1.1 micrograms/ml) during the 24- to 72-hour infusion periods. Compared with the respective baseline values (383.8 +/- 56.0 and 67.6 +/- 11.8 pg/ml for NE and E), the following postinfusion plasma catecholamines reached statistically significant difference: 664.0 +/- 125.1 pg/ml for NE at 24 hours (p less than 0.05), and 214.9 +/- 57.8, 233.7 +/- 82.2, and 137.6 +/- 39.4 pg/ml for E at 2, 24, and 48 hours (p less than 0.01). Despite the fact that similar plasma theophylline concentrations were maintained, plasma E, which peaked at 24 hours after dose, returned toward the baseline at the end of infusion (99.7 +/- 24.1 pg/ml), whereas this trend was not observed for NE. The postinfusion PEF increased (p less than 0.01) in a stepwise fashion, compared with the baseline, as the infusion progressed. The change in PEF correlated significantly (p less than 0.002) with plasma theophylline concentrations but not with the increase in plasma E from the baseline. Theophylline concentrations did not correlate with the increase in plasma NE or E from the baseline.(ABSTRACT TRUNCATED AT 250 WORDS)

Role of chemical mediators after antigen and exercise challenge in children with asthma.

Changes in chemical mediators after antigen challenge and exercise challenge tests were studied in children with asthma. Chemical mediators studied after antigen challenge and exercise challenge included histamine, leukotrienes (LTB4, LTC4, and LTD4), and neutrophil chemotactic factor of anaphylaxis (NCA). The pharmacologic modification of immediate and late-phase reactions was evaluated for procaterol (beta 2-agonist), cromolyn sodium, and prednisolone. Histamine levels were noted to rise in patients who had a dual response of a mild to moderate nature, but did not change in patients who had severe asthma. During exercise challenge cromolyn sodium inhibited both immediate and late-phase reactions but also inhibited plasma generation of NCA. Prednisolone, on the other hand, did not affect immediate reactions, but blocked late-phase reactions to exercise and also decreased NCA generation. Procaterol inhibited the generation of LTD4 and also inhibited NCA when compared with placebo. Exercise challenge did not alter levels of plasma histamine or of LTB4 or LTC4.