Determinants for asthma control, quality of life and use of complementary and alternative medicine in asthmatic pediatric patients in four cities.

BACKGROUND: Asthma is a significant chronic health problem worldwide. Management aims at disease control by reducing functional impairment and exacerbations and improving quality of life (QoL). We report a multi-center study to survey asthma control and QoL in four cities in the Pearl River Delta. METHODS: The conjoint survey involved ten Hong Kong pediatric hospitals/units, two Shenzhen hospitals, two Macau hospitals, and two Guangzhou hospitals on asthma control (using Asthma Control Test) and QoL (Pediatric Allergic Disease Quality of Life Questionnaire, PADQLQ). Acceptability of a treatment is graded as very good/good/fair/poor. RESULTS: Good asthma control was only reported in 80% subjects in Hong Kong, but higher in sister cities (85-94%, P < 0.001). Allergic rhinitis, "incense burning", and "smoker in family" were prevalent among the four cities. Logistic regression showed better control of asthma was associated with better PADQLQ (B = - 0.029, P < 0.001), better acceptability of bronchodilator (B = - 1.488, P = 0.025), negatively with "smoker in family" (B = - 0.83, P = 0.015) and various PADQLQ domains. Conversely, worse PADQLQ was associated with allergic rhinitis severity (B = 4.77, P < 0.001), poor control of asthma (B = 7.56, P < 0.001), increased frequency of traditional Chinese medicine use (B = 1.7, P < 0.05), increased frequency of bronchodilator usage (B = 1.05, P < 0.05), "smoker in family" (B = 4.05, P < 0.05), and incense burning at home (B = 3.9, P < 0.05). CONCLUSIONS: There are some clinical and cultural differences among the four southern Chinese cities within the Guangdong province. This study identifies potentially modifiable environmental and treatment factors associated with poor asthma control and QoL for health-care interventions. Having a smoker in the family is independently associated with poor asthma control and QoL.

Invasive pneumonia and septic shock in infants as a presentation of cystic fibrosis with vitamin-deficiency.

Herein we describe three infants with the rare presentation of pneumonia with septic shock as their initial medical encounter leading to the diagnosis of cystic fibrosis (CF). At the time of their presentation all three children had significant nutritional deficiency. We initiated an aggressive treatment regimen including nutritional supplementation which resulted in improvement in their pulmonary status and no further recurrences. This series highlights the possible presentation of CF in infancy as a life-threatening invasive infection of Staphylococcus aureus or Pseudomonas aeruginosa. It also supports neonatal screening and emphasizes the role of early attention to nutritional status and vitamin supplementation.

Application of videotape in the screening of obstructive sleep apnea in children.

OBJECTIVE: To determine if watching a videotape that shows features of obstructive sleep apnea (OSA) will improve the accuracy of a verbally administered questionnaire in the prediction of OSA in pediatric snorers. PATIENTS AND METHODS: In a prospective single-blinded, randomized, controlled study at a pediatric clinic for sleep-disordered breathing, we studied children aged 0-18 years, who had been referred to a sleep laboratory for overnight polysomnography (PSG), and their parents from November 1999 to November 2000. The parents were randomized to answer a standard verbally administered panel of three questions (SQ) or a verbally administered panel of questions assisted by videotape (VQ). RESULTS: The parents of 52 and 56 pediatric snorers were assigned to answer SQ and VQ, respectively. The areas under the receiver operating characteristic [ROC] curves (AUCs) for screening of OSA in patients were similar at 0.709 (95% confidence interval (CI)=0.561-0.851) for SQ and 0.714 (95% CI=0.571-0.858) for VQ. The two questionnaires had a reasonable negative predictive value to rule out the presence of OSA (VQ=0.816 and 95% CI=0.726-0.885, SQ=0.828, 95% CI=0.714-0.913). CONCLUSION: The addition of a videotape showing important features of OSA achieved no better accuracy than a standard questionnaire.

Survey of children with obstructive sleep apnea syndrome in Hong Kong of China.

BACKGROUND: Obstructive sleep apnea affects up to 2.9% of children. This study was to determine demographic and clinical characteristics of a group of children with obstructive sleep apnea syndrome (OSAS) as defined by sleep polysomnography (PSG). METHODS: A prospective study was conducted in a public-funded general hospital in Hong Kong of China. Children confirmed to have OSAS by PSG were followed up between January 1997 and December 1998. Tonsillectomy and adenoidectomy (T&A) was offered to those with moderate to severe OSAS, and medication was offered to those with mild OSAS. All children were followed up regularly in the sleep clinic and sleep PSG was repeated for those with marked relapse in symptoms. RESULTS: Eighty-nine children (64 boys and 25 girls, mean age 7 years) were confirmed to have OSAS out of 352 children who underwent PSG during the study period. The most common symptoms of OSAS were snoring (100%) and sweating (81%) during sleep and nasal blockage (61%) and sleepiness (34%) during daytime. Severe OSAS occurred in 15 children. Moderate OSAS occurred in 33 children. Forty-one children had mild OSAS. Forty-nine children underwent T&A, 5 (boys, < 5 years) out of whom were found to have recurrent OSAS within 1 year. CONCLUSION: A male predominance has been found in a group of Hong Kong children with OSAS. Boys undergoing T&A at an early age (< 5 years) will be more likely to develop repeated OSAS.