Increased breath naphthalene in children with asthma and wheeze of the All Age Asthma Cohort (ALLIANCE).

Exhaled breath contains numerous volatile organic compounds (VOCs) known to be related to lung disease like asthma. Its collection is non-invasive, simple to perform and therefore an attractive method for the use even in young children. We analysed breath in children of the multicenter All Age Asthma Cohort (ALLIANCE) to evaluate if 'breathomics' have the potential to phenotype patients with asthma and wheeze, and to identify extrinsic risk factors for underlying disease mechanisms. A breath sample was collected from 142 children (asthma: 51, pre-school wheezers: 55, healthy controls: 36) and analysed using gas chromatography-mass spectrometry (GC/MS). Children were diagnosed according to Global Initiative for Asthma guidelines and comprehensively examined each year over up to seven years. Forty children repeated the breath collection after 24 or 48 months. Most breath VOCs differing between groups reflect the exposome of the children. We observed lower levels of lifestyle-related VOCs and higher levels of the environmental pollutants, especially naphthalene, in children with asthma or wheeze. Naphthalene was also higher in symptomatic patients and in wheezers with recent inhaled corticosteroid use. No relationships with lung function or TH2 inflammation were detected. Increased levels of naphthalene in asthmatics and wheezers and the relationship to disease severity could indicate a role of environmental or indoor air pollution for the development or progress of asthma. Breath VOCs might help to elucidate the role of the exposome for the development of asthma. The study was registered at ClinicalTrials.gov (NCT02496468).

["Little hedgehogs of doubts"--success and discourse of insulin shock therapy in the 1930s to 1950s]. / "Little Hedgehogs of Doubts"--die Insulinschocktherapie in den 1930er bis 1950er Jahren.

Insulin shock therapy was one of the major somatic treatments in psychiatry in the 1930s. Even though this treatment was risky, expensive and completely empirical, it spread all over the industrialised world within few years. The development of several centres for this new treatment contributed to this success story, mainly the Viennese Psychiatric-neurological clinic and the Swiss asylum Münsingen. Visiting psychiatrists in these clinics and Jewish émigrés became important advocates of the new therapy in other countries. The success of insulin coma therapy was also based on the hope of many psychiatrists in the 1930s for a more somatic approach for mental illness- thereby promising to catch up with biologically defined 20th century medicine. However the discussion shows that the basic concepts of psychiatric treatment first changed with the discovery of new drugs in the 1950s.