Branhamella catarrhalis colonization in preschool asthmatics.

Branhamella catarrhalis has been associated with exacerbations of chronic bronchitis and asthma in adults. To investigate the possible role of B. catarrhalis in asthma of early childhood, we took posterior pharyngeal swabs from 24 normal children, 20 well asthmatics, and 20 acutely wheezy asthmatics, all between 1 and 4 years of age. On culture, 33% of the normal children were colonized with B. catarrhalis; colonization rates in the well asthmatics (70%) and in the wheezy asthmatics (75%) were significantly higher than in normals. The nature of this association requires further study.

Adolescent diabetic amyotrophy.

A 16-year-old boy with insulin-dependent diabetes mellitus since age five years was admitted with severe ketoacidosis, and suffered a cardiorespiratory arrest from which he made a full recovery. He subsequently developed the typical clinical picture of diabetic amyotrophy with painful asymmetrical weakness and wasting of proximal lower limb muscles. Cerebrospinal fluid protein was elevated, and electromyography showed typical changes. Diabetic amyotrophy has not previously been reported in this age group.

Respiratory problems in children with neurological impairment.

Children with severe neurological impairment have a high incidence of respiratory problems which are multifactorial and may be related to or dependent on the underlying disability. In addition, common respiratory conditions such as asthma will be represented in this group as in the general paediatric population. In order to maximise quality of life and reduce morbidity and mortality, each child should be carefully assessed and treated, making adjustments where necessary in the treatment regime to take account of the disability.

Long term outcome of ventilated asthmatics.

Over a 25 year period, 31 asthmatic children received artificial ventilation for acute asthma at Alder Hey Children's Hospital on 48 occasions. Altogether 47 episodes occurred from 1971-89, with no decline in the number of episodes per year (mean 2.5) over this period. Eight children died during intermittent positive pressure ventilation (IPPV), and of the 23 survivors, three further children had subsequently died from asthma. Seventeen children were followed up for more than a year after IPPV. Sixteen still had symptoms of asthma and over half had symptoms every day. Ten cooperated with pulmonary function tests: mean forced expiratory volume in one second was 83% of predicted and geometric mean provocative histamine concentration (PC20) was 2.1 mg/ml. Since the follow up study a fourth patient had died from asthma. IPPV continues to be required for a small number of asthmatic children each year. The survivors remain a high risk group with significant continuing morbidity and mortality.

Do tidal expiratory flow patterns reflect lung mechanics in infants?

It has been suggested that during tidal breathing, the time to maximal expiratory flow, as a proportion of total expiratory time (Tme/TE), can be used as an index of airways obstruction. However, the relationship of Tme/TE to lung mechanics in infants is unclear. We examined this relationship in 42 premature infants (21 intubated and 21 not intubated) by comparing direct measures of pulmonary mechanics (lung resistance, dynamic lung compliance, and lung impedance) with Tme/TE measured over the same sample of tidal breathing. Tme/TE was positively correlated with lung compliance, expressed as a percent of the predicted value, in both intubated (r = 0.69, p < 0.005) and nonintubated (r = 0.64, p < 0.02) infants. There was no significant association between Tme/TE and lung resistance, expressed as a percent of the predicted value, in intubated (r = 0.32) and nonintubated (r = 0.23) infants. Tme/TE also showed, in nonintubated infants, a positive association with lung impedance, expressed as a percent of the predicted value, on the basis of the predictive values for compliance and resistance at the infant's unique respiratory rate, but this was significant only because of the influence of compliance on Tme/TE. These findings suggest that, in infants, the relationship between pulmonary mechanics and Tme/TE is complex, with Tme/TE being influenced by the elastic rather than the flow-resistive properties of the lungs.

Management of acute childhood asthma: a prospective multicentre study.

Children with acute asthma account for a significant proportion of paediatric hospital admissions, and clear guidelines exist for their care. The aim of this study was to determine their management in the UK. Over 1 year (February 1995 to January 1996), children aged 1-14 yrs admitted with acute asthma were studied in both teaching and district general hospitals. An admission pro forma was used to collect data prospectively, with a computer-based information management system for the input of admissions in each centre. Ten centres collected data prospectively, with 1,578 admissions involving 1,352 children (median age 3.6 yrs). Sixty two per cent of children were <5 yrs of age. Sixty three per cent of admissions had initial arterial oxygen saturation (Sa,O2) recorded, and, in those older than 5 yrs, 36% had their initial peak expiratory flow rate recorded. Systemic steroids were given to 78%. An initial Sa,O2 of <92% was associated with a longer stay in hospital, and also with intravenous treatment. Preventative treatment increased from 42% on admission to 53% on discharge. The rates of documented education were low. This is the largest UK study following publication of national guidelines and shows that there is still room for improvement in the management of children admitted with acute asthma.