Risk Factors for Lung Function Decline in Pediatric Asthma under Treatment: A Retrospective, Multicenter, Observational Study.

Background: Childhood asthma is a major risk for low lung function in later adulthood, but what factors in asthma are associated with the poor lung function during childhood is not known. Objective: To identify clinical factors in children with asthma associated with low or declining lung function during the treatment. Methods: We enrolled children with asthma who had been treated throughout three age periods, i.e., 6−9, 10−12, and 13−15 years old, at seven specialized hospitals in Japan. Clinical information and lung function measurements were retrieved from the electronic chart systems. To characterize the lung function trajectories during each age period, we evaluated the forced expiratory volume 1 (FEV1) with % predicted values and individual changes by the slope (S) from linear regression. We defined four trajectory patterns: normal (Group N) and low (Group L), showing %FEV1 ≥80% or <80% throughout all three periods; upward (Group U) and downward (Group D), showing S ≥ 0 or S < 0%. Logistic regression analysis was performed to compare factors associated with the unfavorable (D/L) versus favorable (N/U) groups. Results: Among 273 eligible patients, 197 (72%) were classified into Group N (n = 150)/U (n = 47), while 76 (28%) were in Group D (n = 66)/L (n = 10). A history of poor asthma control, long-acting beta2 agonist use, and a lower height Z-score during 13−15 years were associated with an unfavorable outcome (Group D/L). Conversely, inhaled corticosteroid (ICS) use during 10−12 years and high-dose ICS use during 13−15 years were associated with a favorable outcome (Group N/U). Conclusion: We identified several factors that are associated with unfavorable lung function changes in pediatric asthma. Attention should be paid to the possible relationship between yearly changes in lung function and poor asthma control, use of ICS (and its dose) and use of LABA.

Early intervention for psychosomatic symptoms of adolescents in school checkup.

BACKGROUND: The purpose of this study was to evaluate the efficacy of early medical intervention for psychosocial problems detected in adolescents in a school health checkup, with the broader goal of prevention of these problems in adolescents. METHODS: The Questionnaire for Triage and Assessment with 30 items score and scores for five subscales (physical symptoms, depression symptoms, anxiety symptoms, self-efficacy, and family function), and an investigation of lifestyle were determined in a school health checkup for 5th grade elementary to 3rd grade junior high school students. Forty-three children were found to be at high risk for psychosomatic disorder, of whom 18 then received a medical intervention (early intervention group) and 25 did not (non-intervention group). Fifty-seven children (outpatient group) treated for psychosomatic disorder for ≤3 months were also included in the study. The Questionnaire for Triage and Assessment with 30 items (QTA30) was completed by all participants every 3 months for 1 year and scores were compared among the groups. RESULTS: In the early intervention group, total Questionnaire for Triage and Assessment with 30 items scores; physical, depression, and anxiety symptoms; and unstable relationships with friends and teachers at school all significantly improved after 1 year compared to the first survey. None of these items improved in the non-intervention group, while the outpatient group had gradual improvement in all scores. Family function scores in the early intervention group improved over time, whereas those in the non-intervention group worsened. CONCLUSIONS: Early detection of children at high risk for psychosomatic disorder at a school health checkup and early medical intervention were useful for prevention of psychosomatic disorder in adolescents.

Wheezing Characteristics and Predicting Reactivity to Inhaled ß2-Agonist in Children for Home Medical Care.

Background: Given that wheezing is treated with inhaled ß2-agonists, their effect should be reviewed before the condition becomes severe; however, few methods can currently predict reactivity to inhaled ß2-agonists. We investigated whether preinhalation wheezing characteristics identified by lung sound analysis can predict reactivity to inhaled ß2-agonists. Methods: In 202 children aged 10-153 months, wheezing was identified by auscultation. Lung sounds were recorded for 30 s in the chest region on the chest wall during tidal breathing. We analyzed the wheezing before and after ß2-agonist inhalation. Wheezing was displayed as horizontal bars of intensity defined as a wheeze power band, and the wheezing characteristics (number, frequency, and maximum intensity frequency) were evaluated by lung sound analysis. The participants were divided into two groups: non-disappears (wheezing did not disappear after inhalation) and disappears (wheezing disappeared after inhalation). Wheezing characteristics before ß2-agonist inhalation were compared between the two groups. The characteristics of wheezing were not affected by body size. The number of wheeze power bands of the non-responder group was significantly higher than those of the responder group (P < 0.001). The number of wheeze power bands was a predictor of reactivity to inhaled ß2-agonists, with a cutoff of 11.1. The 95% confidence intervals of sensitivity, specificity, and positive and negative predictive values were 88.8, 42, 44, and 81.1% (P < 0.001), respectively. Conclusions: The number of preinhalation wheeze power bands shown by lung sound analysis was a useful indicator before treatment. This indicator could be a beneficial index for managing wheezing in young children.

Wheeze Recognition Algorithm for Remote Medical Care Device in Children: Validation Study.

BACKGROUND: Since 2020, peoples' lifestyles have been largely changed due to the COVID-19 pandemic worldwide. In the medical field, although many patients prefer remote medical care, this prevents the physician from examining the patient directly; thus, it is important for patients to accurately convey their condition to the physician. Accordingly, remote medical care should be implemented and adaptable home medical devices are required. However, only a few highly accurate home medical devices are available for automatic wheeze detection as an exacerbation sign. OBJECTIVE: We developed a new handy home medical device with an automatic wheeze recognition algorithm, which is available for clinical use in noisy environments such as a pediatric consultation room or at home. Moreover, the examination time is only 30 seconds, since young children cannot endure a long examination time without crying or moving. The aim of this study was to validate the developed automatic wheeze recognition algorithm as a clinical medical device in children at different institutions. METHODS: A total of 374 children aged 4-107 months in pediatric consultation rooms of 10 institutions were enrolled in this study. All participants aged ≥6 years were diagnosed with bronchial asthma and patients ≤5 years had reported at least three episodes of wheezes. Wheezes were detected by auscultation with a stethoscope and recorded for 30 seconds using the wheeze recognition algorithm device (HWZ-1000T) developed based on wheeze characteristics following the Computerized Respiratory Sound Analysis guideline, where the dominant frequency and duration of a wheeze were >100 Hz and >100 ms, respectively. Files containing recorded lung sounds were assessed by each specialist physician and divided into two groups: 177 designated as "wheeze" files and 197 as "no-wheeze" files. Wheeze recognitions were compared between specialist physicians who recorded lung sounds and those recorded using the wheeze recognition algorithm. We calculated the sensitivity, specificity, positive predictive value, and negative predictive value for all recorded sound files, and evaluated the influence of age and sex on the wheeze detection sensitivity. RESULTS: Detection of wheezes was not influenced by age and sex. In all files, wheezes were differentiated from noise using the wheeze recognition algorithm. The sensitivity, specificity, positive predictive value, and negative predictive value of the wheeze recognition algorithm were 96.6%, 98.5%, 98.3%, and 97.0%, respectively. Wheezes were automatically detected, and heartbeat sounds, voices, and crying were automatically identified as no-wheeze sounds by the wheeze recognition algorithm. CONCLUSIONS: The wheeze recognition algorithm was verified to identify wheezing with high accuracy; therefore, it might be useful in the practical implementation of asthma management at home. Only a few home medical devices are available for automatic wheeze detection. The wheeze recognition algorithm was verified to identify wheezing with high accuracy and will be useful for wheezing management at home and in remote medical care.

Late bedtime reflects QTA30 anxiety symptoms in adolescents in a school checkup.

BACKGROUND: In adolescence, physical symptoms may develop due to psychosocial problems but such problems are not fully evaluated in school medical checkups. The aim of this study was to compare lifestyle factors with psychosomatic symptoms in adolescents using the subscales of the Questionnaire for Triage and Assessment with 30 items (QTA30) in school health checkups. METHODS: The QTA30 was used in checkups for 3,414 students from the fifth grade of primary school to the third grade of junior high school in south Wakayama prefecture. The QTA is a self-completed questionnaire with five subscales of physical symptoms, depression symptoms, self-efficacy, anxiety symptoms, and family function. Each subscale is divided into three groups of clinical, borderline, and healthy, based on the subscale score. Subscale scores were compared with lifestyle items of gender, grade, habits, life events, and school attendance. RESULTS: The clinical rate for all subscales was significantly higher for a higher grade (P < 0.001). Anxiety symptoms were correlated with physical symptoms (r = 0.560). Anxiety and physical symptoms were significantly higher for students who went to bed at a later time with no absences in the last month and who had problems with friends and teachers (both P < 0.001). Family function correlated with self-efficacy (r = 0.418) but not with other subscales. Study time was most related to self-efficacy (P < 0.001). CONCLUSIONS: The QTA30 subscale scores facilitated detection of psychosomatic stress and latent risks of psychosomatic disease at an early stage. Thus, the use of the QTA30 in a school medical checkup may permit early intervention for psychosomatic stress in adolescents.

A wheeze recognition algorithm for practical implementation in children.

BACKGROUND: The detection of wheezes as an exacerbation sign is important in certain respiratory diseases. However, few highly accurate clinical methods are available for automatic detection of wheezes in children. This study aimed to develop a wheeze detection algorithm for practical implementation in children. METHODS: A wheeze recognition algorithm was developed based on wheezes features following the Computerized Respiratory Sound Analysis guidelines. Wheezes can be detected by auscultation with a stethoscope and using an automatic computerized lung sound analysis. Lung sounds were recorded for 30 s in 214 children aged 2 months to 12 years and 11 months in a pediatric consultation room. Files containing recorded lung sounds were assessed by two specialist physicians and divided into two groups: 65 were designated as "wheeze" files, and 149 were designated as "no-wheeze" files. All lung sound judgments were agreed between two specialist physicians. We compared wheeze recognition between the specialist physicians and using the wheeze recognition algorithm and calculated the sensitivity, specificity, positive predictive value, and negative predictive value for all recorded sound files to evaluate the influence of age on the wheeze detection sensitivity. RESULTS: The detection of wheezes was not influenced by age. In all files, wheezes were differentiated from noise using the wheeze recognition algorithm. The sensitivity, specificity, positive predictive value, and negative predictive value of the wheeze recognition algorithm were 100%, 95.7%, 90.3%, and 100%, respectively. CONCLUSIONS: The wheeze recognition algorithm could identify wheezes in sound files and therefore may be useful in the practical implementation of respiratory illness management at home using properly developed devices.

Wheeze sound characteristics are associated with nighttime sleep disturbances in younger children.

BACKGROUND: Wheezing is a typical symptom of respiratory conditions. Few objective methods are available for predicting sleep disturbance in young children with wheezing. OBJECTIVE: We investigated whether wheezing characteristics, detected by lung-sound analysis, were associated with risk of sleep disturbance. METHODS: We recorded the lung sounds of 66 young children (4-59 months) every morning, for the entire duration of a wheezing episode. On lung-sound analysis, wheezing was displayed as horizontal bars of intensity with corresponding sharp peaks of power. The sharp peak of power was defined as a wheeze band. Wheezing characteristics (e.g., number, frequency, duration, and frequency of maximum intensity of wheeze bands) were analyzed using lung-sound analysis. Patients were divided into 3 groups based on sleep disturbance on the first night after wheezing was recorded: mild group (no sleep disturbance and disappearance of wheezing within 2 days), moderate group (no sleep disturbance but disappearance of wheezing after 3 or more days), and severe group (sleep disturbance and disappearance of wheezing after 3 or more days). Wheezing characteristics on the first morning were compared among the 3 groups based on sleep disturbance on the first night. RESULTS: The highest frequency, the frequency of maximum intensity, and the number of wheeze bands per 30 seconds were significantly higher in the severe group than in the mild group (p < 0.005, p < 0.005, p < 0.001, respectively). The number of wheeze bands per 30 seconds was a predictor of nighttime sleep disturbance, with a cutoff value of 11.1. The sensitivity, specificity, and positive- and negative-predictive values were 100%, 65%, 32%, and 100% (p < 0.001), respectively, with an area under the curve of 0.86 ± 0.05. CONCLUSIONS: The number of wheeze bands per 30 seconds on lung-sound analysis was a useful indicator of risk of prolonged exacerbation.

Utility of the QTA30 in a school medical checkup for adolescent students.

BACKGROUND: In adolescence, physical symptoms may develop due to psychosocial problems, but such problems are not fully evaluated in school medical checkups. The aim of the study was to compare the characteristics of students with high and low scores on the Questionnaire for Triage and Assessment with 30 items (QTA30) in a school health checkup. METHODS: The QTA30 (a self-completed questionnaire) was used in checkups for 3,414 students from the 5th grade of primary schools to the 3rd grade of junior high schools in south Wakayama Prefecture. The students were divided into groups with high (QTA30 ≥ 37) and low (QTA30 < 37) risk for psychosomatic disorder. Eleven items, including gender, grade, lifestyle habits, and life events, were compared between these groups, and in subgroups with and without recent absence from school. RESULTS: The QTA30 response rate was 87.9%. The high-risk group had significantly more 3rd grade students (P< 0.001), females (P< 0.001), problems with teachers or friends (P< 0.001), and experience of bullying (P< 0.001), in addition to game playing for ≥2 h (P< 0.001), late bedtime (P< 0.001), and many absences (P< 0.001). Students in the high-risk group with no absences for 1 month regardless of age still had a late bedtime and problems with friends, and 76.4% of the high-risk students had not visited a medical institution. CONCLUSIONS: Use of the QTA30 facilitated detection of psychosomatic stress in school medical checkups, with latent risks of truancy detectable at an early phase. The QTA30 may thus be useful in early intervention for psychosomatic stress of adolescents.

Early control treatment with montelukast in preschool children with asthma: A randomized controlled trial.

BACKGROUND: While Japanese guideline recommends initial control treatment for preschool children with asthma symptoms more than once a month, Western guidelines do not. To determine whether control treatment with montelukast was more effective than as-needed ß2-agonists in this population, we conducted a randomized controlled trial. METHODS: Eligible patients were children aged 1-5 years who had asthma symptoms more than once a month but less than once a week. Patients were randomly assigned in a 1:1 ratio to receive montelukast 4 mg daily for 48 weeks or as-needed ß2-agonists. The primary endpoint was the number of acute asthma exacerbations before starting step-up treatment with inhaled corticosteroids. This study is registered with the University Hospital Medical Information Network clinical trials registry, number UMIN000002219. RESULTS: From September 2009 to November 2012, 93 patients (47 in the montelukast group and 46 in the no-controller group) were enrolled into the study. All patients were included in the analysis. During the study, 13 patients (28%) in the montelukast group and 23 patients (50%) in the no-controller group had acute exacerbations with the mean numbers of 0.9 and 1.9/year, respectively (P = 0.027). In addition, 10 (21%) and 19 (41%) patients received step-up treatment, respectively. Cumulative incidence of step-up treatment was significantly lower in the montelukast group (hazard ratio 0.45, 95% confidence interval 0.21 to 0.92; P = 0.033). CONCLUSIONS: Montelukast is an effective control treatment for preschool children who had asthma symptoms more than once a month but less than once a week.

Treatment evaluation using lung sound analysis in asthmatic children.

BACKGROUND AND OBJECTIVE: Non-invasive assessment of treatment and prediction of attacks in asthmatic children do not yet exist. Lung sound analysis can non-invasively evaluate airway obstruction. We used a recently developed technology for analysing lung sounds using ic700 (index of the chest wall at 700 Hz, sound intensity at 700 Hz) to evaluate response to inhaled corticosteroid (ICS) in asthmatic children. METHOD: Seventy asthmatic children, including infants, underwent lung sound recording in the asymptomatic state prior to and 1, 2, 4, 6 and 8 weeks after ICS treatment, and asthma control was assessed at 10 weeks. The ic700 scores at 4, 6 and 8 weeks were compared with the presence of attack during the following 2 weeks. Subjects were divided into uncontrolled and well-controlled groups. RESULTS: The mean ic700 scores of all subjects significantly reduced after 8 weeks of treatment. The mean scores of the uncontrolled group were significantly higher than those of the well-controlled group at 4, 6 and 8 weeks after starting treatment. The ic700 cut-off value for predicting asthma attacks within 2 weeks following the evaluation was set at 0.0. After 6 weeks of treatment, the area under the curve was 0.92 ± 0.04; the sensitivity, specificity and positive and negative predictive values were 83%, 88% and 88% and 84%, respectively. Similar results were observed at 4 and 8 weeks. CONCLUSION: The ic700 score is useful in assessing the effects of ICS treatment, predicting attack symptoms and identifying asymptomatic asthmatic children at a high risk for asthma attack.

Changes in lung sounds during asthma progression in a guinea pig model.

BACKGROUND: Lung sound analysis is useful for objectively evaluating airways even in children with asymptomatic asthma. However, the relationship between lung sounds and morphological changes in the airways has not been elucidated. We examined the relationship between lung sounds and chronic morphological changes in the airways during the progression of asthma from onset in guinea pigs. METHODS: Eleven male guinea pigs were examined; of these, seven were used as asthma models and four as controls. The asthma models were sensitized and repeatedly challenged by inhaling albumin chicken egg. We measured lung sounds and lung function twice a week for 21 weeks. After the final antigen challenge, the lungs were excised for histological examination. We measured the ratio of airway wall thickness to the total airway area and the ratio of the internal area to the total airway area in the trachea, third bronchi, and terminal bronchioles. RESULTS: Among the lungs sounds, the difference between the two groups was greatest with respect to inspiratory sound intensity. The ratio of airway wall thickness to the total airway area of the terminal bronchioles was greater in the asthma models than in the controls, and it correlated best with the changes in inspiratory sound intensity in the 501-1000-Hz range (r = 0.76, p < 0.003). CONCLUSIONS: Lung sound intensity in the middle frequency range from 501 to 1000 Hz correlated with peripheral airway wall thickness. Inspiratory sound intensity appeared to be an indicator of morphological changes in small airways in asthma.

Evaluation of airflow limitation using a new modality of lung sound analysis in asthmatic children.

BACKGROUND: Reliable assessment of not only symptoms but also lung function is essential in asthma management. We developed a new technology for analyzing lung sounds and assessed its clinical usefulness in asthmatic children. METHODS: Forty-four children underwent lung sound recording with simultaneous airflow measurement using a sensor on the upper right anterior chest. We calculated a sound parameter index from the amplitude of inspiratory lung sounds at 700 Hz (ic700). ic700 were compared depending on flow and body size. In addition, 184 asthmatic children and 16 non-asthmatic children underwent lung sound analysis and lung function test in an asymptomatic state. In the asthma group, 135 children received treatment continually. The untreated asthma group included 28 children who had never received treatment continually and 21 children who had not been treated for at least 1 year. The asthmatic children were divided into four classes according to asthma severity. ic700 were compared depending on spirometric parameters and asthma severity classification. RESULTS: The influences of flow and body size were negligible for ic700. ic700 correlated with FEV1%, MMF and FEF50 (r = -0.436, -0.339 and -0.302, respectively). There was a significant difference of ic700 between asthmatic and non-asthmatic children (p < 0.001), and ic700 correlated with the classification of asthma severity (p < 0.001). The ic700 scores of the severe group were higher than those of the intermittent group and non-asthmatic children. CONCLUSIONS: It was possible to evaluate airway dysfunction of asthma using ic700, which was calculated non-invasively by analyzing lung sounds alone, without measuring body size and airflow.

Evaluation of airway responsiveness using colored three-dimensional analyses of a new forced oscillation technique in controlled asthmatic and nonasthmatic children.

BACKGROUND: Bronchodilator response (BDR) is routinely used in asthma management. A new forced oscillation technique (FOT) is able to quickly measure respiratory system resistance (Rrs) and reactance (Xrs) at each tidal breath phase. The present study evaluated bronchial changes by using the new FOT. METHODS: Respiratory resistance and reactance were measured using FOT in 132 children (age, 10.86±4.78 years; M:F=88:44), including asthmatic (n=98) and nonasthmatic children (n=34), pre- and post-bronchodilator inhalation in an asymptomatic state. Whole-breath or within-breath changes in Rrs and Xrs were measured and compared pre- and post-bronchodilator inhalation and between each group. All patients performed spirometry and forced expiratory nitric oxide pre- and post-bronchodilator inhalation. RESULTS: Spirometric parameters showed significant positive changes at V50 and V25 in both groups; however, these changes were not significantly different between the groups. eNO was significantly higher in the asthmatic group than in the nonasthmatic group; however, there was no significant change pre- and post-inhalation in either group. Rrs in the asthma group was significantly higher in the expiratory phase than in the inspiratory phase. Rrs and Xrs before and after bronchodilator inhalation were significantly different in the asthma group alone, except for the expiratory-inspiratory phase of each of these parameters. Changes in Rrs and Xrs at 5Hz (R5 and X5) in a whole-breath and the inspiratory phase were significantly different between the groups. CONCLUSIONS: Changes in X5 and R5 reflect bronchial reversibility. The new FOT is useful for asthmatic children.

A New Modality Using Breath Sound Analysis to Evaluate the Control Level of Asthma.

BACKGROUND: Reliable symptom assessment is essential in asthma management. We developed new technology for analyzing breath sounds and assessed its clinical usefulness for monitoring asthmatic children. METHODS: Eighty asthmatic children and 59 non-asthmatic children underwent breath sound analysis in an asymptomatic state. Their asthma control was assessed by the Asthma Control TestTM or Childhood ACTTM scores and divided into two groups, namely, well-controlled (perfect) (n = 19) and not well-controlled (not perfect) (n = 61). Breath sounds were recorded using two sensors, located on the right anterior chest and trachea. We calculated the acoustic transfer characteristics between the two points, which indicated the relationship between frequencies and attenuation during breath sound propagation. Two indices of sound parameters, the chest wall sound index (CWI) and the tracheal sound index (TRI), were calculated from the transfer characteristics and tracheal sounds. We also developed a new parameter, the breath sound index (BSI), on a 2-dimensional diagram of CWI and TRI and tried to determine whether BSI may clarify asthma control better than CWI or TRI alone. RESULTS: There was a significant difference in TRI and BSI between asthmatic and non-asthmatic children (p = 0.007, p < 0.001). There was a significant difference in CWI and TRI between the well-controlled and not-wellcontrolled groups (p < 0.001). BSI discriminated between the two groups accurately (p < 0.001). The sensitivity and specificity of BSI for asthma control were 83.6% and 84.2%, respectively. CONCLUSIONS: Asthma control could be evaluated using a new index calculated from breath sound analysis.

A new modality using breath sound analysis to evaluate the control level of asthma.

BACKGROUND: Reliable symptom assessment is essential in asthma management. We developed new technology for analyzing breath sounds and assessed its clinical usefulness for monitoring asthmatic children. METHODS: Eighty asthmatic children and 59 non-asthmatic children underwent breath sound analysis in an asymptomatic state. Their asthma control was assessed by the Asthma Control TestTM or Childhood ACTTM scores and divided into two groups, namely, well-controlled (perfect) (n = 19) and not well-controlled (not perfect) (n = 61). Breath sounds were recorded using two sensors, located on the right anterior chest and trachea. We calculated the acoustic transfer characteristics between the two points, which indicated the relationship between frequencies and attenuation during breath sound propagation. Two indices of sound parameters, the chest wall sound index (CWI) and the tracheal sound index (TRI), were calculated from the transfer characteristics and tracheal sounds. We also developed a new parameter, the breath sound index (BSI), on a 2-dimensional diagram of CWI and TRI and tried to determine whether BSI may clarify asthma control better than CWI or TRI alone. RESULTS: There was a significant difference in TRI and BSI between asthmatic and non-asthmatic children (p = 0.007, p < 0.001). There was a significant difference in CWI and TRI between the well-controlled and not-well-controlled groups (p < 0.001). BSI discriminated between the two groups accurately (p < 0.001). The sensitivity and specificity of BSI for asthma control were 83.6% and 84.2%, respectively. CONCLUSIONS: Asthma control could be evaluated using a new index calculated from breath sound analysis.

The effect of Lactobacillus brevis KB290 against irritable bowel syndrome: a placebo-controlled double-blind crossover trial.

BACKGROUND: Irritable bowel syndrome (IBS) is a functional disorder of the digestive tract that causes chronic abdominal symptoms. We evaluated the effects of Lactobacillus brevis KB290 (KB290), which has been demonstrated to be effective at improving bowel movements and the composition of intestinal microflora, on IBS symptoms. METHODS: We performed a placebo control double-blind cross matched trial. Thirty-five males and females (aged 6 years and above) who had been diagnosed with IBS according to the Rome III criteria were divided into 2 groups, and after a 4-week pre-trial observation period, they were administered test capsules containing KB290 or placebo for 4 weeks (consumption period I). Then, the capsule administration was suspended for 4 weeks in both groups (washout period), before the opposite capsules were administered for a further 4 weeks (consumption period II). Fecal samples were collected on the first day of the pre-consumption observation period, the last day of consumption period I, the last day of the washout period, and the last day of consumption period II. In addition, the subjects' IBS symptoms and quality of life (QOL) and any adverse events that they experienced were evaluated. RESULTS: No significant difference in IBS symptoms was noted among the various periods. However, the mean QOL scores were improved during the test capsule consumption.The frequencies of watery and mushy feces were significantly lower in the test capsule consumption period than during the pre-consumption observation period, and the frequency of abdominal pain was significantly reduced in the test capsule consumption period compared with the other periods.The frequency of the genus Bifidobacterium was significantly higher, and that of the genus Clostridium was significantly lower, after the test capsule consumption than after the placebo consumption. The frequencies of the genera Lactobacillus, Bacteroides, and Enterococcus were also investigated, but no differences in their frequencies were detected between the placebo and test capsule consumption periods. CONCLUSIONS: Probiotics, the safety of which has been established, are used widely in various foods and can now be purchased readily. The results of the present study suggest that KB290 is useful for early intervention in IBS.

Changes in the highest frequency of breath sounds without wheezing during methacholine inhalation challenge in children.

BACKGROUND AND OBJECTIVE: It is difficult for clinicians to identify changes in breath sounds caused by bronchoconstriction when wheezing is not audible. A breath sound analyser can identify changes in the frequency of breath sounds caused by bronchoconstriction. The present study aimed to identify the changes in the frequency of breath sounds during bronchoconstriction and bronchodilatation using a breath sound analyser. METHODS: Thirty-six children (8.2 +/- 3.7 years; males : females, 22 : 14) underwent spirometry, methacholine inhalation challenge and breath sound analysis. Methacholine inhalation challenge was performed and baseline respiratory resistance, minimum dose of methacholine (bronchial sensitivity) and speed of bronchoconstriction in response to methacholine (Sm: bronchial reactivity) were calculated. The highest frequency of inspiratory breath sounds (HFI), the highest frequency of expiratory breath sounds (HFE) and the percentage change in HFI and HFE were determined. The HFI and HFE were compared before methacholine inhalation (pre-HFI and pre-HFE), when respiratory resistance reached double the baseline value (max HFI and max HFE), and after bronchodilator inhalation (post-HFI and post-HFE). RESULTS: Breath sounds increased during methacholine-induced bronchoconstriction. Max HFI was significantly greater than pre-HFI (P < 0.001), and decreased to the basal level after bronchodilator inhalation. Post-HFI was significantly lower than max HFI (P < 0.001). HFI and HFE were also significantly changed (P < 0.001). The percentage change in HFI showed a significant correlation with the speed of bronchoconstriction in response to methacholine (P = 0.007). CONCLUSIONS: Methacholine-induced bronchoconstriction significantly increased HFI, and the increase in HFI was correlated with bronchial reactivity.

High-pitched breath sounds indicate airflow limitation in asymptomatic asthmatic children.

BACKGROUND AND OBJECTIVE: Asthmatic children may have airway dysfunction even when asymptomatic, indicating that their long-term treatment is less than optimal. Although airway dysfunction can be identified on lung function testing, performing these tests can be difficult in infants. We studied whether breath sounds reflect subtle airway dysfunction in asthmatic children. METHODS: The highest frequency of inspiratory breaths sounds (HFI) and the highest frequency of expiratory breath sounds (HFE) were measured in 131 asthmatic children while asymptomatic and with no wheezes for more than 2 weeks. No child was being treated with inhaled corticosteroids (ICS). Breath sounds were recorded and analysed by sound spectrography and compared with spirometric parameters. After initial evaluation, cases with more than step 2 (mild persistent) asthma were treated using inhaled fluticasone (100-200 microg/day) for 1 month, and then breath sound analysis and pulmonary function testing were repeated. RESULTS: On initial evaluation, HFI correlated with the percentage of predicted FEF(50) (%FEF(50)), (r = -0.45, P < 0.001), the percentage of predicted FEF(75) (%FEF(75)) (r = -0.456, P < 0.001), and FEV(1) as a percentage of FVC (FEV(1)/FVC (%)) (r = -0.32, P < 0.001). HFI did not correlate with the percentage of predicted PEF (%PEF). The 69 children with lower than normal %FEF(50) were then treated with ICS. The %FEF(50) and %FEF(75) improved after ICS treatment, and increases in %FEF(50) (P < 0.005) correlated with decreases in HFI (P < 0.001). CONCLUSIONS: Higher HFI in asymptomatic asthmatic children may indicate small airway obstruction. Additional ICS treatment may improve the pulmonary function indices representing small airway function with simultaneous HFI decreases in such patients.