Protocol for a multicentre randomised controlled trial to investigate the effect on asthma-related quality of life from breathing retraining in patients with incomplete asthma control attending specialist care in Denmark.

INTRODUCTION AND AIM: Uncontrolled asthma is a global health challenge with substantial impact on quality of life (QoL) and overall healthcare costs. Unrecognised and/or unmanaged comorbidities often contribute to presence of uncontrolled asthma. Abnormalities in breathing pattern are termed dysfunctional breathing and are not only common in asthma but also lead to asthma-like symptoms and reduced QoL, and, in keeping with this, improvement with breathing normalisation. Evidence-based guidelines recommend breathing retraining interventions as an adjuvant treatment in uncontrolled asthma. Physiotherapy-based breathing pattern modification interventions incorporating relaxation have been shown to improve asthma-related QoL in primary care patients with impaired asthma control. Despite anecdotal reports, effectiveness of breathing retraining in patients referred to secondary care with incomplete asthma control has not been formally assessed in a randomised controlled trial (RCT). We aim to investigate the effect of breathing exercises on asthma-related QoL in patients with incomplete asthma control despite specialist care. METHODS AND ANALYSIS: This two-armed assessor-blinded multicentre RCT will investigate the effect of physiotherapist-delivered breathing retraining on asthma QoL questionnaire (MiniAQLQ) in addition to usual specialist care, recruiting from seven outpatient departments and one specialised clinic representing all regions of Denmark during 2017-2019. We will include 190 consenting adults with incomplete asthma control, defined as Asthma Control Questionnaire 6-item score ≥0.8. Participants will randomly be allocated to either breathing exercise programme in addition to usual care (BrEX +UC) or UC alone. BrEX compiles three physiotherapy sessions and encouragement to perform home exercise daily. Both groups continue usual secondary care management. Primary outcome is between-group difference in MiniAQLQ at 6 months. Secondary outcomes include patient-reported outcome measures, spirometry and accelerometer. ETHICS AND DISSEMINATION: Ethics Committee, Region Zealand (SJ-552) and Danish Data Protection Agency (REG-55-2016) approved the trial. Results will be reported in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER: NCT03127059; Pre-results.

[Congenital methaemoglobinaemia--a rare cause of dyspnoea and cyanosis]. / Kongenit methæmoglobinæmi er en sjælden årsag til dyspnø og cyanose.

Dyspnoea in young people often leads to the diagnosis of asthma. A young female (with related parents) showed symptoms of cyanosis, dyspnoea and fatigue during physical activity despite asthma medication. High levels of methaemoglobin were measured. Genetic testing showed homozygote type 1b5r-deficiency. Cyanosis and lacking effect of asthma treatment should lead to further diagnostic evaluation with arterial blood gas analyses, including assessment of methaemoglobin. Congenitally inherited methaemoglobinaemia is a rare disease, but its diagnosis is important to ensure correct handling and treatment.

[Acute psychosis following bupropion overdosage]. / Akut psykose efter bupropionoverdosering.

Bupropion is an antidepressant, which in Denmark is only used as an aid for smoking cessation. The toxicological side-effects include insomnia, gastrointestinal symptoms, tachycardia and seizures. A case of intentional overdose in a fourteen-year-old boy is presented. He developed hallucinations and tachycardia after ingesting only 1500 mg of bupropion, but recovered without sequelae.

Bone mineral status in children with cow milk allergy.

To investigate bone mineral status in children with verified cow milk allergy for more than 4 yr compared with a large reference population of 343 local healthy controls. Whole body bone mineral content (BMC), projected bone area and bone mineral density (BMD) were determined by dual energy x-ray absorptiometry in nine children (8-17 yr old, one girl and eight boys). All children had cow milk allergy for more than 4 yr. All children had asthma and was treated with corticosteroids. BMC and BMD were reduced for age (p < 0.01). Height for age was significantly reduced (p < 0.01), indicating 'short' bones. BMC for bone area was borderline reduced (p = 0.05), indicating reduced bone mineralization. The growth of the children was reduced compared with there parents and siblings (p < 0.01), and the bone age was retarded (mean 1.4 yr, p < 0.01). Calcium consumption calculated from food intake was about 25% of the recommended. All laboratory tests were normal. Short bones were the main reason for reduced BMC and BMD for age in children with cow milk allergy, but a borderline low BMC for bone area indicated reduced bone mineralization of the bones. A supplementation of calcium to children with cow milk allergy is recommended.

The prevalence of latex sensitisation and allergy in Danish atopic children. Evaluation of diagnostic methods.

BACKGROUND: All over the world natural rubber allergy is reported to be responsible for a wide spectrum of allergic symptoms ranging from mild rhinitis to severe anaphylaxis. AIM: To estimate the prevalence and the clinical significance of latex sensitisation in atopic children seen in a university paediatric outpatient clinic. MATERIALS AND METHODS: During 1997-1998, a total of one hundred atopic children (4-14 years old, 64 boys and 36 girls) were consecutively screened for latex sensitisation by skin prick tests (SPTs) with standard inhalant allergens (ALK) and latex (Stallergenes SA), measurement of specific IgE (CAP System, Pharmacia, and Magic Lite, ALK) and total IgE. A clinical history with attention to surgical history, latex exposure and presence of symptoms possibly due to latex or food allergy was obtained. RESULTS: Five children (5%) had positive SPT to latex. Four (4%) had positive specific IgE to latex but had a negative SPT to latex. Only one patient (1%), who had spina bifida, had a positive SPT together with symptoms which could be related to latex allergy. This patient also had RAST class 4 to latex both with CAP System and Magic Lite. A history of previous surgery was found in only one of the children with positive latex SPT. Latex CAP System was positive in two of the five latex SPT positive patients, and latex Magic Lite in one of the five. In one patient without any symptoms of latex allergy, both SPT and in vitro tests were positive. Another child without symptoms, and with negative SPT, also had positive in vitro results. CONCLUSION: We found that the prevalence of sensitisation to latex was 9% in atopic children, but the prevalence of manifest type 1 latex allergy was only 1%. Latex allergy in atopic children seems to be a small problem in Denmark. How to evaluate the significance of positive in vitro tests and positive latex SPT in patients without symptoms to latex, remains an open question.

[Peanut allergy]. / Peanutallergi.

Four Danish cases of peanut allergy are described. Peanut allergy is increasing in Western countries, and is a known cause of severe reactions, some of them fatal. The prevalence in Denmark is still unknown, but it is probably under-diagnosed.