Validation of an asthma symptom diary for interventional studies.

OBJECTIVE: The Pediatric Asthma Diary was developed and validated to assess efficacy of interventions in children with asthma. DESIGN, PATIENTS, AND SETTING: Diary validation was performed in a three week, prospective study of 106 children aged 6-14 years with asthma. Children were classified at baseline as either stable (requiring no additional asthma treatment) or new onset/worse (requiring either addition of or increase in anti-inflammatory treatment). RESULTS: A daytime symptom scale and "day without asthma" were defined from diary questions. Both measures demonstrated significant validity and responsiveness to anti-inflammatory treatment. The stable group experienced a higher percentage of days without asthma during week 1 compared with the new onset/worse group (39.6% v 11.6%, respectively). The new onset/worse patients experienced significant improvement in days without asthma (24.5%) compared with stable patients (6.4%). CONCLUSIONS: The Pediatric Asthma Diary daytime symptom scale and day without asthma are acceptable measures for use in asthma intervention studies of children aged 6-14 years.

Urticaria. The diagnostic challenge of hives.

Hives pose a diagnostic challenge to physicians. With an acute episode, a careful look for possible triggers and relief of symptoms with H1 antihistamines are usually sufficient. For both urticaria and angioedema, the most helpful diagnostic tool may be a carefully taken medical history, including a family history. When a patient's urticaria lasts for more than 6 weeks, further physical and laboratory evaluation is warranted. Treatment of chronic urticaria generally involves the use of antihistamines first. Corticosteroids are to be avoided, if possible.

Evaluation of the Autohaler actuator: the effect of written patient instructions on correct use.

The Autohaler actuator is a breath-actuated device designed by 3M Pharmaceuticals. The objective of this study was to measure and improve the effectiveness of the device's package insert instructions (PII). Using only the PII for guidance, 5 of 20 (25%) subjects failed to trigger the device. The PII were revised based on the subject's performance and suggestions. Using the revised PII, only 1 of 20 (5%) different subjects failed to trigger the device. These results indicate that relatively minor modifications to instructions can result in significant improvements in patient use. Eighty-five percent of the participants thought the device was easier to use than a metered-dose inhaler.

A quantitative fluorescent method for measurement of bacterial adherence and phagocytosis.

We have developed a new two-color fluorescent method for the quantitative measurement of adherence and ingestion of Streptococcus pneumoniae by human monocytes. The method employs a fluorescent naphthalimide, Lucifer Yellow VS, that has been covalently linked to the bacterial cell wall. Bacteria were opsonized and allowed to adhere to monocytes. Lucifer Yellow did not alter the bacterial interaction with complement in serum or with the phagocytic cell. The ability of monocytes to ingest the adherent bacteria was tested under a variety of conditions. Rabbit antibody to Lucifer Yellow derivatized with Texas Red was used to detect monocyte-bound, but uningested bacteria. Dual laser flow cytometry simultaneously quantitated the total number of monocyte-associated S. pneumoniae and the number that remained surface adherent. This method allows separate analysis of the opsonins and receptors involved in bacterial adherence to phagocytes and in the ingestion process.