[A better measure for exposure levels to tobacco smoke is needed].
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Child↗
Biomedical subjects
E Svenonius
Publications and source records attributed to E Svenonius.
Passive smoking and childhood asthma. Urinary cotinine levels in children with asthma and in referents.
Passive exposure to tobacco smoke was assessed in children with asthma (age 3-15) and in referents. There was statistically significantly (P less than 0.0005) higher excretion of the nicotine metabolite, cotinine, in the urine of 49 children with asthma (geometric mean 10 ng/ml) compared with 77 referents (4.8 ng/ml). Maternal smoking was statistically significantly more prevalent among the asthmatics than among the referents (relative risk = RR = 2.6, 95% C1 = 1.2-5.3). In conclusion, the exposure to environmental tobacco smoke in asthmatic children was higher than among healthy children, indicating that passive smoking may be a predisposing and/or aggravating factor for childhood asthma.
Adolescent↗
Heterozygous alpha 1-antichymotrypsin and PiZ alpha 1-antitrypsin deficiency. Prevalence and clinical spectrum in asthmatic children.
In a case-control study we compared the prevalence of heterozygous deficiency of two closely related anti-neutrophil protease inhibitors, alpha 1-antitrypsin and alpha 1-antichymotrypsin, in 172 consecutive children with asthma. In a cohort study the clinical spectrum and severity were compared. On the basis of family studies 5/172 (2.9%) were classified as heterozygotes for alpha 1-antichymotrypsin deficiency, a high prevalence compared with that of an unselected adult population (prevalence ratio 4.5 (1.7-11.9), P less than 0.005). This finding suggests that the carrier state of this rare allele (prevalence 0.64%) may predispose to asthma in children. Among these heterozygous patients the prevalence of positive RAST tests for foodstuffs was significantly increased (prevalence ratio 4.8 (1.7-13.2), P less than 0.005) and 2/5 manifested food allergy with Quincke oedema. Either the PiMZ or SZ phenotype of alpha 1-antitrypsin deficiency was found in 12 (7.0%) of the 172 patients, a prevalence similar to that of a normal population (prevalence ratio 1.3 (0.67-2.6), P = 0.44). However, the asthma was more severe among the Z allele carriers, judged by the number of hospital admissions, compared with the non-Z asthmatic children (mean 2.92 vs. 1.72, P less than 0.05). The results indicate that heterozygous deficiency of protease inhibitors directed against neutrophil proteases may affect the severity and clinical spectrum of childhood asthma, and to some degree be predisposing.
Asthma↗
Effect of physiotherapy in asthmatic children--a one-year follow-up after physical training once a week.
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Adolescent↗
A double-blind comparison between a new multidose powder inhaler (Turbuhaler) and metered dose inhaler in children with asthma.
Turbuhaler is a ready-loaded multiple dose inhaler which does not require co-ordination between release of dose and inhalation. 57 children with asthma participated in this clinical trial to compare the clinical effect and acceptance of terbutaline sulphate via Turbuhaler with that of metered dose inhaler (MDI). The trial consisted of two parts. In the first part of the study, which made use of a double-blind cross-over design, the clinical effect and number of treatment occasions with Turbuhaler were compared with those of MDI. In the second part, which was open, all patients were treated with Turbuhaler for 2 weeks. At the end of this period the patients were asked to make a subjective assessment of effect and to state their preference. There was no difference in clinical effect and number of treatment occasions between Turbuhaler and MDI. A majority of the patients thought Turbuhaler had the best effect and was easy to use.
Adolescent↗
Treatment of asthma in pre-school children with inhalation of terbutaline in Turbuhaler compared with Nebuhaler.
The aim of this study was to evaluate the efficacy, safety and preference of pre-school children with regard to two different devices for treatment of bronchial asthma with terbutaline. Turbuhaler, a powder inhaler preloaded with pure terbutaline for inhalation, was compared with a pressurized metered dose inhaler, attached to a Nebuhaler. The study had an open, cross-over randomized design. Each treatment period consisted of 2 weeks. Diary cards were filled in every morning and evening by the parents regarding PEF, asthma symptoms, extra inhalations of terbutaline, and side effects. Twenty-one children (mean age 3.9 years) were included in the study. A highly significant (P less than 0.001) increase in peak expiratory flow (PEF) was obtained after inhalation with both devices. The PEF values in the mornings after inhalation of terbutaline with Turbuhaler were significantly higher (P = 0.046) than those with Nebuhaler. Further, the PEF baseline values in the evenings before inhalation were also significantly higher (P = 0.03) with Turbuhaler. No difference was found in asthma symptoms and extra medication between the two devices. Side effects were mild and few with both devices. The parents found Turbuhaler easier to handle and 19 of 21 preferred this device for future use.
Asthma↗
Prevention of exercise-induced asthma by drugs inhaled from metered aerosols.
The capacity of salbutamol 0.3 mg (SAL), disodium cromoglycate 3 mg (DSCG), a combination (SAL + DSCG), and ipratropium bromide 80 ug (IB), all given as metered aerosols to prevent exercise-induced (EIA), was compared with that of a placebo, a peroral lactose pill. Seven children participated, having reproducible EIA provoked by running on a treadmill at a heart rate of 170 sustained for 6 min. FEV1 and volume of trapped gas (VTG), defined as the air volume released during rebreathing oxygen with maximum breaths at the end of a multiple breath nitrogen wash out, were used as tests of spasm in large and small airways. SAL and SAL + DSCG offered complete protection in large and small airways. DSCG and IB prevented EIA in large airways (FEV1) to 95%, but only to about 50% in small airways (VTG). SAL or SAL + DSCG gave significantly better protection (FEV1 and VTG) than DSCG and IB (P less than 0.01). Differences between DSCG and IB were not statistically significant. DSCG or propellant caused significant irritation and spasm in small airways (VTG) before exercise. Most subjects seemed to obtain satisfactory protection against EIA by beta 2-agonists.
Administration, Inhalation↗
Decrease of exercise-induced asthma after physical training.
Exercise-induced asthma (EIA) is a multifactorial disease induced by cooling and drying of the airways. Mediator release or vagal stimulation, or both, may transmit the reaction to bronchial muscles. Premedication with beta 2-aerosol before exercise has the best preventive effect, although disodium cromoglycate (DSCG) or atropine prevent EIA in about 50% of the patients. EIA is provoked when the anaerobic threshold is passed. Training with high load interval exercise after premedication increased the anaerobic threshold in three groups of children, and a significant decrease in EIA was recorded, while a non-training control group showed no changes.
Albuterol↗
Improvement after training of children with exercise-induced asthma.
Fifty children with exercise-induced asthma (EIA) volunteered to take part in a study of the influence of training on EIA. 1) Ten children did not change physical activity. 2) Twelve children trained after premedication with salbutamol inhalations. 3) Thirteen children trained after premedication with disodium chromoglicate (DSCG) and used that drug for treatment. 4) Fifteen children trained in their own regimen, commonly after premedication with salbutamol. Their training programme (groups 2-3) consisted of high load exercise periods of two minutes interrupted by intervals of rest for two minutes during 30 minutes followed by interval swimming for another 30 minutes, twice a week for 3-4 months. Before the training period the degree of EIA was tested with a battery of lung function tests before and after running for 6 minutes on a treadmill at heart rate 170. EIA after training was measured applying the same procedure. Cardiocirculatory performance was evaluated before and after training with work on a cycle ergometer and expressed as W/kg body weight at heart rate 170. The children in groups 2, 3 and 4 improved their physical working capacity by 11% (p less than 0.01), 21% and 11%, respectively, but no improvement was found in group 1. Significant improvements in EIA after the training periods were found in all training groups, but basal asthma improved most in group 3, probably due to the basal treatment with DSCG.
Adolescent↗
The volume of trapped gas in healthy children aged 7--16.
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Adolescent↗
The volume of trapped gas: a new and sensitive test for the detection of exercise-induced bronchospasm in children.
The volume of trapped gas (VTG) was measured at the end of a nitrogen multiple breath wash out procedure in 16 asthmatic and 10 healthy children before and after exercise. When compared to conventional spirometric variables VTG was the most sensitive test for detection of exercise-induced asthma (EIA). The VTG was significantly higher before exercise in the asthmatic children and increased significantly after exercise, while it did not change in the healthy controls. The significance of changes caused by EIA increased if VTG/TLC % or VTG/VC % wer used. Salbutamol inhalation normalized the VTG in all the asthmatic children.
Adolescent↗