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Biomedical subjects

J Gerritsen

Publications and source records attributed to J Gerritsen.

At least 91 records · Page 5Linked to original sources
PubMed1993

Cessation of long-term treatment with inhaled corticosteroid (budesonide) in children with asthma results in deterioration. The Dutch CNSLD Study Group.

Inhaled corticosteroid has been shown to be effective in the management of asthma. However, there is a lack of studies that assess the effect of cessation after long-term treatment with inhaled corticosteroid. This question was addressed in 28 children with stable asthma, aged 11 to 18 yr of age, who had completed 28 to 36 months of treatment with inhaled corticosteroid (budesonide 200 micrograms 3 times/day) and inhaled beta-2-agonist (salbutamol 200 micrograms 3 times/day). The children were randomized in a 1:2 ratio in a double-blind study either to continue budesonide (n = 8) during a period of 6 months or to decrease the dose of budesonide (n = 20) within 2 months, followed by placebo for 4 months. Treatment with salbutamol 600 micrograms daily was continued in both groups. Eight children from the tapering-off group withdrew, mainly due to symptoms of asthma, compared with none in the continuous treatment group. Five patients in the tapering-off group experienced exacerbations for which prednisolone was given, compared with none in the continuous treatment group. After tapering-off, symptoms of asthma and additional bronchodilator use increased, and both FEV1% predicted and PD20 histamine (provocation dose of histamine causing a 20% fall in FEV1) decreased, whereas these all remained unchanged in the group that continued treatment with inhaled corticosteroid. We conclude that in this study long-term treatment with 600 micrograms budesonide daily suppressed underlying mechanisms of asthma, but did not cure the disease.

Administration, Inhalation↗
PubMed1993

Risk factors for the persistence of respiratory symptoms in childhood asthma.

We studied the prognosis of childhood asthma in a cohort of 406 children 8 to 12 yr of age when enrolled. Subjects were followed for a mean of 14.8 yr after their initial evaluation, with a follow-up rate of 86%. The mean age at follow-up was 24.7 yr. We assessed the predictive value of sex and various childhood variables on the outcome of symptoms and medication use in adulthood. Although only 19% of subjects were still under a physician's supervision at the time of follow-up, 76% had respiratory symptoms, 32% used maintenance medication, and 22% used medication intermittently. The incidence of cigarette smoking was disturbingly high (33%). In adulthood, women were more likely than men to have symptoms (85 versus 72%, respectively). The childhood symptom severity and the childhood degree of bronchial responsiveness in combination with a low %FEV1 were also related to the outcome of asthma in adulthood. The high prevalence of symptoms in adults at follow-up coupled with the low rate of physician supervision and medication usage suggest that more aggressive treatment may be indicated in asthmatic children.

Adult↗
PubMed1993

[Interstitial pneumonia in childhood: a clinical picture different from COPD].

Chronic respiratory symptoms in children are often caused by asthma. In this paper we present two children with chronic respiratory symptoms, which we first attributed to asthma. Since the presence of symptoms were not in agreement with asthma and because the children did not respond to asthma therapy, another cause of chronic lung disease was suspected. An open lung biopsy was performed. Histological diagnosis in both patients was an interstitial pneumonia. Differential diagnosis between interstitial pneumonia and asthma can be difficult, however there is a difference in symptomatology between these two diseases. Symptoms which may indicate the presence of another chronic lung disease than asthma are: absence of symptom-free periods, persistence of impaired exercise tolerance, hemoptysis, recurrent auscultation of crackles during symptomatic periods and digital clubbing.

Adrenal Cortex Hormones↗
PubMed1993

Changes in respiratory symptoms and airway hyperresponsiveness after 27 years in a population-based sample of school children.

We wanted to test the hypothesis that childhood airway hyperresponsiveness, even in the absence of respiratory symptoms, is a risk factor for respiratory disease in adulthood. In a childhood survey of 1963, three groups of 20 children aged 8-11 yrs, were selected from a population sample: 1) a group with recurrent respiratory symptoms (symptomatic group); 2) a group with no symptoms but a positive family history of atopy; and 3) a control group. All children completed assessment of symptoms, atopy, lung function, and airway hyperresponsiveness. At the adulthood survey 27 yrs later, 85% of the original sample were reinvestigated. Only 10 out of 19 subjects (53%) of the original symptomatic group still had symptoms. The significant difference of forced expiratory volume in one second (FEV1) % predicted in childhood between the symptomatic and the control group had disappeared. The prevalence of airway hyperresponsiveness had decreased in all groups. In asymptomatic hyperresponders it had normalized at adult age. The asymptomatic hyperresponders in childhood had lower levels of lung function, both in childhood and in adulthood. In univariate and multivariate analyses, respiratory symptoms at adult age were related to childhood atopy. Results suggest that childhood atopy is a risk factor for respiratory symptoms in young adulthood, but that mild childhood airway hyperresponsiveness is not.

Bronchial Hyperreactivity↗
PubMed1993

Skin reactivity and eosinophil count in relation to the outcome of childhood asthma.

The aim of this study was to determine whether an association can be found between childhood skin reactivity and the outcome of asthma in young adulthood in a group of 406 asthmatic children, of whom 348 (86%) could be followed up in adulthood. A complete data set on skin tests and eosinophil count was available in 259 allergic subjects. They were stratified into three classes, according to initial skin test score in childhood. An increase in skin reactivity was noted from childhood to adulthood, while the differences in skin reactivity between the three classes remained significant. In childhood, a marked difference in total eosinophil count was found between the classes. Towards adulthood, a decrease in eosinophil count was noted, and the differences between the classes were no longer significant. The children with lowest skin reactivity also had the lowest symptom score in childhood. In adulthood, the prevalence of respiratory symptoms in this class was lower than in the other two classes. The prevalence of bronchial responsiveness to histamine was lowest in subjects with the lowest skin test score in childhood. Ventilatory parameters revealed no differences between the three classes. We conclude that although a low skin reactivity in childhood might be associated with a relatively favourable prognosis for asthma symptoms in adulthood, there is only limited evidence to support this hypothesis in our study.

Asthma↗
PubMed1993

Assessment of bronchodilator response in children with asthma. Dutch CNSLD Study Group.

The bronchodilator response (BDR) in forced expiratory volume in one second (FEV1) is routinely assessed to estimate the reversibility of airways obstruction. However, there is no consensus on how the BDR should be expressed, and recommendations applying to children are lacking. Similarly, the relationship between BDR and nonspecific bronchial hyperresponsiveness to histamine (BHR) has not been elucidated. These questions were addressed in 116 children, 7-16 yrs of age, with stable asthma after withdrawal of all pulmonary maintenance medication. Inclusion criteria were an initial FEV1 between 55-90% predicted, and/or FEV1/forced vital capacity (FVC) between 50-75%, as well as a fall in FEV1 of 20% or more when challenged with up to 150 micrograms histamine. The change in FEV1 (delta FEV1) 20 min after inhalation of 800 micrograms salbutamol was expressed in four ways: as an absolute difference (delta FEV1(l)), as a percentage of predicted FEV1 (delta FEV1%pred) or initial FEV1 (delta FEV1%init), and as a percentage of the deficit in FEV1 (delta FEV1%(pred-init)). delta FEV1%init and delta FEV1%pred were not related to age and stature of the children; delta FEV1%(pred-init) was related to stature, whilst delta FEV1(l) was related to both age and stature. All indices correlated with initial FEV1. However, this is an artefact introduced by relating change to initial value, rather than to the mean of initial and final value. In fact, BDR, expressed as delta FEV1%pred, was only slightly greater in children with the lowest initial airway calibre (p = 0.08), unlike delta FEV1%init. BDR was weakly related to BHR.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

The effect of an inhaled corticosteroid (budesonide) on exercise-induced asthma in children. Dutch CNSLD Study Group.

The effect of long-term treatment with inhaled corticosteroid on exercise-induced asthma (EIA) was studied in 55 children, aged 7-18 yrs (mean 12 yrs). We also compared the time course of stabilization of EIA to that of other indicators of airway responsiveness, such as peak expiratory flow (PEF) variation and the provocation dose of histamine causing a 20% fall in forced expiratory volume in one second (FEV1). All children participated in an ongoing multicentre study to compare the effects of long-term treatment either with the beta 2-agonist salbutamol (600 micrograms.day-1) plus the inhaled corticosteroid budesonide (600 micrograms.day-1) (BA+CS), or salbutamol plus placebo (BA+PL), on airway calibre, airway responsiveness and symptoms. After a median follow-up of 22 months, the study design had to be changed, because of the high number of drop-outs on BA+PL. At that time, the treatment regimen of all children who had not withdrawn was changed into BA+CS. At the moment of change, and after 2 and 8 months of treatment, a treadmill exercise test was performed in two centres. Eighteen of the 22 children (82%) who were treated with BA+PL from the beginning had EIA, compared to 18 of the 33 children (55%) who were treated with BA-CS (p < 0.05). After 2 and 8 months of treatment with BA+CS in the patients previously on BA+PL this percentage decreased to 59 and 55%, respectively, and was not significantly different between both groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Administration, Inhalation↗
PubMed1992

Influence of a positive family history and associated allergic diseases on the natural course of asthma.

The outcome of childhood asthma was studied in a cohort of 406 asthmatic children, with emphasis on the influence of family history for allergic disease, as well as the influence of associated allergic diseases on prognosis. Sixty-two per cent had a positive family history for atopy. In young adulthood no differences, either in symptoms or lung function were demonstrated in comparison to subjects with a negative family history. Fifty-two per cent of the children had no other allergic disease, 48% had either eczema or hay fever or both. When subjects were stratified based on associated allergic disease, no differences in outcome in adulthood were revealed either. It is concluded that neither a positive family history, nor concurrent associated allergic diseases in the child contribute to the prognosis of asthma from childhood to young adulthood. Therefore, environmental factors as well as patient characteristics (including lung function level, level of bronchial responsiveness) are likely to be more important for the prognosis.

Adult↗
PubMed1991

Repeated provocation tests in asthmatic children for testing tachyphylaxis to histamine.

Tachyphylaxis to histamine was investigated in 16 children, aged 7-15 years, with mild asthma. Three consecutive histamine challenges were performed at intervals of 24 hours and 1 hour, respectively. No significant differences in IVC, FEV1, and PC20-histamine values between the three measurements were observed. After a 24 hour interval there was no difference in percentage fall of FEV1, but there was a slight (not significant) decrease in fall of FEV1 after a 1 hour interval. The PC20-histamine values showed good reproducibility with a 24 hour as well as with a 1-hour period between the tests (geometric mean PC20, 2.04 mg/mL +/- 3.50 %SD, 1.96 mg/mL +/- 4.37 %SD, 2.17 mg/mL +/- 4.12 %SD; correlation coefficients for a 24 hour interval, r = 0.87 and for a one-hour interval, r = 0.94 (P less than 0.01]. We conclude that in children there is no strong evidence for tachyphylaxis to histamine. Our results differ from studies on tachyphylaxis in adult asthmatics. Possibly different mechanisms exist in children and in adults.

Adolescent↗
PubMed1991

Budesonide and terbutaline or terbutaline alone in children with mild asthma: effects on bronchial hyperresponsiveness and diurnal variation in peak flow.

The effects of treatment with budesonide (200 micrograms twice daily) and terbutaline (500 micrograms four times daily) has been compared with the effects of placebo and terbutaline in 27 children with mild asthma, aged 7-14 years, in a double blind, randomised placebo controlled study over eight weeks. Bronchial responsiveness (PC20 histamine), lung function, the amplitude of diurnal variation in peak expiratory flow (PEF), and symptom scores were measured. Baseline FEV1 was over 70% predicted and PC20 histamine less than 8 mg/ml. Twelve children were treated with budesonide and terbutaline and 15 with placebo and terbutaline. After four and eight weeks of treatment the change in PC20 was significantly greater after budesonide and terbutaline than after terbutaline alone by 2.1 (95% CI 0.5-3.8) and 1.3 (95% CI 0.1-2.5) doubling doses respectively. Mean FEV1 did not change in either group. The change in afternoon and nocturnal PEF was significantly greater after budesonide and terbutaline than after terbutaline alone. The amplitude of diurnal variation in PEF did not change significantly in either group. Peak flow reversibility decreased in the budesonide group. There were no differences between treatments for cough and dyspnoea, but wheeze improved in the budesonide group. The children with mild asthma treated with budesonide and terbutaline showed improvement in bronchial responsiveness, afternoon and nocturnal PEF, and symptoms of wheeze and a fall in peak flow reversibility by comparison with those who received terbutaline alone.

Administration, Inhalation↗
PubMed1991

[Bronchial hyperreactivity].

Bronchial hyperreactivity, the abnormal reaction of the airways on non-allergic stimuli, is a feature of patients with chronic nonspecific lung disease. Several underlying mechanisms such as the neurogenic pathways, inflammatory cells and mediators, increased vascular leakage, epithelial damage and pathological changes in airway smooth muscle seem to play a role of importance in bronchial hyperreactivity. Recent developments in these research fields produce more clarity in the mutual connection of these factors in relation to the phenomenon of bronchial hyperreactivity.

Adrenergic Fibers↗
PubMed1990

Nocturnal asthma, histamine and vagal activity.

In a study of two groups of nine allergic asthmatic children, consisting of one group with (group I) and one group without (group II) increased nocturnal airflow obstruction, we determined whether an increase in vagal activity, or inflammatory mediators like histamine are responsible for the nocturnal increase in airflow obstruction. The results of investigations in the two groups of asthmatics were compared to the results of an age matched control group. Forced expiratory volume in one second (FEV1) and electrocardiogram recordings of one minute were obtained every 4 hours during 24 hours. Heart rate and sinus arrhythmia gap were used to express vagal activity indirectly. N tau-methylhistamine was determined in urine samples collected in periods of 4 hours between the measurements. In group I, overall N tau-methylhistamine excretion was on a higher level than in both other groups, and was significantly higher overnight. Parasympathetic stimulation did not seem of importance to the increase of airflow obstruction at night.

Adolescent↗
PubMed1990

Guidance of children and adolescents with cystic fibrosis.

Cystic fibrosis is the most common serious genetic disorder in people of European descent. Treatment of these patients is ongoing throughout life and until now has been aimed at the consequences and is still not curative. Over the past 10-20 years, there has been a dramatic improvement of mortality rates for cystic fibrosis, due in large part to advances in medical care. The average age of survival for young people with cystic fibrosis is pushing well into the 20s with one third living into their 30s. Consequently, education plays a major role in management of patients with cystic fibrosis, and starts directly after being sure of the diagnosis. Growing up, these patients experience a lot of problems, and these are especially marked in the adolescent. A special problem, for many cystic fibrosis patients is becoming an adult. Continuity in care for these patients from the pediatric to the adult department is not always guaranteed. It is concluded that patients with cystic fibrosis should be treated in specialized centers, and such treatment cannot be carried out sufficiently by one person, but has to be embedded in a team of caregivers.

Adolescent↗
PubMed1990

Change in airway responsiveness to inhaled house dust from childhood to adulthood.

Between 1966 and 1969, housedust (HD) inhalation provocation tests were performed in 119 children with asthma. Between 1984 and 1987, 101 of the 119 subjects (85%) were reinvestigated. Thirty-one of these 101 adults who participated in a study on the outcome of childhood asthma were rechallenged with HD after a mean interval of 16 years to establish the change in airway responsiveness to HD from childhood to adult life. In the childhood study in these 31 subjects, six had no response (NAR); six, an early response (EAR); eight, a late (LAR); and eleven subjects, an EAR followed by an LAR (dual asthmatic response [DAR]) to the inhalation of HD. In the second survey, two of the subjects with NAR in the first study had a bronchoconstrictor response to HD. Five subjects with an EAR or an LAR response in childhood had NAR as an adult. The eleven subjects with a DAR during childhood also had a response to HD as an adult; five had an EAR, and six adults again had a DAR. Eleven of the 13 adults (85%) with current respiratory symptoms had a response to HD during the second survey. Although they were symptom free, 11 of the other 18 adults (61%) responded on inhalation of HD. One of the 18 subjects without (6%), and six of the 13 subjects (46%) with current respiratory symptoms, had a provocative concentration of histamine in FEV1 10% of baseline less than or equal to 16 mg/ml. We conclude that, although respiratory symptoms disappear in one half the children with asthma and although adults may believe that they have outgrown their disease, adults still have the potency to respond to inhaled allergens. Most children do outgrow their respiratory symptoms but not the susceptibility of their airways to allergens.

Adult↗
PubMed1990

Allergy in subjects with asthma from childhood to adulthood.

We studied the change from childhood to adulthood in skin test reactivity to house dust, animal dander, grass pollen, and molds, and, in addition, the change in number of blood eosinophils. The study was carried out in a group of 119 children with asthma, aged 6 to 14 years first observed between 1966 and 1969. In the present study, 101 subjects (85%) were reinvestigated after a mean period of 16 years; 43% had current symptoms. Skin test reactivity to all allergens and the number of subjects with positive skin tests to more than one allergen increased from childhood to adulthood. Subjects with allergic rhinitis (38%) had a higher number of positive skin tests to grass pollen in both childhood and adulthood than subjects without allergic rhinitis. Fifty-three children and 10 adults had atopic dermatitis. Atopic dermatitis occurred with equal frequency in children who did and in children who did not have current symptoms later in life. No differences in skin test reactivity to allergens were found between smoking and nonsmoking subjects. Although the smoking period was relatively short, smoking was correlated with eosinophilia in adulthood. The mean number of eosinophils decreased significantly between the first and second survey. The outcome of childhood asthma as defined by current symptoms was not predicted by skin reactivity to allergens, eosinophilia, atopic dermatitis, or allergic rhinitis in childhood.

Adolescent↗
PubMed1990

Respiratory infections and vascular rings.

Recurrent respiratory infections after the first years of life are not easily related to vascular rings as the cause of these infections. Therefore six cases of older children are presented in whom a vascular ring was the cause of their respiratory problems. None of them ever had stridor or swallowing problems in early infancy, and recurrent respiratory infections occurred later in life as a symptom of a vascular ring. Unfamiliarity with this association caused a delay in diagnosis and treatment in two patients and persistent lung damage in one child. Five of the 6 children recovered well after operation. The diagnosis can be made at an early stage if close inspection of the outline of the trachea on the chest radiograph shows an impression from the right side.

Aorta↗