[The use of theophylline retard in asthmatic children].
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Biomedical subjects
Publications and source records attributed to M R Benoist.
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Continuous sustained-release theophylline therapy was used in 61 children with severe asthma, aged 5 to 16 years. Mean treatment duration was 5 months 8 days (range: 8 days-16 months). The necessary dosage to obtain correct blood theophylline levels was 18 +/- 3.6 mg/kg/day (range: 10-31 mg/kg/day). The adaptation of the doses to blood theophylline levels and regular check-ups confirmed intrapatient variability and the dose-dependent disposition of theophylline. In 35 of the 42 children (82%) who were observed for more than 3 months, theophylline induced a decrease of the frequency of the attacks and a better attendance to school. Nine times out of 30, oral steroid administration or sustained-release cosyntropin injections could be stopped and in 15, the dosages could be decreased by at least 50%. Evaluations of pulmonary function, performed several times in 12 children, showed that theophylline induces significant bronchodilatation, mostly of the large bronchi.
The effect of whole lung irradiation on lung function was investigated in 48 children treated for Wilm's tumour with pulmonary metastases. Lung function tests were performed before irradiation and were repeated annually for as long as possible, the length of follow-up varying from two to 17 years. A reduction in both lung volume and in dynamic compliance was clearly observed. In some patients these changes occurred in the early post-irradiation months, but in most the decrease observed progressed over longer periods of time. Static pressure volume curves, blood-gases, and carbon monoxide transfer were normal. These findings make it unlikely that post-irradiation pulmonary fibrosis was involved. Another explanation for the decreased lung volume and dynamic compliance might be failure of alveolar multiplication. Muscular injury is unlikely as the patients were able to produce normal transthoracic pressures. A failure of chest wall growth is also possible and would explain the progressive restrictive impairment but not the early lung function changes. It is suggested that the early effects detected in some patients were the result of lung injury and that later effects resulted from impaired chest wall growth.
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Six healthy children, 5 boys and 1 girl aged from 13 months to 4 years had a severe measles bronchopneumonia. The end result is established chronic airflow obstruction. On a background of fairly severe respiratory failure there were paroxysms of breathlessness with fever, wheezes and cyanosis which were little affected by bronchodilators or steroids. The anatomical basis of this syndrome is before all else a bronchiolar obstruction, shown at autopsy in a child dying after four months of the illness. But also there is a disorder of the large bronchi with bronchiectasis and problems with ventilation centrally and/or peripherally. The major radiological signs are airways distension which is always clearly in keeping with emphysema and a thickening of the peri-bronchial walls which are clearly visible on tomography. Thus it appears that measles, as with other respiratory viruses, can lead to permanent sequelae in very young children. It is however possible that the respiratory sequelae may be due to associated viral infections, with adenovirus in particular. On the practical level, the occurrence of an early and severe measles pneumonia in a young child and its persistence with a hypoxia and a lowering of dynamic compliance requires a prolonged follow up and a guarded prognosis. Unfortunately the treatment of this type of chronic airflow obstruction is only symptomatic.
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Fifty asthmatic children were tested for cholinergic bronchial sensitivity and subjected to a free running exercise test; 92% of them showed hypersensitivity to acetylcholine challenge, and exercise-induced bronchospasm occurred in 80%. On pooling the results, 98% had a positive response to at least one of the tests. Qualitatively, there was a correlation between exercise-induced bronchospasm and bronchial sensitivity to acetylcholin in 38 of the 50 children. Quantitatively, however, no correlation could be found between the severity of the exercise-induced bronchospasm and the threshold dose of acetylcholin. This could be explained by the fact that the non-immunological spasmogenic mechanisms involved in the two tests are different.
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Functional residual capacity (FRC), dynamic lung compliance (CLdyn) and lung resistance (RL) were measured in a group of 51 healthy children aged 18 months to 6 years (group A) and in a group of 69 survivors of the respiratory distress syndrome (RDS) of the same age (group B). Forty-four per cent of the latter had clinical and radiological abnormalities. In the healthy children significant correlations were found between FRC and height (p less than 0.01), CLdyn and height (P less than 0.01) and CLdyn and FRC (p less than 0.01) but a poor correlation existed between RL and height (p greater than 0.05). There was no significant difference between groups A and B in the slopes of the regression lines for FRC, CLdyn and RL against height, but the intercept for the regression lines relating to CLdyn and RL was lower in group B than in group A. Group B was divided into two subgroups according to the length of exposure to artificial ventilation with an FIO2 in excess of 60 %. A lower value for CLdyn was found in the sub-group with the longer exposure (greater than 120 hours) to a high FIO2, suggesting that this is an additional factor in causing lung damage.