This study utilized a survey of the families and doctors of outpatients at fifteen Osaka hospitals, and analyzed the current state of pediatric bronchial asthma patients in Osaka. The questionnaire was completed by 765 patients between August and November of 2003.
Of the 765 cases, 383 cases were of intermittent asthma, 231 cases were of mild persistent asthma, 119 cases were of moderate persistent asthma, and 15 cases were of severe persistent asthma. The percentage of patients whose family members smoked in close proximity to the patients was 62.8, and the mothers' smoking significantly increased the wheezing of patients, indicating that education regarding the hazards of smoking is urgently needed. A quarter of the families felt burdened emotionally, but there was no relationship between emotional problems and the severity of a patient's asthma. During consultations, it is clearly necessary to take into consideration a patient's social environment and daily life.
The two primary medications provided were the oral agents theophylline and antileukotriene, while inhaled steroids were used by 25.2% of patients. Most of the patients treated with inhaled steroids were 6 years of age, and the percentages by severity were 53.8% for moderate asthma and 73.3% for severe asthma.
These results indicate that parents and pediatricians should be educated regarding the usability of inhaled steroid therapy for pediatric bronchial asthma. Furthermore, a formulation of steroid that infants and preschool children could inhale should be developed to promote the wider use and benefits of steroids.

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Recently, a dry powder inhaler, Clickhaler was introduced as a device for beta2-agonist inhalation in Japan. To evaluate the ability of asthmatic children to inhale through Clickhaler, peak inspiratory flow rates (PIFR) of 91 stable asthmatic children aged 5-8 years and 33 children with mild to moderate attack aged 4-10 years were measured with In-Check Meter after training with instructors. The percentages of the 5-, 6-, 7-, 8-year old stable asthmatic children who were able to inhale reliably through the device were 89.7% (26/29), 95.2%, (20/21), 100% (14/14), and 100% (27/27), respectively. These 87 and all the children with acute exacerbation achieved adequate PIFR (>20L/min). These results indicate that Clickhaler could be applicable even for younger children, if they have ability of reliable inhalation.

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