Changes in ECG R-R intervels (RR) and blood pressure were assessed by the autoregressive power spectral analysis method in a bronchial asthma patient (severe type: nine years old boy). We studied that there were two spontaneous oscillations of RR and blood pressure. Low frequency (LF: less than 0.1cycle/beat) fluctuations of RR are known to be mediated by the parasympathetic and β-adrenergic nervous system, while high frequency (HF: 0.1-0.5cycle/beat) are mediated by the parasympathetic nervous system. And LF fluctuations of systolic blood pressure (SYS) are mediated by the α-adrenergic nervous system.
In this case, LF power of RR decreased, while HF power of RR and LF power of SYS increased at severe attack. The results suggested that β-adrenergic nervous system activity decreased and α-adrenergic and parasympathetic nervous system activity increased in asthma attack.

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Mite dust was collected from the residences of 5 bronchial asthmatic patients and 5 non-asthmatic persons, living in and around Urasoe city, Okinawa Prefecture from Oct. 1990 to Oct. 1991
The number of mites had raised 2, 038 to 61, 200 and 2, 125 to 81, 000 in 1g fine dust collected from the houses of the asthmatic and non-asthmatic groups, respectively. An Increase of mites was observed in both April and May. Dermatophagoides pteronyssinus was a dominant species in all houses throughout this period.
Dp. occupied about 72.8-96.1% in the distribution of the mites in fine dust of all houses. On the other hand, Dermatophagoides farinae was found to be very low in fine dust, being under 0.6%.
There was no significant difference in seasonal appearance of mites between asthmatic and non-asthmatic groups.
It seemed that the frequency of asthma attack increased in April and May due to increasing numbers of mites. But there was an observation of a high asthma attack rate during October to January as well, in spite of the lowest number of mites during this period. In conclusion, there was no significant means between the number of mites and the frequency of asthma attacks in the winter period.

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A 15-years old girl was admitted to our hospital with severe asthmatic attack. She failed to respond to intravenous administration of aminophylline, corticosteroid and isoproterenol. She was getting worse, and finally lost her consciousness, and then required controlled mechanical ventilation. Isoflurance inhalation (1.5%) was started with PSV and HFJV after CMV. Within an hour, high airway pressure with barotrauma decreased and clinical signs including arterial blood gas-analysis improved. Isoflurane inhalation was ceased on the 3rd hospital-day. She showed unevenful recovery, and was discharged from the hospital on the 47th hospital-day. We consider that isoflurane is a useful drug to treat status asthmatics because of the potent bronchodilation effect and the few adverse actions.
Levels of LTB₄ and LTC₄ in bronchial lavage fluid on the first hospital day was increased, when compaired with those of the third hospital-day, indicating that LTs may play important roles for the development of the symptoms of bronchial asthma such as airway constriction and mucus secretion.

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We analysed 81 patients with asthmatic attack in the outdoor school during the past two years. The incidence of asthmatic attack was 24.3% in all patients. The predilection seasons of asthmatic attack were autumn and spring. The duration from asthmatic attack to medical examination was long: more than 10 hours: 40%. Six patients were hospitalized and one of them with underlying disease died. In the outdoor school it is necessary to take adequate prophylactic measures to prevent asthmatic attack, to consult a doctor at one's earliest convenience and to bring a letter of introduction.

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We mailed a questionnaire to 263 hospitals in Kanagawa Prefecture asking whether mechanical ventilation for severe asthma attack in children had been used in the past 3 years. Hospitals responding positively were sent a second questionnaire. When results from thesecond questionnaire were analyzed, it was found that out of 10 children so treated, 5 were classified as severe, 3 were moderate, and 1 was mild. (In one case, the degree of severity was not identi-fied.) Five were allergic, and the other 5 were nonallergic. It wasthe first hospitalization for 5 cases. Oxygen was not used in 2 cases prior to mechanical ventilation.
In our department, the annual number of children admitted for asthma attack has decreased by two thirds in the last 15 years. Oxygen use has increased to 80% following introduction of the pulse-oxymeter monitor for SPO₂. Subcutaneous injection of epinephrine, although popular until 1985, has been replaced with continuous isoproterenol inhalation and use of systemic steroid. Wehave treated 11 asthma attack cases with mechanical ventilation during the past 15 years, although none occurred during the last 3 years.
In conclution, it seems to be possible to decrease the necessity for mechanical ventilation for asthma attack by active and timely treatment at an early stage of the attack.

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The case described is the growth impairment of a 9 year old boy, who had been suffering severe atopic dermatitis (AD), during non-steroidal treatment. Eczema of the patient has exacerbated since he was seven years old. In spite of the anti-allergic therapy, together with topical corticosteroids, his skin condition did not improve. This ineffectiveness, along with the information provided by the media, the patient's mother came to be distrustful towards the topical corticosterid therapy. Consequently, any topical corticosteroid therapy was ceased.
However, his skin condition remained ill, and the growth impairment began to be seen. He showed a serious suppression of GH secretion. After obtaining an informed consent from his parents, the treatment involving topical corticosterid started again. His skin condition showed remarkable improvement and significant growth catch up was observed. The growth impairment with suppression of GH secretion found in this patient seems to be induced not by topical corticosteroids but by atopic dermatitis itself or by sleep disturbance with the stress of severe itchiness.

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To clarify the effect of the diet in infancy on the development of atopic dermatitis and the production of IgE antibody against mite, 96 babies received varieties of diet were evaluated retrospectively. They were divided into 5 groups. The infants restricted egg from early infancy were divided into 2 groups (group A: showed no food allergy, n=10, group A': showed allergy against some foods, n=14). Eighteen were excluded food (s) that exacerbated symptoms (group B). Thirteen could not avoided the food (s) which worsened their clinical manifestations (group C). Infants showed no exacerbation after ingestion of food were fed unrestricted diet (group D, n=29). The other12 were control infants (group E).
We could not find any difference in the development of atopic dermatitis between group A and D, and between grup A' and B. The dermatitis was significantly severe in group C. About 39% of positive RAST related with the clinical symptoms. The incidence of food allergy was high in infants with RAST scores 3 or more and with more than 3 kinds of positive RAST. The production of IgE antibody against mite was also most frequently detected in those with more than 3 kinds of positive RAST. The incidence of mite allergy was significantly high in group C, and the incidence in group Bwas higher than that in group A'.
In conclusion, the eliminating diet in infancy is effective for the prevention of the development of atopic dermatitis and the production of IgE antibody against mite in children who showed exacerbation of symptoms after ingestion of the food. The ingestion of egg from early infancy was supposed to affect partly the developement of allgic diseasein future.

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To investigate the influence of high-dose inhaled steroid in children with asthma therapy for 2 weeks using high-dose (900μg/day) inhaled beclomethasone dipropionate (BDP) was carried out in ten institutionally hospitalized asthmatic children. The change in various parameters including serum osteocalcin (OC) during therapy was evaluated, and results obtained were as follows;
1) There were no significant differences in serum osteocalcin, alkaline phosphatase, circadian rhythm of serum cortisol level, peripheral eosinophil counts, eosinophils in nasal and sputum smear, and serum IgE between before and after BDP therapy. Regarding local side effect, positive oropharyngeal Candidia colony was found in three of ten patients after therapy.
2) Short-term, high-dose inhaled BDP therapy significantly attenuated bronchial hyperresponsiveness to acetlycholine. Furthermore maximum mid-expiratory flow rate (MMF), maximal flow rate at 50% of vital capacity (V₅₀) and maxmal flow rate at 25% of vital capacity (V₂₅) were improved significantly during therapy period.
We concluded that short-term, high-dose BDP therapy (900μg/day for 2 weeks) may be useful without sever side-effects in the treatment of asthmatic children.

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The causes of asthma death were analyzed on 89 patient from 1990 to October, 1995. Ages ranged 0-26 years old (mean 11.5±6.2 years), including 59 boys and 30 girls. Of 89 patients, comprised 20 cases of mild, 21 cases of moderate, 29 cases of severe asthma, and 19 cases of unknown, 62.9% were dead in the hospital including emergency department. The contributory factors to asthma death were thought to be unexpected sudden excercerbation and delayed decision on medical consultation. A strong dependence on β-stimulant with MDI was observed in 32.6% of the patients, especially in older ages. The possible causes of death were overtreatment with β-stimulant in 11 cases. Five cases of 89 patients were steroid dependent.

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