The annual number of outpatients and acute hospitalization in 1994 were 2, 194 and 723 cases in the pediatric department of National Minami-Fukuoka Chest Hospital, which were 4.7 times and 6.0 times higher respectively than those in 1975 (466 and 121 cases). There was, however, one case of asthma death per year, and the majority of deaths occurred at own home or on the way to the hospital. These observations show the great advancement in the medical science and care for controlling asthmatic attacks in children.
Eighty-three percent of deaths from asthma (20/24 cases), however, was sudden death in our hospital, whose age was ranged 10 to 29 years old. There has been the three-folded increase in asthma death rates in males among 15-29 years of ages during past 10 years in Japan. These data suggests the difficulty in the management for the adolescent to young adults asthmatic patients with psycho-socio-economical problems.
The prognosis of children with severe and intractable asthma has not been improved satisfactorily. It has been reported that the rates of remission are ranged 40.9 to 57.7% over 20 year alter the onset of asthma.
The method and technique of treatment of asthma has been really improved. The children with severe asthma, however, have tremendous number of problems such as influence of long-term medication, various obstacles for school attendance or employment, poor comprehension of their family or society regarding disease of asthma, etc.
It is considered that continuous and comprehensive care from the social stand-point of view is essen tiai to them.

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First objects were households of 12 children with asthma (3-12 years) that Dermatophagoides farinae (Der f) specific IgE value was more than 17.5PRU/ml and 12 normal children. The staffs of health center visited the 24 households once a month during five months and gathered dust by cleaner with Dust Sampler. The Dust Sampler is maked of double filters with 16 mesh (1000μ) and 2000 mesh (74μ) and around shape 5cm in diameter. The antigen value of house dust mite was measured by double antibodies sandwich ELISA method of specific monoclonal antibody Dust Checker, The households of children with asthma were cleaned regularly by determined method. The antigen value of house dust mite of 1g dust in shikifuton and bedroom floor of children with asthma decreased, and clinical symptom tended to remit. Second objects were households of 20 children with asthma (2-11 years) that Der f specific IgE value was more than RAST score 2. Once a month during a year their mothers gathered dust by cleaner with Dust Sampler. The monthly mean antigen value of house dust mite increased in autumn and decreased mostly in February and March. It is thinked that shikifuton make major effect on attack of asthma.

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House dust mite is the chief allergen for atopic patients, and in managing patients with alllergic diseases, it is important to reduce exposure to this antigen. One of the points of emphasis in patient education in allergy treatment is environmental control. To give the information about the level of mite antigen in the residence to patients and their families in order to help them to control the antigen effectively, we checked and measured the antigen (Der I) in the houses of atopic children by sandwich ELISA. We analysed 218 Der I data in 52 houses (n=211) and in the hospital (n=7). The level of Der I was low in the hospital (below 1.8μg/g), but higher in some areas of the houses, such as in beddings (futon: 10.3μg/g), carpets (7.7μg/g), sofa (35.2μ/g), and stuffed toys (59.4μg/g). There was a statistically significant positive relationship between beddings on the floor and the floors of the bedroom for the level of Der I.
These findings incited various reactions and interpretations regarding the levels of measured house dust mite antigen among the patients and their families. It is our objective to inform and educate environmental control individually, and evaluate its effects as part of the management of allergy. This is already being utilized clinically.

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To measure the concentration on of exhaled NO in children, we improved the system of analyzing NO_x and estimated the results. The system we used is a chemiluminescence analyzer CLM-500 (SHI-MADZU, JAPAN) sensitive to NO from 0.1 to 5000 parts per billion (ppb, by volume), adapted for an online recorder U-224 (NDKCL Co., Japan). On the hypothesis that expiration velocity influences NO concentrations in expired air, a flow volume regulator of a control capacity from 0 to 3000ml/min was assembled between a mounthpiece and CLM-500, hence NO concentration is measured under a constant expiration flow rate. In our method, the NO concentration on curves show up-hills first, then plateaus and down-hills finally. If the flow rate increased, the curve reached the plateau sooner and the plateau-value in a serial measurement in one patient were statistically constant. On our speculation, the plateau values are the good parameters of NO production in their bronchi.

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Theophylline is one of the most frequently administered drug in children with bronchial asthma. But, accumulation of serum theophylline during viral infections or some febril disease has been described.
We studied alteration of serum theophylline concentration, theophylline clearance and urinary excretion of theophylline metabolites during influenza virus infection. The results were as follows: 1) During influenza virus infection, the first febrile day, serum theophylline concentrations were two times as much as those in a convalescent state. For the first time, serum theophylline concentrations were normal at the third day since to alleviate fever.
2) The first febrile day, theophylline clearances were half as much as those in a convalescent state.
3) The urinary excretion of the theophylline metabolites, 1, 3-demethyluric acid, 1-methyluric acid, 3-methylxantine, were decreased during influenza virus infection.
The ratios of theophylline metabolites to theophylline in urine were decreased, too.
Our study indicates that serum concentrations of theophylline are higher in children with influenza virus infection than in those in a convalescent state. The higher concentrations are due to decreased theophylline clearance. We concluded that it may be the result of depression of the metabolic activity of hepatic cytochrome P-450 enzyme system during influenza virus infection.

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There are few reports on chronological pulmonary function test results in children who have experienced near-fatal status asthmaticus. To further investigate this point, we studied periodically the pulmonary function tests in 92 children with bronchial asthma (61 males and 31 females) who had been hospitalized for more than one month. Subjects were divided into two groups. Intubation (+) group; patients who required intubation for severe attacks (four males and three females). Intubation (-) group; patients who never experienced intubation (57 males and 28 females). It was significant that FEV_1.0%, %FE V_1.0, %MMF, %V₅₀, and %V₂₅ were lower in intubation (+) group than intubation (-) group, FEV_1.0% was negatively correlated with the morbid period (r=-0.814, p<0.05) in intubation (+) group, Three patients were intubated in hospitalized, and they had persisted airway-obstruction, which appeared to be related to the number of intubation episode. From the results, it is suggested that patients in intubation (+) group have narrowing of small airways even when they do not have an asthmatic attack, and the more morbid period is extended, the more airway-obstruction may progress.

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Three infants had redness and swelling on their arms one or two days after gelatin component vaccine inoculation. Drug induced lymphocyte stimulation tests for vaccine and gelatin were positive in the cases. Lymphocyte stimulation tests for gelatin were positive in one of eight adult volunteers. The positive volunteer had a redness area of 11×13mm after 48hours following an intradermal test of measles vaccine. Gelatin component vaccine may cause side effects of delayed hypersensitivity.

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Technical instruction on how to use a MDI for asthma children patients is usually given by doctors. Our hospital pharmacists have also given this instruction since 1994. A survey on whether the dose instruction is actually practiced was conducted on 37 long-term outpatients with bronchial asthma at our children allergy section (average age 10.6±4.5: mean±SD) through inquiries either by interview or by mail.
Of the respondents, 54.1% actively practiced inhalation, while 78.4% answered they forgot to inhale (including those who occasionally forgot). They tended to forget during the daytime, but 60-80% practiced “shaking the cylinder” before inhalation and “breath holding” and “gargling” after inhalation as encouraged in the instructions. The percentage of respondents who understand the reason for each procedure was 30-50%. The percentage utilizing the spacer with MDI was 70.3% and the percentage who carried the spacers was 42.3%.
This survey revealed the necessity of tactful motivation of the patients to ensure compliance from them and their families. To attain this goal it is important to encourage patients to use the easy-to-use, portable spacers and to understand the reason for each procedure.

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We report the cases of an 11-years-old boy and a 16-year-old boy who were admitted by non-school attendance with severe atopic dermatitis.
Examination of their blood showed highly elevated serum IgE (12, 000IU/ml, 55, 300IU/ml) and positive RAST to house dust mites and several food allergens. Sigle open food challenge tests were carried out, following elimination diets and environmental control during about 3 weeks of admission achieved marked improvement. These challenge tests revealed that patient 1 was allergic to rice, soy bean and egg but wheat, cow's milk and pork, while patient 2 was allergic to rice and wheat but shrimp.
It is thought that number of children absent from school due to severe atopic dermatitis will increase in the future. This report emphasizes that avoidance of allergens, should be done firstly for patients of non-school attendance by atopic dermatitis, though psychological treatment is important.

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Asthma mortality rates were very stable, and very low, in Western countries during the first half of this century. However, there were asthma mortality epidemics in six Western countries in the 1960s. These were linked with the introduction of isoprenaline forte which was only marketed in the six epidemic coon tries (England and Wales, Scotland, Ireland, Norway, Australia and New Zealand), and in two other countries for whom sales were low (The Netherlands and Belgium). Although the high-dose (forte) formulation of isoprenaline was not marketed in Japan, and the country showed only a modest increase in asthma mortality in the 5-34 years age-group, there was a more marked increase in mortality in the 10-414 years age-group which paralleled the increase in total sales of beta-agonise aerosols. A second mortality epidemic occurred in New Zealand in the 1970s. This was linked with the introduction of fenoterol, which was not licensed in the USA and had a low market share in most other countries. Japan experienced a doubling in asthma deaths in the 5-34years age-group following the introduction of fenoterol in 1985, and there was a parallel between the increase in fenoterol sales and the increase in mortality. Fur thermore, a recent study found that a high proportion of asthma deaths were in persons prescribed fenoterol (53% compared with a market share of 18%). Thus, the available data for Japan is consistent with the studies in Western countries that have indicated an increase in the risk of asthma death in pa tients prescribed isoprenaline or fenoterol, which are both poorly selective full agonists that were market ed in high dose preparations. These findings have policy implications for Japan and the Asia Pacific region, as well as for the rest of the world.

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The causes of asthma death were analized on 123 patients from 1990 to October, 1996. Ages ranged 0-28 years old (mean 12.2±6.6 years), including 79 males and 44 females, Of 123 patients. comprised 23 cases of mild, 28 cases of moderately severe, 37 cases of severe asthma, and 34 cases of unknown, 57.4% were dead in the hospital including emergency department. Over aged 13 years old, cases who died on the way to the hospital or in ambulance car increased. The contributory factors to asthma death were thought to be unexpected sudden excercerbation and delayed decision on medical consultation, As con tributory factors to the delayed decision on medical consultation, a miss judgement on severity of the last asthma attack by their familiers or by patients themselves and a strong dependence on β-stimulant MDI were suggested. The possible causes of deaths were overtreatment with drugs in 18 cases (14.6%) and 11 cases of these were β-stimulant MDI. Seven of these 11 MIDI were fenoterol MDI. Five cases of 123 patients were steroid dependent.

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