Asthmatic children should be treated by psychosomatic approach because bronchial asthma has been known to be organic and/or functional disorders with close relation to psychosocial factors. The asthmatic attacks could disturb their life task and have influence their prognosis. Asthmatic children are often treated by their parents incorrectly which the parents have never noticed.
We have to ask parents notice this problem and need assistance by psychologists in clinical practice. The pediatrician could care asthmatics by either individual or group psychotherapy, and should play the important role as the key person to unite psychologist, pediatric psychiatrist, nurse, instructor and kindergarten teacher and utilize educational and welfare institutions.

View full abstract

Physical training including cold water bathing is widely accepted as one of the non-pharmacological therapeutic modalities for childhood asthma in Japan. Although the effectiveness of the treatment has been proved, mechanisms of the therapy have not been fully studied. In order to clarify the mechanism by which cold water bathing modifies asthma pathophysiology, we investigated changes in the parasympathetic nerve activity measured by Holter electrocardiogram before and after cold water bathing in children with stable asthma.
Electrocardiography was performed, and changes in heart rate, as reflected on RR₅₀ [the episodes of shortened or prolonged (by at least 50msec; compared with the preceding RR interval) RR interval during sinus rhythm], were analyzed using “RR Interval Spectroscopic Analysis Soft HPS-RRA (version 2.01)”. The RR50 is in general used as an index of a parasympathetic function. On the first day of the study, the pediatric patients underwent no cold water bathing, and their baseline data were obtained as the control. On the second day of the study, the patients underwent 5 rounds of cold water bathing at intervals of 15min. The following results were obtained: 1) The parasympathetic nerve activity after the cold water bathing was significantly lower than the pre-bathing data; 2) The parasympathetic nerve function following 3 rounds of the cold water bathing (hereinafter; “bathing”) was significantly reduced, relative to the control data; 3) The respiratory function showed a tendency for an improvement after bathing but there was no significant difference compared with the control; 4) The heart rate after bathing was significantly higher than the prebathing data. These results suggest that cold water bathing can improve respiratory function by suppressing the parasympathetic nerve activity and by stimulating the sympathetic nerve activity.

View full abstract

In order to determine the possibility whether cyclosporin D (CSD) and CSH can be used for allergic disorders as an anti-degranulation drug, inhibitory effects of CSD and CSH on IgE-mediated degranulation in rat basophilic leukemia 2H3 cells were examined and compared with that of CSA. Degranulation was assessed by measuring the activity of beta-hexosaminidase released into culture medium after IgE receptor-mediated stimulation. Although CSD and CSA dose-dependently inhibited the degranulation, CSH showed no inhibitory effect. The IC50 values of CSD and CSA were 0.27μg/ml and 0.15μg/ml, respectively. We also examined inhibitory effects of rapamycin and FK506, other class of immunosuppressive drugs, and anti-inflammatory drugs, dexamethasone and DSCG, on IgE-mediated degranulation. Rapamycin, DSCG and dexamethasone showed no inhibitory action. Among the tested substances, FK506 showed the most potent inhibitory action, IC50 of which was 0.0064μg/ml. Immunosuppressive action of cyclosporins mediated by the inhibition of T-lymphocyte function is not completely correlated with other pharmacological effects including inhibition of degranulation. To clarify the precise inhibitory mechanisms of immunosuppressive substances might lead to exploration of more useful therapeutic drugs for allergic diseases.

View full abstract

We studied the clinical pictures of the recurrent croup, which have recently attracted attention because it was thought to be related to allergy. Among the 40 patients with croup syndrome who were admitted during the period from February in 1976 to June in 1988, four (10%) had relapses twice or more. Our study on 10 patients (the above 4 and 6 others that we had studied in Saitama Children's Hospital at Yorii) revealed that the majority was male. Most of those patients had family and past histories of allergic diseases and higher IgE levels. The recurrent croup patients had predisposition to allergy. To make sure of the foregoing fact and to know the incidence of the recurrent croup, we studied 7131 primary school children in Saitama prefecture. 1404 among the school children (19.7%) had experienced croup syndrome including 367 (5.1%) cases of recurrent croup. The average number of relapses was 2.8 and the maximum was 11. Both the patients with croup syndrome and recurrent croup had high incidence of allergic family history and past history (more than 70% respectively). It suggests that allergy must be taken into consideration in the treatment of the patient with croup syndrome.

View full abstract

The Outpatient Department of Pediatrics for Allergy at Shiga University of Medical Science opened its Home Page regarding children's asthma in September 1995 to support asthmatic patients and their families by providing related information on the Internet. We conducted 3-year questionnairing on our Home Page readers from January 1997 to research their backgrounds and types of needed information.
Our Home Page readers distributed all over Japan; the most predominant age and occupation groups were 30s and housewives, respectively. The most predominant age category of patients was 3 to 6 years. The most common anxiety the readers felt was about the recovery time (27.6%), and a majority of 66.0% chose their doctors as the best to talk about their anxieties. Only 12.0% had ever participated in study meetings or lectures on asthma. 25.1% of readers knew nothing about adverse effects of drugs. Regarding the types of information they wanted or the pages for which they wanted more details, they chose multiple items including “about asthma”, “management at home” and “medicines and treatments”.
Information about asthma will be more effectively distributed through the Internet that certainly grows more popular. Medical professionals should search for the patients' needs and provide appropriate information to the public on Internet.

View full abstract

Nebulizers are in widespread use for asthmatic children on purpose of long-term treatment with regular inhalation of DSCG plus beta agonist in Japan. The aim of this study was to survey how they use the nebulizers for acute asthma exacerbation in the home. Questionnaires were completed by 768 asthmatic children or their parents who possessed nebulizers at home. They were recruited from allergy specialists (20 hospitals and 7 clinics), and 55.9% of them were younger than 7-year old. Most of them (92.3%) used nebulizers in acute exacerbations to inhale beta agonists. Younger children tended to inhale beta agonist for milder symptoms compared with older children: more than 60% of the children younger than 7 year-old answered that they received beta agonist in acute onset of coughing, while most of the older children inhaled beta agonist when they had wheezing or dyspnea. In 20.3% of the patients, the symptoms when they used beta agonists were milder than their doctors' recommendation. We conclude that asthmatic children and their families are struggling to manage acute exacerbation without any standard guidelines regarding beta agonist nebulization. There is a need for more practical guidelines.

View full abstract

The causes of asthma death were studied on 158 patients, 98 male and 60 female, aged from 0 to 30 years old, from 1988 to 1999. Ten cases were excluded because of non-asthma death such as car accident.
Subjects studied were divided 2 groups, 1988-1994 and 1995-1998, depending on the period registerd to observed chronological changes of causes of asthma death.
Male/female ratio of asthma death decreased in last group comparing with former group.
Concrning garde of severity, severe (41%), moderate (32.5%) and mild (26%) are in former group, severe (45.2%), moderrate (29%), mild (25.8%) in last group.
In 0-6 years old group, number of the death home or in ambulance appear to decrease in last group comparing with former group.
Unexpected sudden exerbation were 89% in former group, and 98% in last group.
The delay by patients and/or families in seeking help was 95% in former group and 72% in last group.
The delay in seeking help when condition begin to deteriorate was made by patients in 69% in former group and in 71% in last group, and by families in 65% in formr group and in 71% in last group.
The possible causes of deaths were overtreatment with drugs in 21 cases and 14 of them were beta-stimulants by metered dose inhaler (MDI).
Nine of them reported to be fenetrol by MDI and 2 of them tulobuterol by MDI.

View full abstract