A questionnaire survey was conducted to study the acceptance of the “Japanese Pediatric Guideline for the Treatment and Management of Asthma 2002” and the changes in asthma treatment. Replies were obtained from 4, 354 pediatricians in Japan. Their replies showed that the prevalence of asthma in children had increased, especially in infants, while the number of patients hospitalized with asthma exacerbations had decreased. The percentage of physicians who were aware of the guidelines was almost 100% among specialists, and 98% among non-specialists. The treatment for exacerbation of asthma was largely similar to the basic recommendations of the guidelines, except that intravenous steroids tended to be used as an earlier stage of treatment. Sustained release theophylline, inhaled corticosteroids, leukotriene receptor antagonists and DSCG+β₂ treatment were the four principal pillars of long-term management. The guidelines recommend using inhaled corticosteroids for the treatment of step 2 or more severe asthma, and this study showed many physicians prescribed inhaled corticosteroids for step 2 asthma.

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The efficacy of pranlukast hydrate (pranlukast) in treatment of bronchial asthma was investigated in 48 children with bronchial asthma who were given pranlukast for 6 months or longer. The prevalence of upper and lower respiratory infection was simultaneously investigated before and after the treatment period.
Administration of pranlukast for six months resulted in a rating of “improved” or better in 41.7% of the children and “slightly improved” or better in 79.2% of the children. The prevalence values for cold and fever were 4.60±2.09 and 1.81±1.33, respectively, 6 months before administration. These showed a significant reduction to 3.31±2.18 (p<0.001) and 1.23±1.15 (p=0.003), respectively, after administration of pranlukast for 6 months. The number of children whose attacks were aggravated by cold also decreased. Administration of pranlukast for 12 months had similar effects.
In conclusion, the results suggest that pranlukast improves asthmatic symptoms and decreases the prevalence of cold and fever.

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To evaluate the efficacy and safety of budesonide inhalation suspension (BIS) in the treatment of infantile bronchial asthma, BIS was given to infants with bronchial asthma aged from 6 months to less than 5 years at a daily dose of 0.5-1.0mg (qd or bid) for 24 weeks using an electric nebuliser. At week 12 (FAS with LOCF), the frequency of asthmatic attacks was significantly decreased by 6.99 times/week as compared with the baseline (p<0.001). At week 12, frequency of asthmatic attacks (times/week), frequency of cough, disturbance of daily activity, and disturbance of nighttime sleep showed a tendency toward improvement as compared with the baseline, which continued until week 24. Once daily (qd) and twice daily (bid) groups showed similar changes. Although all the patients experienced at least one adverse event, a total of 3 patients experienced 4 adverse events in which a causal relationship to BIS could not be ruled out: one case each of cheilitis and stomatitis, and 2 cases of oral candidiasis. One patient discontinued the treatment because of stomatitis and oral candidiasis, and these symptoms disappeared after discontinuation. Twenty-four patients experienced a total of 41 serious adverse events including aggravated asthma attack and respiratory tract infection throughout the study period. However, no causal relationship to this drug was observed in any of these patients. Plasma cortisol significantly decreased at week 12 (8.10μg/dL) and at week 24 (8.81μg/dL) as compared with the baseline level (average 11.1μg/dL). (vs 12W: p<0.001, vs 24W: p=0.0086). Administration of BIS via nebuliser at a daily dose of 0.5-1.0mg is considered effective for infantile bronchial asthma. However, it seems necessary to titrate down to a minimum required dose of each patient while monitoring its efficacy, as significant serum cortisol lowering was seen in the study.

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The causes of asthma death were analyzed on 189 patients aged from 0 to 28 years old, from 1988 to 2004.
Subjects studied were divided in two groups by the year: former group who died between 1988 and 1997, and later group between 1998 and 2004, to observe recent change of causes of asthma death.
Annual number of registered asthma death tended to decreased since 1998.
Sex ratio male to female was 97 to 62 in former group and 19 to 11 in later group.
The grade of asthma severity prior to their asthma death were; severe (44%), moderately severe (30%) and mild (26%) in former group and severe (50%), moderately severe (28%) and mild (22%) in later group.
Number of death in hospital was 71.1% aged from 0 to 3 yars old, 54.2% aged from 7 toll years old, and 39.8% aged over 13 years old.
The main contributory factors to asthma death were unexpected sudden exacerbation that is most important facter same as last reports.
Medications given in the last one year was anlyzed. Steroid inhalation therapy tended to increase in later group compared with former group and patch therapy of β stimulator appeared in later group.
Over treatment of β stimulator inhalation appeared to decrease.
Annual number of the patients with incompliance with medication tended to decrease but increase in adolescent.
The patients with incompliance with medication was more in the incomplete families than in the complete families.

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