Asthmatic camp of the child has shown many achievements in the treatment of asthma. Recently, the asthmatic symptom has been improved in many children. But improvement of symptom of the asthma mainly was brought by the spread of medicine medical therapy. Therefore, improvement of self management and adherence/compliance furthermore are more important than in the past in control of the recent asthma. Camp is useful as the appropriate place for giving the such improvement. Camp is thought that many empirical effects are brought to the asthmatic children, as a place of comprehensive medical care. Several problems such as co-operating of the staff, execution place and psyclosomatic problems of the children exist in recently. For the variety of the children, guaranty of the special staff is necessary. In the future, also evaluation of the method of utilizing camp effectively is necessary. In addition, the long-term effect of asthmatic camp including also the social economic side, also it is necessary to study.

View full abstract

Probiotics are defined as ''live microorganisms which when administered in adequate amount confer a health benefit on the host''. Many clinical studies have been conducted to see the clinical and/or the prophylactic effects of probiotics for allergic diseases. One meta-analysis which appeared on the January issue of the Journal of Allergy and Clinical Immunology showed the conclusion ''Current evidence is more convincing for probiotics' efficacy in prevention than treatment of pediatric atopic dermatitis''. Further study is necessary to clarify what kind of probiotics should be used for allergic diseases.

View full abstract

Continuous isoproterenol inhalation therapy (CIIT) is known to be useful in the management of children with severe asthma exacerbation. However, it has been recently reported that children develop bradycardia during CIIT. Therefore, we evaluated the changes in cardiac rhythm of children who admitted to our hospital for moderate to severe asthma attack. From April 2004 through October 2006, CIIT was performed in 47 children, whereas 49 children were treated with conventional therapies including frequent inhalation of beta2-agonist. During the recovery period, percentages of children whose heart rate became lower than normal limit were similar in both CIIT group and conventional therapy group (15%, 8%, respectively: p=0.39). In those children, only 2 of CIIT group were defined as bradycardia. All patients were asymptomatic, and all recovered spontaneously. Subsequent cardiac workup revealed catecholaminergic long-QT syndrome in one of the conventional therapy group. From our observation, bradycardia is not induced by CIIT itself, rather caused by a relative parasympathetic over-ride. However, rare cardiac complications need to be borne in mind.

View full abstract

A 7-year-old boy was bitten by Mamushi and he presented swelling and pain on his right upper arm. He was brought to our hospital about ten hours after surgical treatment performed by a family doctor. The severity of the snakebite was Grade III. The intracutaneous reaction test against the anti toxin was negative, and methylprednisolone was administered for the prevention of possible allergic reaction to antivenom. Anaphylaxis symptoms such as rash, wheezing and shortness of breath appeared immediately after administration of antivenom. Administration of intramuscular 0.1% adrenaline and intravenous hydrocortisone improved the symptoms immediately. Since the antivenom derives from the serum of horses, it has been described that it frequently induces anaphylaxis. However, most cases of anaphylaxis were those of adults, with few reports of pediatric patients. Although some cases of snakebite in childhood in Japan have been described, no pediatric cases of anaphylaxis to antivenom have not been reported. Further studies are needed to define the indication of prophylaxis use of adrenaline as that in abroad.

View full abstract

[Objective]
We examined the effect of squeezing on asthma attack by using peak expiratory flow, oxygen saturation and number of sputum.
[Object & Methods]
We included inpatient children with bronchial asthma from 3 to 9 years old that was able to measure peak expiratory flow. The number of the children was 34 (24 boys and 10 girls).
We separated children into a squeezing group and a control group. For a squeezing group immediately after they finished inhalation therapy, nurse started to squeeze sputum. When 15 minutes hadpassed after inhalation, we measured peak expiratory flow, oxygen saturation, and number of children who can let out sputum.
[Result]
The squeezing group showed improvement of peak expiratory flow, and a tendency of improvement for oxygen saturation. The squeezing group also showed better number of sputum than the control group.
[Conclusion]
Our results show that squeezing is effective for children with asthma attacks.

View full abstract

Inconsistency of care with guideline leads to poor asthma control. Therefore, we developed a simple questionnaire and checklist for primary physicians to implement Japanese guideline for childhood asthma. We asked doctors of 20 hospitals and 19 clinics to use this questionnaire and checklist for evaluating control levels of children with asthma, and to discuss with their caregivers regarding the treatment status. Their control levels were reevaluated afterward. Out of 938 children, 258 (27.5%) were defined as poor control, and the treatment level was stepped up in 46.1% of them. One month later, approximately 60% of the children showed the improvement in their control levels, and this improving tendency was clearer in the children with step-up treatment level compared with children whose treatment was not changed (77.4% vs 39.1%, p<0.001). These results suggest that it could be useful to use this simple questionnaire and checklist for implementation of asthma guideline.

View full abstract

We assessed the long-term efficacy and safety of salmeterol /fluticasone propionate (FP) combination (SFC) delivered by a chlorofluorocarbon-free pressurised metered-dose inhaler (pMDI) in 40 asthmatic children aged 5 to 14 years in Japan. All subjects were taking inhaled corticosteroids (FP 100-200μg/day or equivalent) before the study and 37 subjects had moderate persistent asthma and 3 had severe persistent asthma. The mean age was 8.7 years. Each subject took SFC pMDI 25/50μg, two inhalations twice daily, for 24 weeks. The majority (85.0%) used the Aerochamber Plus^® spacer. All the subjects completed the 24-weeks study treatment period.
There were improvements in morning PEF beginning on the first day of treatment and continuing through the study treatment. Mean change in morning PEF over 24 weeks of treatment was 32.9L/min. Mild tremor noted in one subject was the only adverse event assessed by the investigating physician as ''drug-related''. There were no significant changes in plasma cortisol concentrations.
The study demonstrated the long-term efficacy and tolerability of SFC pMDI 25/50μg, two inhalations twice daily, in children with moderate persistent or severe persistent asthma.

View full abstract

[in Japanese]

View full abstract

In 2007, three cases of asthma death in childhood and adolescence were newly registered in The Committee on Asthma Death in Children of Japanese Society of Pediatric Allergy and Clinical Immunology. Thus the total number of 218 cases with asthma death was enrolled since 1989. According to the most recent Japan's demographic statistics reported by the Ministry of Health, Labour and Welfare, the mortality rate of asthma in infants and young children (≤4 years of age) have been steadily decreasing during the period between 1980 and 2002. However, thereafter the rate of asthma death has not satisfactorily declined although it is very small (i.e., 0.1-0.4 /100,000 persons). To determine the risk and predictive factors of asthma death in infants and young children, all cases of asthma death with ≤5 years of age (40 cases), enrolled in the committee since 1989, were surveyed. The following results were obtained.
1) Of 40 cases with asthma death, male and female cases were 24 and 16, respectively. Among all cases of asthma death, seven males and two females were enrolled during the period between 1998 and 2006.
2) An average of age at asthma death was 2.2 years and that of periods between onset, diagnosis of asthma and death was 1.1 and 0.7 years, respectively.
3) Disorders of cardiovascular or central nervous systems were associated with 15 % of all cases of asthma death.
4) Asthma attack requiring hospital admission occurred during one year before asthma death in 45 % of all cases. However, only a small number of cases had episodes of severe asthma attack with unconsciousness or requiring artificial ventilation and so on.
5) None of the cases had received inhaled glucocorticosteroids although some anti-allergic drugs, including disodium cromoglycate, were given in a small number of cases with asthma death.
6) More than 70% of all cases dyed of asthma in the hospitals where they usually visited.
Diagnosis and management of asthma are difficult in children at 5 years or younger. Such problems should be resolved by pediatric allergists as soon as possible. This survey clearly indicates that early therapeutic intervention is needed to prevent asthma death. In addition, it is difficult to determine the precise mortality rate of asthma in infants and young children probably because asthma death occurring in the first attack has been easily missed and asthma attack is not necessarily the cause of death in asthmatic patients. Therefore, we should pay more attention to determine the causes of death in infants or younger children with asthma.

View full abstract