In order to define the clinical symptoms of infant bronchial asthma or asthmatic bronchitis under two years old, we at first divided the infants who were under four years old and admitted to our hospital because of the illness from November 1986 to December 1989 into two groups. Group A consisted of 58 cases, and 45 infants who were under two years old. Group B were 80 cases, and 62 infants from two years old to four years old. And after that we compaired the clinical symptoms of the two Groups.
1) Severity of attack when hospitalized
The frequencies of moderate to severe attack of Group A and Group B were 44.8% and 61.2% respectively.
2) Admission term
The average admission period of Group A and Group B were 6.29 days and 5.33 days respectively. That of Group A was longer than that of Group B. (P<0.05)
3) Complications
The rates of complicated pneumonia and bronchopneumonia of Group A and Group B were 60.3% and 47.5% respectively. That of Group A was higher than that of Group B. (P<0.025)
4) The terms of treatments
The average treatment terms using β-adrenergic agonist inhalation of Group A and Group B were 5.59 days and 4.60 days respectively. (P<0.05)
5) The numbers of the cases in which steroid inhalation was necessary
The numbers of all cases of Group A and Group B were 16/58 and 6/80 respectively. The steroid using rate of Group A was higher than that of Group B. (P<0.01)
6) The numbers of the cases in which isoproterenol continuous inhalation was necessary
The numbers of all cases of Group A and Group B were 11/58 and 1/80 respectively. The isoproterenol inhalation required frequency of Group A was higher than that of Group B. (P<0.01) Group A were more frequently suffered from infection and required β-adrenergic agonist inhalation, isoproterenol continuous inhalation, or steroid inhalation than Group B. The admission term of Group A was longer than that of Group B. The severity of infant asthma or asthmatic bronchitis judged from clinical symptoms was apt to be underestimated.

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Based on the data from questionnaires on first grader through sixth-grader of elementary schools (3356 pupils, rate of collected replies: 97.3%) using a Japanese version and a revised version of the ATS-DLD, the difference in the definitions of bronchial asthma, especially the difference between the definition in the narrow sense (a close definition) and that in the wide sense (an approximate definition), and the degree of disease prevalence rates that would be changed depending on cumulative rates, etc. were studied. The following shows the result of our study.
1. Current pvevalence rates of bronchial asthma based on a close definition: 5.23%
2. Cumulative prevalence rates of bronchial asthma based on a close definition: 7.07%
3. Cumulative prevanlence rates of bronchial asthma on an approximate definition: 8.90%
4. Current prevalence rates of wheeze: 4.65%
5. Cumulative prevalence rates of wheeze: 13.57%
6. Cumulative prevalence rates of bronchial asthma in each past clinical history: 17.53%
7. Current prevalence rates of bronchial asthma defined closely together with wheeze: 9.35%
The difference in prevalence rates due to different definitions showed maximally 3 times or more. There was a tendency that prevalence rates turned out to be on the decrease as each pupil advanced to a higher grade. Usually prevalence rates of boys showed higher rates than those of girls, regardless of the different definitions to be used.

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We examined clinical symptoms and the changes of the MEFV curve under the conditoins of different breath holding time in patients with childhood asthma who inhaled β-stimulant with MDI. A total of 30 subjects with an average age of 11.4 years were studied. As a result, no significant difference was observed between the 3 seconds holding group and the 9 seconds holding group.
In the second trial, we also examined effects of mouth rinsing and gargling after inhalation on changes of clinical symptoms and those of the MEFV curve in asthmatic children in the same manner. 21 subjects with an average age of 11.5 years were studied. The result showed that improvement of pulmonary function was higher in the group without mouth gargling.
These results suggest that instruction for the optimal inhalation of β-stimulant MDI in children is to hold breath for up to 3 seconds between inhalation, and not to rinse and gargle mouth after inhalation.

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It has been reported that in case of childhood bronchial asthma, an abnormal shadow is noted at a high percentage in the X-ray photograph of paranasal sinuses and that in case of bronchial asthma complicated by sinusitis, not only did symtoms of bronchial asthma such as coughing a weezing took a fovourable turn in response to the treatment for sinusitis, the respiratory function also improved. The present examination was made on 59 cases of childhood bronchial asthma in which clinical symptoms such as coughing, weezing and rhinorrhea have not been sufficiently controlled. X-ray photographs of these patients were taken in Water's pasition, a shadow of maxillary sinus was divided into a hypertrophic one and a diffuse one, and these were compared with the results of an examination of clinical symptoms.
1. The result of the X-ray examination showed 6 cases of normality, 11 cases of slight peripheral mucosal hypertrophy, 10 cases of medium peripheral mucosal hypertrophy, 2 cases of intese mucosal hypertrophy, 9 cases of a slight diffuse shadow of the whole maxillary sinus, and 18 cases of a medium diffuse shadow of the whole maxillary sinus. Of these, 13 cases were complicated by a shadow of frontal sinus, and 9 cases were complicated by a shadow of ethmoidal sinus. There were no cases of intense diffuse shadows or cases of polypoid shadow.
2. In the cases complicated by sinusitis, it was noticed that such symptoms as noctal coughing, low grade fever, nasal congestion, and headache existed in more than half of the cases.
3. An examination of the cases complicated by sinusitis was conducted by dividing these cases into those of hypertrophic lesion and those of diffuse lesion and on the bases of an IgE value of 500IU/ml. The 14 cases out of the 23 cases of hypertrophic lesion whereas the IgE value exceeded 500IU/ml in 9 cases out of the 29 cases of diffuse lesion. That is, the IgE value was high in the cases complicated by hypertrophic lesion, and this indicated the existence of correlations between allergy and hypertrophic lesion.
From the above, it is considered that in taking care of intractable bronchial asthma, it is necessary to examine whether or not the bronchial asthma has been complicated by sinusitis such as siagonantritis, ect.

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The efficacy of use an air cleaner at home was evaluated in 17 children with moderate or severe bronchial asthma aged between 5 and 13 years treated in the Department of Allergy of the National Children's Hospital. The patients were divided into two groups: 12 who used an air cleaner (Bellflow Super Supplied by Dai-ichi Seiyaku Co., Ltd.) with a filter and 5 who used the air cleaner with no filter. Changes in clinical symptoms and respiratory function were evaluated in the morning, daytime and night during the pre-treatment control period, treatment period and post-treatment control period. Significant improvement was observed in dyspnea, sputum, runny nose and sleep disorders in patients who used the filter (p<0.05). Asthma symptoms were also significantly improved in the night (p<0.05). In contrast, no significant improvement was observed in the patients who used no filter. Respiratory function remained virtually unchanged in both groups.
From these findings, it can be concluded that the air cleaner with a filter is useful in improving symptoms of bronchial asthma in children.

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Cord blood IgE, IgE binding factor and neonatal blood IgE levels were determined in 555 newborns who were born during 1988 to 1991. Cord blood and IgE binding factor were measured by using enzyme linked immunoassay. Development of atopic diseases were observed through 1 to 3 years.
In the cases of non-atopic babies, cord blood IgE levels were below 0.5IU/ml in 98.5% cases. Cord blood IgE of non-atopic group ranged 0.04-0.26IU/ml in boys and 0.02-0.24IU/ml in girls. In the cases of atopic group, cord blood IgE ranged 0.15-0.90IU/ml in boys and 0.14-0.77IU/ml in girls and showed higher than non-atopic group.
In the group of positive family history and high cord blood IgE levels over than 0.5IU/ml, 70.3% cases developed atopic diseases in infancy. In the group of negative family history and low cord blood IgE levels, only 10.9% cases developed atopic diseases in infancy.
Combination of cord blood IgE level and family history appeared predictive for the development of atopic diseases in infancy.

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