213. Resolution of severe acute asthma in children

American

-I

Academy

J. ALLERGY CLIN. IMMUNOL. MARCH 1978

of Allergy

Maxima: increases in NAR after increasing doses of polymyxin B were 52.4% 2 32.9% (SD) for 13 symptomatic HFP, 128.3% 2 59.5% for 10 asymptomatic atopic subjects (AAS), 127.2% ? 74.9% for 11 nonatopic subjects (NA§), and 149.1% 2 73.4% for 10 VR patients; the HFP differed significantly from the other groups (p < 0.01). Maximal percent increases in NAR after intranasal histamine also were significantly less in HFP than in asymptomatic subjects, perhaps related to the elevated basal NAR values in HFP. Responses to an irritant, NHa, were significantly less in both HFP and VR cases than in AAP and NAS Atropine , chlorpheniramine , and phenylephrine all produced significant NAR decreases in HFP (p < O.Ol), but maximal responses to the 3 drugs did not differ significantly. Atropine and chlopheniramine did not significantly decrease NAR in asymptomatic persons. Results suggest depletion of nasal histamine stores in HFP but not VR cases and the additional importance of autonomic control of the nasal vasculature.

ntihistamines

II. lier

The role of Hi and HZ histamine receptors in allergic reactions has not been well defined. The effects of H1 receptor blockade with chlorpheniramine (CPM), 0.3 mg/kg intravenously, HZ receptor blockade with cimetidine (CIM), 4 mg/kg intravenously, and the combination of both drugs on whealing responses in the skin of 10 unconscious rhesus monkeys were studied. The stimuli used were intradermal histamine and passive cutaneous anaphylaxis (PCA) reactions witb a serum from a subject allergic to ragweed. The mean wheal areas in mm2 at the midpoint of each of these dose-response curves were calculated and are shown in Table I.

Intradermal histamine PCA

CPM

212. The treatment of nasal intranasal beclomethasone d T. H. Aaron, MOD., and E. L. C. Muttitt, Edmonton, Canada.

IVl.IXX

Seventy-five cases of nasal polyps were treated with aerosol intranasal beclomethasone dipropionate. The majority had had previous nasal surgery. All patients bad symptomatic relief using 400 pg daily and some could be maintained on a lower dose. The duration of treatment varied from 3 to 18 mo. The mucosal edema decreased and the nasal polyps became smaller. The senses of smell and taste improved slightly in some. The symptoms deteriorated and the polyps enlarged with respiratory infection. No major complications occurred. Some patients noted irritation and crusting of the nasal mucosa.

in

. Bruce J. Hutchcroft, M.D., Elizabeth Moore, El.%., and Robert P. Orange, .Q., Toronto, Qntario, Canada.

Control

only caused partial inhibition. This suggests mat a combination of chlotpheniramine and cimetidine may be more effective against allergic reactions than II1 blockade alone.

CIM

Combination

129

66*

121t

44$

529

110*

6257

W

*p < 0.05 vs control. Tp = NS vs control. $p < 0.1 KS CPM.

II1 receptor blockade is markedly inhibitory to whealing produced by intradermal histamine. At this concentration of CPM, maximal H1 blockade occurred. HZ receptor blockade is only apparent when all H1 receptors are already inhibited. In the PC4 reaction, II1 plus Hg receptor blockade completely inhibited me response, whereas H1 blockade alone

213. Resolution of severe acute ast in children. F. Estelie, R. Simons, M.D. R. D. Pagtakhan, M.D., R. S. Stanwick, N. Muller, M.D., Winnipeg, Manitoba,

Canada.

The rate of resolution of severe acute asthma in children has important implications for timing of termination of intravenously administered medications and discharge from hospital. In this study, we correlated serial changes in respiratory function with clinical improvement after severe acute asthma. Ten children, aged 7 to 16, received similar pharmacologic treatment for severe acute asthma. IJnder standardized conditions, the following measurements were made for 7 consecutive days: static lung volumes (SLV)functional residual capacity (FRC), total lung capacity (TLC), and residual volume (RV) by helium dilution technique, vital capacity (VC)-and flow indices (FI)-forced expiratory volume in 1 set (FEV,), peak flow (Vr,eaJ, and flow at 50% of vital capacity (Vs,,). FI and VC values were considered to be abnormal if ll@% predicted normal (Table I). I. Results: abnormalities TABLE

Number

Wheezing FI (at least 1 abnormal test) SLV (at least 1 abnormal test)

of patients

with

IO

9

9

3

2

10

8

9

7

4

9899798

I 4

1 2

On day ‘7, only 1 patient had wheezing during forced expiration, but 2 had at least 1 abnormality in FI and 8 had at least 1 abnormality in SLV. We conclude that clinical improvement precedes improvement in pulmonary function tests, and that the latter, particularly SLV, are imperative for accurate assessment of rate of resolution of severe acute asthma.

ass screening of children to detect structive pulmonary disease. J. S. Hyde, D., C. M. Kumar, Chicago, Ill”

M.D., and B. S. Moore,

M.S.,

Mass screening for ventilatory function was done on school age children in a community of 62,000. The purpose of this study was to determine the usefulness of this approach to detect obstructive pulmonary disease. The survey included 6,495 children, ages 5 to 14 yr, at the time of compulsory vision and hearing evaluations. Medistor pulmonary analyzers were used to test flow and volume changes. Equations for forced expiratory flow rate (FEF,+&, peak expiratory flow rate (PEFR), and forced expiratory volume in 1 set (FEVJ were obtained for men and women by computer analyses. Based on these equations, percent predicted values were calculated for each subject. Seventy-five percent or less of predicted values were found in 17.5% of children for FEFZs-Ts, 10.5% for PEFR, and 14.5% for FEVr. Based on Chemiak’s equation programmed in the Medistars, 14.3% of all subjects had ~75% of predicted values for FEVZ+Ts. Of these, 887 were available for retesting, and 194 failed again. Thus, the prevalence of abnormal FEFZs-Ts was 3.1% of the surveyed population. One hundred forty-six of these children were subjected to a third study before and after isoproterenol inhalation. Of these, 49.3% were reversible, 33.6%, and 17.1% equivocal (11% to 14% improvement). Potentially disabling bronchopulmonary disease can easily be detected by noninvasive ventilatory testing equipment in school age children. Follow-up if required by the physician can be initiated through the school nurse.

ong-term corticosteroid KS) administration: Effect on lung development in steroid-dependent (SD) asthmatic ~~i~dr~ff. H. Chai, M.D., D. Miklich, Ph.D., E-l. S. Spaulding, G. Barwise, .J. Bigiey, Denver, Colo.

B.A., and

Corticosteroids (CS) have a marked depressive effect on linear growth, Consistant demonstration of increased lung volumes and capacities in SD asthmatic children, poorly responsive to reversibility by maximized medication, suggested the possibility of retarded lung maturation. Animal experiments have shown such adverse lung maturation re-

lated to steroids. Seventy-five SD children (46 male, 29 female) who had been on steroids from an early age (<8 yr old) were compared with 130 (77 male, 53 female) normal subjects (N) never on steroids in regard to size of thoracic cage (TC). TC was determined by calculating the frustum of a right eliptical cone from 6 linear measurements. All SD children had lung volumes, capacities, and pertinent ratios measured (SVC, FVC, RV, FRC, TLC, RVITLC, FRCi TLC). Variation was from 120% to 150% of predicted and were refractory to reversal over time. TC of the SD were all lower than N when matched for sex: age, and height at statistically significant levels despite obvious hyperinflation as measured by pulmonary functions and x-ray. Conclusions can be only speculative, but data suggest: (I) CS reduces the size of TC and by inference, lung size. (2) This might be due to a reduction in numbers of mature alveoli over the years prior to reaching age 8. (3) The reduced number of alveoli are hyperinflated and probably permanently so because of reduced numbers. (4) This does not imply destruction of the vascular alveolar bed and, hence, could account for normal diffusion found in such asthmatic patients.

216. Large airway constriction i rhinitis; Response to inhalation helium-oxygen. l3. D. Fairshter, L. E. Marchioli, and H. S. Novey,

Irvine,

Calif.

We previously demonstrated that asymptomatic allergic rhinitis subjects have evidence of large but not sm.all airways constriction. To further characterize their pulmonary function, we studied 15 nonsmoking, nonasthmatic allergic rhinitis subjects. Studies were done: (1) before and after inhalation of isoproterenol; (2) when subjects were symptomatic and asymptomatic for rhinitis. Pulmonary function tests included measurements of maximal expiratory flow ( VEmax), lung volumes, airways resistance (Raw), specific airways conductance (SGaw), closing volume, and distribution of ventilation. In addition, VEmax was measured at 50% of vital capacity after breathing air and after breathing helium-oxygen. The increase in air flow after breathing helium-oxygen ( AVEmaxsO) was then determined. Results were compared to data obtained from 30 normal control subjects. Mean SGaw was significantly lower and Raw was significantly higher in rhinitis subjects. Results of other pulmonary function tests did not differ significantly between the groups. Also, results did not vary with allergic rhinitis symptomatology. Following inhalation of isoproterenol, SGaw and VEmax increased significanrly, whereas Raw and AVErnaxsO decreased significantly. Based upon this data, we conclude that: (1) Subjects with allergic rhinitis have evidence of large but not small airways bronchoconstriction. (2) Pulmonary function does not vary with symptomatology in rhinitis subjects. (3) Equal pressure point locations and sites of flow limitation are similar in rhinitis and control subjects.