- Email: [email protected]
806 Is there an age variation in bronchial responsiveness to bronchodilator and methacholine in asthmatic patients?
VOLUME NUMBER
Abstracts
87 1, PART 2
EXERCISE INDUCEDASTHMA IN SCHOOLv
BY
807
ISTHEREANAGE VAEUATICNINBROKHI?&REspoNAND Ml?mAmLINE SIVENESS To -ILAm IN AS'IWMATIC PATIEXKL’S? so0 Ray m, M.D. L Ph.D., Jyh chenxl Chuarq, M.D., Hwai Lin Lee, and Jaw Ji !Csai, M.D., Ph.D. c Veterans General Hospital,Taipei,Taiwan,RK. Geriatric asthna is characterized by poor response to therapy and higher mortality rate. w studied bronchodilator test and methacholine challenge in (A) 15 aged (man&SD = 6054 yrs, 9M/6F), and (B) 12 you~lg (2756 yrs, @4/4F) non-ding asthmatic patients. Durations of ash were 22212 and 17+8 yrs respedively. The baseline pulmonary function of (A) va.s significantly l-&s thanthose of (B): EVC (liter) 1.27fO.07 vs 2.13f0.15 p = 0.001 ~~v,(liter) 1.14f0.08 vs 2.08kO.16 h = 0.0001 p = 0.0002 FW&.7~l/min)81.0~12.7 vs 2OO;t21 Following two inhalations (0.2 q x 2) of iscproterenol medihaler, the % reversibilities (mean + SE) were: elderly (A) young (B) p value 16.523.3 11.423.1 0.22 Fml FME'>~-~Js 41.8k9.0 18.4+5.6 0.04 (A) were more responsive than (B) in smaller airways.
~hemethacholine provocation dases (n=r@E): elderly (A) YOLUW(B) P value 4.3f1.3 2.OkO.3 0.26 PD FFX, 2.7kO.7 0.73 PD F’MFi.s-75% 3.3IO.8 tie responsiveness were similar in both groups. In conclusion, (A) is very responsive to bronchcxlilator and is equally responsive to methacholine challenge as (B). These results the elderly as-tics should be =w3=t treated with optimal dosages of bronchcdilators.
BRONCHIALRESPONSEOFASTHMA PATIBNTSIN ARTIPICIAL ATMOSPHERE CHANGING CHAMBW. Y.Iii8.M.D.. S. Matsuda, M.D.. Y.Yamashita, M.D.. T.Yamashita M.D., A.Akazawa, M.D., MEbisawa, M.D., H.Saito, M.D., K. Hashimoto, M.D. and A.Oaimi. Tokvo. Jauan. Many asthmatic children are influenced by tyhoons. This phenomenon suggests that asthma attacks
school children is unknown. We surveyed 523 school children mean age 12 years in 3 groups: Group I: 286 (55%) school physicals in pediatric practice (GI). Group II: 113 (22%) documented asthmatics (GII). Group III: 128 (25%) preparticipation high school athletes (GIII). 270 (52%) were male, 253 (48%) were female, 5% were black or Hispanic and 95% were Caucasian. Portable Wright peak flow (PF) was administered in COnjunCtion with Rice Olympic questionnaire (Q) and second Q modified by author (ME’R) to exclude distance running. Children with positive response (+) to Q and/or PF were recommended for challenge with F&ET or cycle ergmetry. 50/408 (12%) of healthy (GI,GIII) and 77 (68%) of the asthmatic group had (+) to the Q. 18/410 (4%) of GI and GIII had low PF only. 17/50 (34%) of (+) responders to (Q) agreed to challenge. 5/44 (11%) refused and remainder failed to respond to repeated phone and mail requests. 11/17 (65%) had accepted > 15% de-. cline in PFTs w/exercise. 3/17 (18%) improved > 20% wfbronchodilator but had no response to exercise. 3/17 (18%) had no response Lo bronchodilator or exercise. 6/18 (33%) w/low PF were challenged. l/6 (17%) responded. Overall 15/23 (65%) of (+) responders to Q and/or PF had (+) response to exercise challenge or bronchodilator. 5/10 (m of pts w (+) PETS had (+) skin tests. 6/8 (75%) 0% those w/(-) exercise response had (+) skin tests. 11/17 (65%) of (+) responders to Q but only l/6 (17%) w/low PF (< 80% avg) had (+) challenge. Overall 64% of pts preferred MFR Q, 24% Rice and remaining 12% saw no difference.
806
341
are brought on by the change in barometic
pressure.
So, in order to find the reason for this phenomenon, we studied the influence of barometric pressure changes on asthmatic children by using an artificial atmosphere changing chamber. Subjects. Study 1: 10 mild asthmatic patients and 6 healthy controls were used in a barometric pressure reduced study. Study 2: 10 asthmatic patients and 5 healthy controls are studied in a barometric pressure increased study.
Method.
In study 1, pressure
was
reduced
gradually until equivalent to that at 2500 meters above sea level. In study 2. pressure. was increased gradually until equivalent to that at 3 meters below sea level. Result. 1. We calibrated the lung function machine for each altitude. 2. The large airway response of asthmatics was the same as controls at each altitude, but the small airway response of 3. When the asthmatics differed from controls. barometric pressure increased, the asthma patient’s lung function increased. Conclusion. Our result shows that even in mild asthmatics, who do not use any drugs in daily life, small airway function does not adapt to less than 1000 meters, demonstrating that their small Increased airway function remains abnormal. pressure environment is useful to treat asthma
attacks.
8~8
A STUDYOF THE RELATIONSHIP BETWEENCHILDHOOD NEPHROTIC SYNDROMEAND ALLERGIC DISEASES. CY Lin M.D., Ph.D. Taipei, Taiwan, R.O.C. The incidence of atopic diseases in 206 children with nephrotic syndiome (NS) was studied.Boys with NS had three times higher incidence of bronchial asthma and both boys and girls about three times more atopic dermatitis than the general po100 of the 206 children received renal pulation. biopsies and serum IgE levels were measured. During acute nephrotic phase the geometric mean serum IgE levels in minimal change nephrotic syndrome (MCNS), IgM mesangial nephropathy (IgMN) and hepatitis B virus-associated membranous nephropathy were all significantly elevated, in descending order of significance. These high serum IgE levels decreased in remission of NS and elevated again during relapse. The relationship between high serum levels and the incidence of allergic diseases showed that l/3 to l/4 of either IgMN or MCNS patients developed allergic diseases. The in vitro IgE synthesis study using pokeweed mitogen stimulation and expression of IL-4, IL-5, IL6, IgE and gamma-interferon (IFN-r) in the renal tissue with an indirect immunoperoxidase technique was also performed during acute nephrotic increasing IgE production was stage. Significant noted in these high serum IgE patients, but with no difference in the expression of IL-4, IL-5, IL-6, IgE and IFN-r in the renal specimen between high and normal serum IgE groups. These results suggest that NS patients have a higher allergic Serum IgE level may serve as disease incidence. However, a incrone of the prognostic factors. ease in the IgE level may reflect systemic immunoregulatory imbalance that plays a direct pathogenic role in the occurrence of NS.
Abstracts
87 1, PART 2
EXERCISE INDUCEDASTHMA IN SCHOOLv
BY
807
ISTHEREANAGE VAEUATICNINBROKHI?&REspoNAND Ml?mAmLINE SIVENESS To -ILAm IN AS'IWMATIC PATIEXKL’S? so0 Ray m, M.D. L Ph.D., Jyh chenxl Chuarq, M.D., Hwai Lin Lee, and Jaw Ji !Csai, M.D., Ph.D. c Veterans General Hospital,Taipei,Taiwan,RK. Geriatric asthna is characterized by poor response to therapy and higher mortality rate. w studied bronchodilator test and methacholine challenge in (A) 15 aged (man&SD = 6054 yrs, 9M/6F), and (B) 12 you~lg (2756 yrs, @4/4F) non-ding asthmatic patients. Durations of ash were 22212 and 17+8 yrs respedively. The baseline pulmonary function of (A) va.s significantly l-&s thanthose of (B): EVC (liter) 1.27fO.07 vs 2.13f0.15 p = 0.001 ~~v,(liter) 1.14f0.08 vs 2.08kO.16 h = 0.0001 p = 0.0002 FW&.7~l/min)81.0~12.7 vs 2OO;t21 Following two inhalations (0.2 q x 2) of iscproterenol medihaler, the % reversibilities (mean + SE) were: elderly (A) young (B) p value 16.523.3 11.423.1 0.22 Fml FME'>~-~Js 41.8k9.0 18.4+5.6 0.04 (A) were more responsive than (B) in smaller airways.
~hemethacholine provocation dases (n=r@E): elderly (A) YOLUW(B) P value 4.3f1.3 2.OkO.3 0.26 PD FFX, 2.7kO.7 0.73 PD F’MFi.s-75% 3.3IO.8 tie responsiveness were similar in both groups. In conclusion, (A) is very responsive to bronchcxlilator and is equally responsive to methacholine challenge as (B). These results the elderly as-tics should be =w3=t treated with optimal dosages of bronchcdilators.
BRONCHIALRESPONSEOFASTHMA PATIBNTSIN ARTIPICIAL ATMOSPHERE CHANGING CHAMBW. Y.Iii8.M.D.. S. Matsuda, M.D.. Y.Yamashita, M.D.. T.Yamashita M.D., A.Akazawa, M.D., MEbisawa, M.D., H.Saito, M.D., K. Hashimoto, M.D. and A.Oaimi. Tokvo. Jauan. Many asthmatic children are influenced by tyhoons. This phenomenon suggests that asthma attacks
school children is unknown. We surveyed 523 school children mean age 12 years in 3 groups: Group I: 286 (55%) school physicals in pediatric practice (GI). Group II: 113 (22%) documented asthmatics (GII). Group III: 128 (25%) preparticipation high school athletes (GIII). 270 (52%) were male, 253 (48%) were female, 5% were black or Hispanic and 95% were Caucasian. Portable Wright peak flow (PF) was administered in COnjunCtion with Rice Olympic questionnaire (Q) and second Q modified by author (ME’R) to exclude distance running. Children with positive response (+) to Q and/or PF were recommended for challenge with F&ET or cycle ergmetry. 50/408 (12%) of healthy (GI,GIII) and 77 (68%) of the asthmatic group had (+) to the Q. 18/410 (4%) of GI and GIII had low PF only. 17/50 (34%) of (+) responders to (Q) agreed to challenge. 5/44 (11%) refused and remainder failed to respond to repeated phone and mail requests. 11/17 (65%) had accepted > 15% de-. cline in PFTs w/exercise. 3/17 (18%) improved > 20% wfbronchodilator but had no response to exercise. 3/17 (18%) had no response Lo bronchodilator or exercise. 6/18 (33%) w/low PF were challenged. l/6 (17%) responded. Overall 15/23 (65%) of (+) responders to Q and/or PF had (+) response to exercise challenge or bronchodilator. 5/10 (m of pts w (+) PETS had (+) skin tests. 6/8 (75%) 0% those w/(-) exercise response had (+) skin tests. 11/17 (65%) of (+) responders to Q but only l/6 (17%) w/low PF (< 80% avg) had (+) challenge. Overall 64% of pts preferred MFR Q, 24% Rice and remaining 12% saw no difference.
806
341
are brought on by the change in barometic
pressure.
So, in order to find the reason for this phenomenon, we studied the influence of barometric pressure changes on asthmatic children by using an artificial atmosphere changing chamber. Subjects. Study 1: 10 mild asthmatic patients and 6 healthy controls were used in a barometric pressure reduced study. Study 2: 10 asthmatic patients and 5 healthy controls are studied in a barometric pressure increased study.
Method.
In study 1, pressure
was
reduced
gradually until equivalent to that at 2500 meters above sea level. In study 2. pressure. was increased gradually until equivalent to that at 3 meters below sea level. Result. 1. We calibrated the lung function machine for each altitude. 2. The large airway response of asthmatics was the same as controls at each altitude, but the small airway response of 3. When the asthmatics differed from controls. barometric pressure increased, the asthma patient’s lung function increased. Conclusion. Our result shows that even in mild asthmatics, who do not use any drugs in daily life, small airway function does not adapt to less than 1000 meters, demonstrating that their small Increased airway function remains abnormal. pressure environment is useful to treat asthma
attacks.
8~8
A STUDYOF THE RELATIONSHIP BETWEENCHILDHOOD NEPHROTIC SYNDROMEAND ALLERGIC DISEASES. CY Lin M.D., Ph.D. Taipei, Taiwan, R.O.C. The incidence of atopic diseases in 206 children with nephrotic syndiome (NS) was studied.Boys with NS had three times higher incidence of bronchial asthma and both boys and girls about three times more atopic dermatitis than the general po100 of the 206 children received renal pulation. biopsies and serum IgE levels were measured. During acute nephrotic phase the geometric mean serum IgE levels in minimal change nephrotic syndrome (MCNS), IgM mesangial nephropathy (IgMN) and hepatitis B virus-associated membranous nephropathy were all significantly elevated, in descending order of significance. These high serum IgE levels decreased in remission of NS and elevated again during relapse. The relationship between high serum levels and the incidence of allergic diseases showed that l/3 to l/4 of either IgMN or MCNS patients developed allergic diseases. The in vitro IgE synthesis study using pokeweed mitogen stimulation and expression of IL-4, IL-5, IL6, IgE and gamma-interferon (IFN-r) in the renal tissue with an indirect immunoperoxidase technique was also performed during acute nephrotic increasing IgE production was stage. Significant noted in these high serum IgE patients, but with no difference in the expression of IL-4, IL-5, IL-6, IgE and IFN-r in the renal specimen between high and normal serum IgE groups. These results suggest that NS patients have a higher allergic Serum IgE level may serve as disease incidence. However, a incrone of the prognostic factors. ease in the IgE level may reflect systemic immunoregulatory imbalance that plays a direct pathogenic role in the occurrence of NS.