Induced Sputum Substance P in Children with Difficult-to-Treat Bronchial Asthma and Gastroesophageal Reflux: Effect of Esomeprazole Therapy

Objectives. To assess the induced sputum substance P (ISSP) levels in children having difficult-to-treat asthma (DA) with and without gastroesophageal reflux (GER). We aimed also to evaluate the association of GER with childhood DA, relationship of GER severity with childhood asthma control test (C-ACT), FEV1, peak expiratory flow (PEF) variability, and ISSP. Finally, we tried to evaluate esomeprazole treatment effect on C-ACT and FEV1 in children with DA. Methods. Spirometry, C-ACT, upper gastrointestinal endoscopy, and ISSP measurement were done for children with DA compared to healthy controls. Results. ISSP was high in DA with higher levels in the group having associated GER. In the latter group, ISSP and C-ACT improved significantly after esomeprazole treatment while FEV1 and PEF variability did not improve. Reflux severity was positively correlated with ISSP and negatively correlated with FEV1. Conclusions. GER was found in 49% of our patients with childhood DA. Very high ISSP levels in children with DA may be used as a marker for presence of GERD. Esomeprazole therapy improved asthma symptoms but did not improve lung function

L-Carnitine Improves the Asthma Control in Children with Moderate Persistent Asthma

The objective. was to investigate L-Carnitine level and the effects of its supplementation in children with moderate persistent Asthma. Methods. Free and total serum carnitine levels were measured in 50 children having moderate persistent asthma and 50 healthy control children. The patients group was randomly divided into two subgroups. Subgroup A was supplemented with L-carnitine for 6 months while subgroup B was used as a placebo controls. Both subgroups were assessed by pulmonary function tests (PFT) and childhood-asthma control test (C-ACT) before and 6 months after carnitine supplementation. Results. Total and free carnitine levels were significantly lower in patient group than in control group. PFT and C-ACT showed significant improvements in asthmatic children supplemented with L-carnitine than in those who were not supplemented. Conclusion. L-carnitine levels were initially lower in moderate persistent asthmatic children as compared to healthy control children. Asthmatic children who received L-carnitine supplementation showed statistically significant improvement of C-ACT and PFT

Right superior vena cava draining in the left atrium associated with tetralogy of Fallot and pulmonary atresia

We report a case of an anomalous drainage of the right superior vena cava to the left atrium with intact atrial septum associated with Tetralogy of Fallot, pulmonary atresia, and major aortopulmonary collateral arteries

Combination therapy versus monotherapy for gastroesophageal reflux in children with difficult-to-treat bronchial asthma

Gastroesophageal reflux (GER) is a common disorder in children with bronchial asthma. It has been identified as a potential trigger, complication and even differential diagnosis for asthma. Our aim was to find out the efficacy of the combined use of both the proton pump inhibitor esomeprazole and the antidopaminergic prokinetic domperidone versus the sole use of esomeprazole in improving asthma severity in children with difficult to treat asthma. Patients and methods: Among 178 children with difficult-to-treat asthma, GER was assessed using upper GIT endoscopy. Those who had GER were randomly divided into 2 equal subgroups the first was treated with esomeprazole for 12 weeks while the other was treated with esomeprazole and domperidone for the same period (beside the usual treatment for asthma in both groups). Childhood-asthma control test (C-ACT), forced expiratory volume in 1st second (FEV1) [% of predicted], peak expiratory flow (PEF) variability, induced sputum substance P (SP) and endoscopic reflux score (ERS) were recorded before and after the treatment. Results: Gastro-esophageal reflux (GER) was observed in about 45% of children with difficult-to-treat asthma. The C-ACT, induced sputum SP, ERS and FEV1 showed significant improvement while PEF variability showed no significant changes when comparing combination therapy subgroup (esomeprazole and domperidone) with esomeprazole only subgroup. Conclusions: Combination of domperidone and esomeprazole was more effective in improving the endoscopic reflux score, childhood-asthma control test (C-ACT) and FEV1 (% of predicted) and significantly reduced the sputum SP than the use of esomeprazole only in children with difficult-to-treat asthma