Lung function and bronchial responsiveness in preschool children

It is hypothesized that childhood asthma, especially when not well controlled, may constitute a risk factor for the development of COLD in adulthood (Cropp, 1985), It is unknown whether lung injury during early life is a risk factor for the development of COLD in adulthood, Asthma often starts before schoolage (Cropp, 1985), Except for the disturbing symptoms, a reason for paying attention to asthma in preschool children is the hypothesis that adequate intervention may reduce the risk of COLD in adult life (Kerrebijn, 1982). To detect lung function abnormalities at as young as possible ages suitable methods should be available. Most lung function methods can only be performed in children over 6 years of age. Lung function was measured with the forced pseudo-random noise oscillation technique (FOT) (Uindser et al., 1976a) because only passive cooperation is needed. Resistance (R,) and reactance (X,) of the respiratory system are simultaneously measured over a frequency spectrum of 2 to 26 Hz. R, is mainly determined by the patency of the upper and large airways. X, is influenced by mass-inertial and elastic properties of the respiratory system. The applicability ofFOT in preschool children was investigated. The method is now suitable for use in clinical practice to measure lung function and BR in children from about 2lfz years of age. We measured airway patency, bronchial smooth muscle tone and BR in preschool asthmatic children. Secondly, we investigated whether lung injury during early influences the development of lung function and bronchial responsiveness in children who do not have a genetic predisposition of asthma. This was investigated in children who had infant bronchiolitis, in subjects who survived infant bronchopulmonary dysplasia after neonatal respiratory distress syndrome and in individuals who experienced a near-drowning accident. The results are compared to data found in healthy controls

Reported adverse drug reactions during the use of inhaled steroids in children with asthma in the Netherlands

Objective: Inhaled corticosteroids (ICS) are widely used in the treatment of asthma. We studied the suspected adverse drug reactions (sADRs) reported during the use of ICS in the Netherlands. Methods: In the Netherlands, health professionals and patients can report suspected ADRs to the Pharmacovigilance Centre Lareb. All reported sADRs on ICS were categorised and assessed as to whether these were likely to be associated with use of the steroid. Age and gender adjusted Reported Odds Ratios (RORs) and Naranjo Scores (NS) were computed for sADRs reported more than 3 times. Results: Since 1984, sADRs of ICS were reported in 89 children (mean age 6 years), 48 (54%) were boys. Suspected drugs were fluticasone in 46 children (52%), budesonide in 21 (24%), and beclomethasone in 22 cases (24%). Psychiatric symptoms were reported in 19 children (21%; ROR 3.8, NS 3.6), growth retardation in 6 children (7%; ROR 47.8, NS 3.0) and rashes in 6 cases (7%; ROR 0.7, NS 2.4). There were 7 reports (8%; ROR 2.1, NS 3.4) concerning abnormalities of the teeth, 4 reports of alopecia (4%; ROR 3.3, NS 3.5), and 3 reports of hirsutism and hypertrichosis (NS 4.0). Non-fatal adrenal insufficiency was reported once. Conclusion: Alteration of behaviour was the most frequently reported sADR. There are more indications that alterations of behaviour could be a real sADR of ICS. Non-fatal adrenal insufficiency was the only reported possible life threatening sADR. The association of hypertrichosis and teeth abnormalities after ICS in children has not been reported in the literature before

Принципи реалізму і теорії націоналізму

Статтю присвячено порівняльному аналізові теорій націоналізму й теорії політичного реалізму. Здійснена спроба синтезу цих двох теоретичних формацій з метою вдосконалення пізнавального апарату політології міжнародних відносин. На підставі базових положень реалізму, розглянуто роль націоналізму, як глобальної соціальної сили в світовій політиці, а також реалістські теоретичні інтерпретації цієї сили. Особливу увагу надано витлумаченню націоналізму як фактору міжнародних конфліктів та наслідкам для систем міжнародних відносин національних державотворчих процесів.Статья посвящена сравнительному анализу теорий национализма и теории политического реализма. С целью усовершенствования познавательного аппарата политологии международных отношений, осуществлена попытка синтеза этих двух теоретических систем. На основании базовых положений реализма рассмотрена роль национализма в мировой политике, а также реалистские интерпретации этой определяющей силы современности. Особое внимание уделено интерпретации роли национализма в международных конфликтах и последствиям для международных систем процессов образования новых государств.The article deals with comparative analysis of the theories of nationalism and theory of political realism. This study aimed at methodological synthesis of these two groups of theories in order to improve a cognitive potential of political science in the sphere of its application to international relations. The role of nationalism as a global social factor and interpretation of this factor by realism is regarded. The special research attention is paid to the ways modern international conflicts and state1building processes are inspired by nationalism

Inhaled corticosteroids and growth of airway function in asthmatic children

Airway inflammation and remodelling play an important role in the pathophysiology of asthma. Remodelling may affect childhood lung function, and this process may be reversed by anti-inflammatory treatment. The current study assessed longitudinally whether asthma affects growth of airway function relative to airspaces, and if so whether this is redressed by inhaled corticosteroids (ICS). Every 4 months for up to 3 yrs, lung function was assessed in 54 asthmatic children (initial age 7-16 yrs), who inhaled 0.2 mg salbutamol t.i.d. and 0.2 mg budesonide t.i.d. (beta2-agonist (BA)+ICS), or placebo (PL) t.i.d. (BA+PL) in a randomised, double-blind design. Measurements were carried out before and after maximal bronchodilation. Airway growth was assessed from the change of forced expiratory volume in one second and of maximal expiratory flows (at 60% and 40% of total lung capacity (TLC) remaining in the lung) relative to TLC, as measures of more central, intermediate and more peripheral airways. Growth patterns were compared with the longitudinal findings in 376 healthy children. Airway patency after maximal bronchodilation in patients on BA+PL remained reduced compared to healthy subjects, whereas in patients on BA+ICS a marked improvement was observed to subnormal. No differences between patients and controls could be demonstrated for growth patterns of central and intermediate airway function. Compliance with BA+ICS was 75% of the prescribed dose, resulting in significant, sustained improvement of symptoms and postbronchodilator calibre of central and intermediate airways to subnormal within 2 months, but postbronchodilator small airway patency remained reduced, though improved compared to patients on BA+PL. Anti-inflammatory treatment of asthmatic children is associated with normal functional development of central and intermediate airways. The persistently reduced postbronchodilator patency of peripheral airways may reflect remodelling, or insufficient anti-inflammatory treatment

No association between glucocorticoid receptor polymorphisms and long-term respiratory outcome after very preterm birth

Developmen

Gender differences in respiratory symptoms in 19-year-old adults born preterm

Objective: To study the prevalence of respiratory and atopic symptoms in (young) adults born prematurely, differences between those who did and did not develop Bronchopulmonary Disease (BPD) at neonatal age and differences in respiratory health between males and females. Methods: Design: Prospective cohort study. Setting: Nation wide follow-up study, the Netherlands. Participants: 690 adults (19 year old) born with a gestational age below 32 completed weeks and/or with a birth weight less than 1500g. Controls were Dutch participants of the European Community Respiratory Health Survey (ECRHS). Main outcome measures: Presence of wheeze, shortness of breath, asthma, hay fever and eczema using the ECRHS-questionnaire

Bronchopulmonale dysplasie bij ex-prematuren die volwassen worden

Many patients born prematurely who developed bronchopulmonary dysplasia (BPD) as neonates are now approaching adulthood. Adults with BPD are at increased risk for respiratory difficulties including respiratory and lung function disorders. Respiratory symptoms include wheezing, cough and dyspnoea. In adult BPD patients lung function is impaired, notably by bronchus obstruction, hyperreactivity and reduced diffusion capacity; exercise capacity is also diminished. The pathophysiology of BPD is not identical to that of asthma and standard treatment for asthma is therefore not effective. Premature infants are currently treated with surfactant therapy that results in less intensive artificial respiration and oxygen being required. The classical BPD clinical picture that results from tissue damage and scarring is therefore becoming less common but another new BPD picture is emerging. This is characterised by large irregularly formed sacculi and alveoli with septation only just beginning and poor vascularization. Patients with chronic respiratory symptoms who were born prematurely should therefore undergo comprehensive testing, including detailed lung function tests and exhaled nitric oxide levels