Is home spirometry useful in diagnosing asthma in children with nonspecific respiratory symptoms?

Background: Variation of lung function is considered to be a hallmark of asthma. Although guidelines recommend measuring it as a diagnostic tool for asthma, the usefulness of this approach has not been studied in children.

Aim: To assess the usefulness of home spirometry in children with nonspecific lower respiratory tract symptoms, to diagnose or exclude asthma.

Airway obstruction at time of symptoms prompting use of reliever therapy in children with asthma.

Background: In asthma treatment, doses of inhaled corticosteroids are often adapted to symptoms and need for bronchodilators. However, in cross-sectional studies in emergency room settings, lung function and respiratory symptoms are not always concordant. Available longitudinal data are based on written peak flow diaries, which are unreliable.

Writing memories with light-addressable reinforcement circuitry.

Dopaminergic neurons are thought to drive learning by signaling changes in the expectations of salient events, such as rewards or punishments. Olfactory conditioning in Drosophila requires direct dopamine action on intrinsic mushroom body neurons, the likely storage sites of olfactory memories. Neither the cellular sources of the conditioning dopamine nor its precise postsynaptic targets are known.

[Treatment of asthma in children: revised international guidelines not suitable for use in the Netherlands].

The most recent revision of the Global Initiative for Asthma (GINA) guidelines for the treatment of asthma propose to classify and monitor the disease based on asthma control. This concept is attractive but not evidence based. Based on methodological shortcomings the revised GINA guidelines fail to meet the standards for evidence-based guidelines.

Reference values for peak flow and FEV1 variation in healthy schoolchildren using home spirometry.

Current reference values for diurnal peak flow variation in healthy children (median 8.2%; 95th percentile 31%) are so high that considerable overlap exists with those of asthmatic children. These values have been obtained using written peak flow diaries, which are unreliable.

Multiphoton imaging can be used for microscopic examination of intact human gastrointestinal mucosa ex vivo.

Background & Aims: The ability to observe cellular and subcellular detail during routine endoscopy is a major goal in the development of new endoscopic imaging techniques. Multiphoton microscopy, which relies on nonlinear infrared optical processes, has the potential to identify cellular details by excitation of endogenous fluorescent molecules. We examined the feasibility of using multiphoton microscopy to characterize mucosal histology in the human gastrointestinal tract.

Comparison between peak expiratory flow and FEV(1) measurements on a home spirometer and on a pneumotachograph in children with asthma.

Background: The accuracy of electronic portable home spirometers has been demonstrated in vitro using computer-based waveforms. We assessed the agreement in vivo between measurements of lung function on an electronic spirometer (Koko Peak Pro) and those obtained by the gold standard, a hospital lung function laboratory pneumotachograph.

Methods: Fifty stable asthmatic children (33 boys), aged 6-17 years, performed peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV(1)) measurements according to international guidelines on a portable home spirometer and on the hospital pneumotachograph in random order.

A New Greenhouse Method to Assay Soybean Resistance to Brown Stem Rot.

Greenhouse, growth chamber, and field experiments were conducted to develop a method to assess resistance of soybeans to Cadophora gregata (Phialophora gregata), causal agent of brown stem rot (BSR). In the new method, C. gregata is introduced at the base of the stems of 2-week-old soybeans, and the presence of the fungus is assessed in the tips of the stems 5 weeks later.

Home spirometry and asthma severity in children.

The usefulness of peak expiratory flow monitoring is disputed because of the unreliability of written peak flow diaries. The aim of the present study was to examine the relationship of peak flow and forced expiratory volume in one second (FEV1) variation to other estimates of asthma severity in children, using an electronic home spirometer with automatic data storage. Over a 3-month period, 36 children with mild-to-moderate persistent asthma recorded peak flow and FEV1 electronically twice daily and noted an asthma severity score in a written diary.

[Developmental delay in breastfed children due to inadequate diet of the mother].

Two infant boys of 7 and 12 months respectively who presented with symptoms of failure to thrive and developmental delay were diagnosed with vitamin B12 deficiency. This deficiency is a rare condition in infants living in developed countries. It does occur, however, in infants who are breastfed by mothers with an inadequate diet.

[Allergy testing possibly useful in children less than 4 years of age with recurrent cough and wheeze].

Objective: To assess the diagnostic value of measuring allergen-specific IgE antibodies in children less than 4 years of age with recurrent cough and wheeze.

Design: Retrospective cohort study.

Method: The prevalence of specific sensitisation for inhaled and food allergens that can be demonstrated by means of Phadiatop and enzymatic assays was determined on the basis of clinical data on 97 children under four years of age that had been referred to a paediatrician for recurrent cough and wheeze.

[Treatment of asthma in children: more than merely 'puffing'].

Five children, four boys aged 6, 9, 12 and 13 years and one girl aged 6 years, had persistent asthmatic symptoms despite maintenance treatment with inhaled corticosteroids and short-acting bronchodilators on demand. One of them required the addition of a long-acting beta 2-agonist to become symptom-free. The other four patients did not need to step up their asthma medication after correction of poor inhaler technique, treatment of dysfunctional breathing, treatment of allergic rhinitis, and elimination of passive cigarette-smoke exposure, respectively.

Video-rate nonlinear microscopy of neuronal membrane dynamics with genetically encoded probes.

Biological membranes decorated with suitable contrast agents give rise to nonlinear optical signals such as two-photon fluorescence and harmonic up-conversion when illuminated with ultra-short, high-intensity pulses of infrared laser light. Microscopic images based on these nonlinear contrasts were acquired at video or higher frame rates by scanning a focused illuminating spot rapidly across neural tissues. The scan engine relied on an acousto-optic deflector (AOD) to produce a fast horizontal raster and on corrective prisms to offset the AOD-induced dispersion of the ultra-short excitation light pulses in space and time.

Impact of nurse-led outpatient management of children with asthma on healthcare resource utilisation and costs.

The high burden of asthma on healthcare utilisation and costs warrants economic appraisal of management approaches. The authors previously demonstrated that the efficacy of nurse-led outpatient management of childhood asthma was comparable to management by a paediatrician and now report on the healthcare utilisation and costs of both management approaches. A total of 74 newly referred children with asthma were randomly assigned to a 1-yr follow-up by paediatricians or asthma nurse.

Variation of peak inspiratory flow through dry powder inhalers in children with stable and unstable asthma.

Drug release from dry powder inhalers depends for a large part on a sufficiently high peak inspiratory flow (PIF). We determined the variation of PIF through two commonly prescribed dry powder inhalers in children with asthma. We analyzed the effect of inhaler device, age, and severity of asthma symptoms on variation of PIF.

Usefulness of monitoring lung function in asthma.

There is no firm evidence from randomised controlled trials that routine monitoring of lung function improves asthma control in children. Guidelines for management of asthma consistently recommend routine home monitoring of peak expiratory flow (PEF) in each patient. However, changes in PEF poorly reflect changes in asthma activity, PEF diaries are kept very unreliably, and self management programmes including PEF monitoring are no more effective than programmes solely based on education and symptom monitoring.

Outpatient management of childhood asthma by paediatrician or asthma nurse: randomised controlled study with one year follow up.

Background: Until now, care provided by asthma nurses has been additional to care provided by paediatricians. A study was undertaken to compare nurse led outpatient management of childhood asthma with follow up by a paediatrician.

Methods: Seventy four children referred because of insufficient control of persistent asthma were randomly allocated to 1 year follow up by a paediatrician or asthma nurse.

Bronchodilator response in asthmatic children is significantly reduced when measured immediately after methacholine challenge.

Aim: Airway responses to a bronchodilator (BDR) and to methacholine are frequently measured in the assessment of childhood asthma and in pulmonary research. For practical reasons, we wondered whether it would be possible to obtain a reliable BDR immediately after completion of a methacholine challenge test. To this end, we compared BDR with and without a preceding methacholine challenge.

Transmission of olfactory information between three populations of neurons in the antennal lobe of the fly.

Three classes of neurons form synapses in the antennal lobe of Drosophila, the insect counterpart of the vertebrate olfactory bulb: olfactory receptor neurons, projection neurons, and inhibitory local interneurons. We have targeted a genetically encoded optical reporter of synaptic transmission to each of these classes of neurons and visualized population responses to natural odors. The activation of an odor-specific ensemble of olfactory receptor neurons leads to the activation of a symmetric ensemble of projection neurons across the glomerular synaptic relay.

[The peak flow meter: limited role in the diagnosis and follow-up of children with asthma].

The peak flow meter is commonly used to diagnose and follow up asthma in children and adults. This practice, however, is not supported by evidence from the literature. The amount of overlap in peak flow level and variation between healthy and asthmatic subjects precludes the use of peak flow diaries as a reliable tool in diagnosing asthma.

Determinants of correct inhalation technique in children attending a hospital-based asthma clinic.

Unlabelled: Many children with asthma use their inhaler device incorrectly even after comprehensive inhalation instruction. The aim of this study was to identify factors associated with correct inhalation technique. Two hundred children with asthma demonstrated their inhalation technique.