During the winter season upper respiratory tract secretions from 166 patients with stable chronic obstructive pulmonary disease (COPD) or asthma were simultaneously cultured for Streptococcus ...pneumoniae and tested for pneumococcal capsular antigen. Latex agglutination was employed to investigate the effect of pneumococcal carriership on pneumococcal capsular antigen detection in upper respiratory tract secretions. All specimens originating from the oropharynx, nasopharynx and saliva were both cultured and investigated in parallel for the presence of antigen. The recovery of pneumococci from the different areas was unequally distributed (oropharynx 29%, nasopharynx 8%, and saliva 16%), with the highest isolation rate from the oropharynx alone. Only 4 (3%) of the oropharyngeal swabs, 1 (1%) of the nasopharyngeal swabs and 14 (9%) of the saliva specimens yielded both pneumococcal antigen and a positive culture for S. pneumoniae. A further 9 (6%) of the oropharyngeal swabs, 5 (3%) of the nasopharyngeal swabs, and 50 (33%) of the saliva specimens were antigen positive only, with no pneumococci isolated on culture. It is speculated that these reactions were due to cross-reacting microorganisms (especially alpha-haemolytic streptococci) present in saliva and contaminating the oropharynx and the nasopharynx. Quantitative cultures of 9 oropharyngeal swabs yielded S. pneumoniae in concentrations too low to be detectable by latex agglutination. The study indicates that there is a poor relation between pneumococcal colonization and antigen detection in the oropharynx and nasopharynx. Antigen present in these secretions is probably not an important disrupting factor by contamination when detecting pneumococcal antigen in washed sputum. The false positive antigen results in saliva are probably due to cross-reactions with alpha-haemolytic streptococci.
In a study of two groups of nine allergic asthmatic children, consisting of one group with (group I) and one group without (group II) increased nocturnal airflow obstruction, we determined whether an ...increase in vagal activity, or inflammatory mediators like histamine are responsible for the nocturnal increase in airflow obstruction. The results of investigations in the two groups of asthmatics were compared to the results of an age matched control group. Forced expiratory volume in one second (FEV1) and electrocardiogram recordings of one minute were obtained every 4 hours during 24 hours. Heart rate and sinus arrhythmia gap were used to express vagal activity indirectly. N tau-methylhistamine was determined in urine samples collected in periods of 4 hours between the measurements. In group I, overall N tau-methylhistamine excretion was on a higher level than in both other groups, and was significantly higher overnight. Parasympathetic stimulation did not seem of importance to the increase of airflow obstruction at night.
Nocturnal airflow obstruction is a common symptom in children with asthma. The increase in airflow obstruction overnight is underassessed by children as well as their parents. Worsening of the early ...morning peak flow values may be an indication for an increase in airflow obstruction overnight. An increase in vagal activity does not, in contrast with the observations in adult patients, contribute to the development of nocturnal airflow obstruction in asthmatic children. However, a nocturnal increase in inflammatory mediators seems to play a role of importance. Treatment of nocturnal airflow obstruction should therefore be focussed on inflammatory processes in the lungs.
CARD from childhood to adulthood Gerritsen, J; Koëter, G H; Schouten, J P ...
Tijdschrift voor kindergeneeskunde
58, Številka:
1
Journal Article
In approximately 50 per cent of the children with asthma respiratory symptoms, these symptoms disappear during puberty. Outgrowing childhood asthma is especially estimated by: the degree of airway ...obstruction as a child, and the degree of bronchial hyperreactivity in childhood. Another childhood factor of influence on the prognosis of asthma seems to be the combined early and late bronchial response after inhalation of an allergen. Factors not predicting the outcome of childhood asthma are: at what age asthma symptoms started; whether the child with asthma had eczema or not, and how strong skin-allergy was. Conceivable risk-factors for the outcome of childhood asthma are: smoking of the parents and a strong degree of eosinophilia. The prognosis of asthma might be improved by more intensive treatment and continuity in treatment of the children with an increased risk.
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