• Clinical and Experimental Pediatrics
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• v.52 no.11
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• pp.1267-1272
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• 2009

Purpose:We examined the ability of preschool aged children to meet the American Thoracic Society (ATS) and European Resiratory Society (ERS) goals for spirometry quality and tried to find out the major factor for improving the rate of success of spiromety test in this age group. Methods:Spirometry was performed in 2-6 aged 155 children with chronic cough or suspicious asthma with the recording of maneuver quality measures of forced expiratory time, end-of-test volume, back-extrapolated volume (Vbe), and forced vital capacity (FVC), as well as flow-volume curve. The subjects were tested several times and the two best results in each subject were selected. All criteria for quality control were suggested by ATS/ERS guidelines. The criteria for starting of the test was Vbe <80 mL and Vbe/FVC <12.5%. The criteria for repeatability of the test was that second highest FVC and FEV1 are within 100 ml or 10% of the highest value, whichever is greater. For the criteria for termination of the test for preschool aged children, we evaluated the flow-volume curve Results:As getting older, the success rate of spirometry increased and rapidly increased after 3 years old. Total success rate of the test was 59.4% (2 years old - 14.3%, 3 years old - 53.7%, 4 years old - 65.1%, 5 years old - 69.7%, 6 years old- 70.8%). The percentage of failure to meet the criteria for starting the test was 6.5%, repeatability of the test was 12.3% and end of the test was 31%. There was a significant difference only in age between success group and failure group. Evaluating the quality control criteria of previous studies, the success rate increased with age. Conclusion:About 60% of preschool aged children met ATS/ERS goals for spirometry test performance and the success rate was highly correlated with age. It is clearly needed that developing more feasible and suitable criteria for quality control of spirometry test in preschool aged children.

• Clinical and Experimental Pediatrics
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• v.45 no.7
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• pp.875-883
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• 2002

Purpose : Airways eosinophilia and increased IgE, characteristic features of asthma, result from a predominant Th2 response. In this study, we investigated the effect of CpG oligodeoxynucleotides (ODNs) on the inhibition of airways eosinophilia in mice with established airway inflammation. We also investigated the immunological mechanisms involved. Methods : Groups of BALB/c mice were sensitized intradermally with ovalbumin(OVA). At week 10, airway inflammation was induced by intranasal challenge of the mice with OVA. At week 14, the mice were challenged intranasally again with OVA in the presence and without the presence of CpG ODNs. Mice with saline administration served as negative controls. Bronchoalveolar lavage fluids(BALF) were obtained and eosinophils were counted. Th1 and Th2 cytokines in the spleen cell cultures were measured by ELISA. Serum OVA-specific IgE and IgG2a antibodies were also measured by ELISA. Results : BALF eosinophils were significantly inhibited in the CpG ODNs-treated mice(P<0.01). IgE and IgG2a levels increased significantly in both CpG ODNs-treated and untreated groups as compared to the negative control group; there was, however, no significant difference between the two groups four days after intranasal administration of CpG ODNs. Cytokine analysis revealed decreased production of IL-4, IL-5, and IL-13 and increased production of IL-12 in the CpG ODNs-treated group as compared to the untreated group. Interestingly, $IFN-{\gamma}$ levels were not upregulated in the CpG ODNs-treated group. Conclusion : CpG ODNs vaccination is a potentially useful approach for reversing airways eosinophilia in mice with established airways inflammation.

• Clinical and Experimental Pediatrics
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• v.50 no.9
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• pp.912-918
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• 2007

Purpose : Breast milk contains several components that provide specific immunity and affect the maturation of the infant's immune system. Allergic disease (AD), including atopic eczema, asthma, allergic rhinitis, and food allergy is characterized by an imbalance between cytokines produced by distinct T-helper cell subtypes. The aim of the study was to investigate the concentrations of cytokines and chemokines that were involved in allergic reactions in breast milk from allergic and nonallergic mothers and then analyse the effect of breastfeeding duration on the prevalence of allergic disease in the age of two. Methods : The breast milk samples were collected from mothers with AD (n=88) and without AD (n=47). Breast milk was collected at the second day (colostrum) and four weeks later (mature milk).The level of Interlukine (IL)-4, IL-5, IL-6, IL-8, IL-10, IL-13, $TGF-{\beta}1$, $TGF-{\beta}2$, RANTES in breast milk were determined by commercially available enzyme-linked immunosorbent assay (ELISA) kits according to the manufacturer's instructions. Results : Mothers with AD had a higher concentration of IL-8 in colostrum compared with those without AD (P=0.021). But, $TGF-{\beta}1$ and $TGF-{\beta}2$ were higher concentrated in colostrum of mother without AD (P=0.013, P=0.001). Whereas concentrations of other cytokines were not significantly different between the two groups. There was no association between levels of cytokines and chemokines in the breast milk and allergic development during the first 2 years of life in the infants. Conclusion : The higher concentration of $TGF-{\beta}1$ and $TGF-{\beta}2$ in colostrum from non-allergic mothers may explain the protective effect. But, the higher concentrations of IL-8 in colostrum from allergic mothers may in part explain the controversial results on the protective effect of breastfeeding against allergic diseases. We conclude that there is no convincing evidence form a relation between cytokines in breast milk and allergic diseases in infants. Longer follow-up are necessary to evaluate the effects of breast milk components on AD.

• Clinical and Experimental Pediatrics
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• v.49 no.4
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• pp.410-416
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• 2006

Purpose : Ciliary abnormalities of the respiratory system usually accompany recurrent or persistent respiratory diseases such as paranasal sinusitis, bronchiectasis, rhinitis, and/or otitis media, since they cause certain derangements in ciliary cleaning activities. This disease is usually inherited by autosomal recessive trait, but may also be found to be acquired or transient in rare cases after heavy exposure to pollutants, cigarette smoking or severe infection. We performed this study in children with frequently recurrent or persistent respiratory diseases to clarify if the ciliary abnormalities are preceding factors. Methods : We enrolled 17 children with suspected respiratory ciliary abnormalities. The indications for evaluation of ciliary ultrastructure were recurrent or persistent respiratory infections. Children with immunologic abnormalities were excluded. From August 2000 to July 2003, we performed a biopsy on nasal mucosa and examined the structure of ciliary status by using an electron microscope. Results : Of the subjects, there were seven males and 10 females, aged 2 to 10 years. Out of the 17 subjects, 12 cases of chronic paranasal sinusitis, nine chronic coughs, nine frequent upper respiratory infections, seven cases of recurrent otitis media, four cases of recurrent pneumonia, and four cases of bronchial asthma were found. Out of the 17 cases on which histologic examinations were conducted, four cases showed pathologic findings, including one case of inner dynein arm defect, one of microtubular transposition, one of supernumerous tubules, and one singlet, respectively. Conclusion : It is essential for differential diagnosis and effective treatment to identify the abnormalities of ultrastructure of nasal cilia in children with symptoms of frequently recurrent or persistent respiratory diseases, if immunodeficiency or respiratory allergy could be excluded.

• Clinical and Experimental Pediatrics
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• v.46 no.4
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• pp.370-375
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• 2003

Purpose : It has been suggested that the exposure to aeroallergens during early infancy after birth is important in the subsequent development of sensitization and allergic diseases. In Korea, the level of house dust mites as one of the important aeroallergens is known to be the highest in autumn. The aim of this study was to test whether the distribution of month of birth bears a relationship to the presence of mite sensitization in children with respiratory allergy. Methods : Skin prick tests and methacholine provocation tests were performed on 1,327 patients with chronic respiratory symptoms who visited Seoul National University Children's Hospital from January 1995 to May 2002. An analysis of patients' month of birth distribution according to the presence of mite sensitization was performed. Results : Atopic subjects who had at least one positive skin test numbered 864(65.1%); and non-atopic subjects numbered 463(34.9%). Among atopic subjects, 787(59.3%) had positive skin tests to mites and 77(5.8%) had positive skin test only to minor allergens. A significantly greater than expected number of mite atopic subjects were born in the months between August and November(P=0.03), however, the birth month of non-atopic subjects didn't show a consistent seasonal preference. Asthma patients numbered 543(40.9%). Among these, atopic asthmatics numbered 421(77.5%) and non-atopic asthmatics, 122(22.5%). Dust-mite atopic asthmatics numbered 387(91.9%) out of 421 atopic asthmatics. Dust-mite atopic asthmatics were born significantly higher in the season lasting from August to November in comparison to non-atopic asthmatics(P=0.002). Conclusion : Month of birth seems to be related with sensitization to allergens. Our results show that August to November is the risk period for the development of mite sensitization in Korea.

• Clinical and Experimental Pediatrics
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• v.45 no.9
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• pp.1090-1096
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• 2002

Purpose : We evaluated the clinical manifestations, bronchoscopic findings and therapeutic effects of flexible fiberoptic bronchoscopy in atelectasis of children. Methods : Sixty six children who received bronchoscopy due to persistent atelectasis, acute severe atelectasis and incidental atelectasis on plain chest radiography were studied retrospectively. Results : The most common causative underlying disease was pneumonia(60.4%). Other underlying conditions were pulmonary tuberculosis, chronic lung disease, postoperative state, bronchial asthma and chest trauma. The most common abnormal findings were inflammatory changes such as bronchial stenosis(n=15), mucosal edema and large amount of secretion(n=14), granulation tissue( n=3) and mucus plug(n=3) although 39.4% showed normal airways. Other findings were congenital airway anomalies, endobronchial tuberculosis, extrinsic compression and obstruction by blood clot. In 32 children with pneumonia-associated atelectasis, 43.7% revealed normal airways, and the most common abnormal findings were also inflammatory changes. Eighteen out of 39 patients who received therapeutic intervention such as suctioning of secretion, bronchial washing and intrabronchial administration of N-acetylcysteine($Mucomyst^{(R)}$) had complete or partial resolution of their atelectasis. In 32 patients with pneumonia-associated atelectasis, 56.5% showed improvement by therapeutic intervention. Conclusion : In this study, atelectasis was mainly associated with inflammatory airway diseases such as pneumonia. The most common abnormal bronchoscopic findings were inflammatory changes such as mucosal edema and large amounts of secretion and bronchial stenosis, although about 40% revealed normal airway. Flexible bronchoscopy is helpful for either diagnosis or treatment, especially in pneumonia-associated atelectasis.

• Clinical and Experimental Pediatrics
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• v.51 no.8
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• pp.842-847
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• 2008

Purpose : Measurement of forced expiratory volume in 1 second ($FEV_1$) is usually difficult to obtain in children under six years of age because it requires active cooperation. This study evaluates the sensitivity of impulse oscillometry system (IOS) parameters for detecting airway obstruction in comparison with $FEV_1$. Methods : We studied 174 children who performed the lung function and methacholine challenge tests to diagnose asthma by IOS and spirometry. Children were divided into two subgroups according to their $PC_{20}$, which is a parameter for bronchial sensitivity. We compared IOS parameters with $FEV_1$ at the baseline, post-methacholine challenge, and evaluated their correlation. Results : At the baseline, reactance at 5 Hz (X5) and resistance at 5 Hz (R5) significantly differed between the $PC_{20}$ positive ($PC_{20}{\leq}16mg/mL$) group and $PC_{20}$ negative ($PC_{20}$ >16 mg/mL) group; however, $FEV_1$, $FEV_1$ % predicted, $FEV_1_-Zs$ (Z score) did not differ. $FEV_1$ is correlated with X5 (r=0.45, P<0.01) and R5 (r=-0.69, P<0.01). $FEV_1_-Zs$ is also correlated with X5_Zs (r=-0.26, P<0.01) and R5_Zs (r=-0.31, P<0.01). After the methacholine challenge test, dose-response slopes in $FEV_1$ and X5 significantly differed between the two subgroups (P<0.05). Conclusion : IOS parameters were more discriminative than $FEV_1$ for detecting decreased baseline lung function between two subgroups and have a good correlation with $FEV_1$.

• Clinical and Experimental Pediatrics
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• v.45 no.11
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• pp.1340-1345
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• 2002

Purpose : We studied the prevalence of snoring and its association with diseases, obesity and environmental factors, as well as sleep disturbance arising from snoring, in school-aged children. Methods : The survey was performed by a special questionnaire on 1,707 children at elementary schools from 1 to 30 July 2001 in Gwangju City. The prevalence of snoring, associated factors, and sleep disturbance were evaluated. Results : 266(16.5%) of the children snored at least once a week. 73(4.3%) of the children snored almost every day. Regarding the associated factors of snoring : There was a statistically significant difference between snoring and nonsnoring groups due to gender, obesity, sinusitis, tonsillar hypertrophy, bronchial asthma and allergic rhinitis. Of them, male gender, tonsillar hypertrophy, and obesity were significant risk factors for development of snoring. Especially, the odds ratio increased to 1.048(CI, 1.004-1.659), 1.748(CI, 1.175-2.599), and 2.266(CI, 1.300-3.950) in children with an obesity index of 20-29%, 30-49%, ${\geq}50%$, respectively. There was a statistically significant association of snoring with decreased sleep duration, sleep talking, and drowsiness during the day as a result of sleep disturbance. Conclusion : 16.5% of school-aged children snored at least once a week. The association of snoring with tonsillar hypertrophy, obesity and gender as risk factors was demonstrated in this study.