Search

Unlabelled: Childhood asthma presents with specific clinical and functional characteristics. The aim of our study was the description of a large cohort of asthmatic children. It was also to assess their outcome with maintenance therapy according to guidelines, and to analyze the relationship with baseline's characteristics. We focused particularly on clinical and functional pediatric specificities., Methods: Prospective study driven on asthmatic children, without treatment, recruited during a hospitalization for exacerbation or a visit for uncontrolled asthma, treated according to GINA guidelines and followed for one year., Results: 412 children (mean age: 11.6 years +/- 2.7), were included. The level of severity was: intermittent asthma for 30% and persistent asthma for 70% (40.5% mild, 28% moderate, 1.5% severe). Mean prebeta2-FEV1 was 88.5% +/- 10.5 (PV) with mean beta2-reversibility of 10.8% +/- 7.8 (> 12% for 42% patients). 374 patients ended the study. After one year, we observed an improvement of clinical symptoms (p < 0.0001), rate of hospitalization (p < 0.0001), and lung function (mean prebeta2-FEV1: 91.2% +/- 7.9, p < 0.001). Asthma control was obtained for only 24.6%. Multivariate analysis show that decrease of symptoms was significantly related to younger age, higher level of initial severity and number of days of hospitalization., Conclusion: This study confirms pediatric specificities of asthma, as a normal FEV1 level and a limited beta2-reversibility of FEV1, and the large part of uncontrolled asthma after one year of treatment. It emphasizes the risk of undertreatment in a strategy based on severity. It argues for the regular assessment of control as now recommended, taking into account the pediatric asthma specificities.

The relationship between bronchial asthma (BA) and gastro-esophageal reflux (GER) impose to study by frequency, reciprocally prognosis and therapeutics difficulty. Coexistence of both diseases is suggested by presence of asthmatics symptoms in non-atopic patients, difficult control and resistance of the specific treatment of asthma disease, worsening of respiratory symptoms in circumstances which favored GER. Pathogenetic relationship between BA and GER in children is the result of the associations- digestive particularity and: esophago-bronchial neurogenic mechanism produced by micro-aspiration , genetic or obtained inflammations development by commune Th2 mediators, medications effects. Classical treatments (H2-inhibitors, prokinetics agents, inhibitors of protonic pumps) is associated of the antiasthmatics "controller" therapy and in the future, anti-cytokine and anti-receptor therapy.

For the study of leukocyte metabolism in the serum and the urine from 52 patients with urinary infections, the Nitroblue Tetrazolium (NBT) test was used for a qualitative estimation of leukocyturia. It was observed that 26 of the 52 patients (50%) presented higher values of NBT positive urinary neutrophils than in the control group. The NBT test might be useful in the estimation of the cellular immune response in the course of urinary infections.