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The bronchodilator and cardiovascular effects of orally administered tablets containing 2.5 mg of terbutaline and 25 mg of ephedrine were compared in a double-blind parallel manner in children (ages, 7 to 14 years) weighing 25 to 50 kg (44 to 110 lb). Both drugs produced bronchodilation within one-half hour, and this effect was maintained up to six hours, with a peak between two and three hours. Small increases in the pulse rate were measured within an hour following administration of both drugs. No significant variation was noted in blood pressure. No adverse effects (including tachyphylaxis and tremor) were observed for either drug during a three-month period. Both bronchodilator agents were shown to be equally effective in the dosages used. Terbutaline is a safe bronchodilator drug when administered orally in 2.5-mg doses for children with chronic asthma in this range of ages and weights, with minimal cardiovascular side effects and effective bronchodilation.

Cloprednol is an oral synthetic glucocorticoid with a short serum half-life of 110 minutes. Twenty children who had chronic corticosteroid-dependent asthma were empaneled to study the effects of cloprednol for a period of 24 months. Three of these dropped out at the end of one year. Alternate-day doses of prednisone were replaced by equivalent daily 8 am doses of cloprednol. Ten of 17 patients had better control during cloprednol therapy than during previous prednisone regimens, and significant improvement was noted in peak expiratory flow rate during the study period (P less than .001). Long-term side effects were absent. Improvement in the degree of hypothalamopituitary adrenal axis responsiveness, based on fasting 8 am cortisol levels, was noted from baseline to the end of study period.

Metaproterenol sulfate was given to 25 children with asthma in the form of a syrup in a continuous treatment course of 180 days. Dosage amounted to 10 to 20 mg metaproterenol four times daily, depending on the patient's age and weight. Double-blind crossover tests of pulmonary function were run against placebo at the beginning and after 3 and 6 mo of treatment. The peak expiratory flow rate responses to metaproterenol consistently exceeded the responses to placebo, the differences proving statistically significant at several intervals after administration. Adverse reactions were limited to instances of hyperactivity in one child and of mild tremors in another; laboratory values remained normal throughout the 6-mo period except for low normal fasting blood sugar values recorded in 2 patients at the end of the study. Pulse rate increases occurring after metaproterenol were not considered clinically important.

A 5-percent solution of the sympathomimetic bronchodilator, metaproterenol sulfate (Alupent) was evaluated by comparison with an 0.5-percent solution of isoproterenol in a double-blind crossover study before and after 60 days of inhalation of metaproterenol administered at least four times daily via a hand-bulb nebulizer. Data from tests of pulmonary function obtained in 27 asthmatic patients indicated that metaproterenol sulfate in this dose form surpassed isoproterenol in the duration of effect after seven weeks of continuous administration. Side effects did not necessitate the interruption of metaproterenol therapy. No evidence of the development of tolerance to the drug was shown by any of the patients at the end of the study.

Serial roentgenograms and technetium Tc 99m macroaggregated albumin lung scans were done simultaneously in 30 bronchodilator-dependent asthmatic children and young adults during both relative remission and attacks of status asthmaticus. When chest roentgenograms showed air trapping and increased peribronchial vascular marking associated with persistent perfusion defects, the children benefited from further laboratory studies and continuous comprehensive therapy. Serial scans provided information about underperfusion that was not discernible either by roentgenograms or by usual blood gas studies. Also, lung scans are easier to obtain in children with long-standing asthma than are detailed pulmonary tests. In our study, technetium Tc 99m macroaggregated albumin scans showed persistent regional perfusion defects in 20 children wiht chronic asthma during relative remission and exacerbations.

The results of systematic medical histories and pulmonary function tests on 26 children and young adults, 10 with Pi variant alpha1-antitrypsin phenotypes and 16 Pi normals, are reported. These subjects were selected from 57 consecutive patients who had chronic asthma. The incidence of Pi variants was 20.4% among 46 Caucasian subjects (ages seven to 21 years). The Pi variant patients required more bronchodilators and long-term corticosteroid therapy. Among the parents and siblings, 50% of those with abnormal Pi type had chronic obstructive lung disease. Grandparents of the Pi abnormal probands had greater incidence of chronic obstructive lung disease (P less than 0.05). Baseline specific airways conductance and maximal midexpiratory flow rates did not discriminat between the two groups. However, bronchodilator inhalation showed the Pi variant group to be significantly less responsive than the Pi normal group. Pi heterozygous state, particularly Pi MZ, should be considered when a young person with chronic asthma is unresponsive to adequate doses of bronchodilators and needs prolonged use of corticosteroids.

IgE antibodies to Mycoplasma pneumoniae antigens were measured by RAST assay in 152 patients with asthma and other IgE and non-IgE mediated diseases. Five patients with asthma and/or atopic dermatitis had highly elevated Mycoplasma RAST binding ratios, p < 0.001. For these five patients the ratios ranged from 1.78 to 4.74. These increased ratios persisted at least two to 16 months in three of four individuals who were evaluated sequentially. RAST inhibition studies using Mycoplasma pneumoniae, Mycoplasma control, Streptococcus MG and viral antigens showed the specificity of binding for M. pneumoniae in these five patients indicating the presence of IgE antibodies to M. pneumoniae.

Ninety-five children with difficult to treat asthma were given cromolyn in double-blind, crossover studies. Of these, 70 were studied for the next five to six years by open trial cromolyn prophylaxis to determine decreasing dependency on bronchodilators or corticosteroids. Evaluated at two-month intervals, 28 children required prednisone and bronchodilators, 37 required round-the-clock bronchodilators only and five required neither. Peak expiratory flow rates were below 80% of predicted normal in eight patients, the remaining 62 showed reversibility of airways obstruction. Exercise-induced asthma was reported by 44 during the first two years but persistent improvement in exercise tolerance occurred in 24 patients. IgE specific RAST indicated a continuing extrinsic element in the etiology of 38 of 45 patients tested. Cromolyn was an effective prophylaxis for children with chronic asthma; however, it was difficult to evaluate in 17 steroid-dependent subjects. Attempts to reduce the need for and especially to discontinue steroids were not as successful as other reports indicate.