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There are apparently irreversible inflammatory changes in the airways of young adults with chronic asthma so a strong case can be made for starting anti-inflammatory treatment early. Corticosteroids have potent and diverse anti-inflammatory activity. High efficacy is established in school age children. Trials in pre-school children and infants have given more mixed results perhaps because of problems with administration. No clinically important systemic effects have been observed in children taking conventional doses of inhaled steroids.

Ninety culled dairy cows were used in this study and were paired by weight and conformation similarity. Forty-five cows were arterially infused immediately after bleeding with 10% volume by weight of a solution composed of dextrose (.23%), glycerin (.21%), a phosphate blend (.14%) and maltose (.1%). The remaining cows (45) served as controls. In infused carcasses, some quantity of solution retained was in the following order: supraspinatus, chuck greater than longissimus, loin greater than semitendinosus, round muscles. Accordingly, percentage of protein, ether-extractable fat, and protein fat-free amounts were lowered (P less than .05) and percentage of moisture and moisture protein ratio were raised (P less than .05) in the supraspinatus muscle. Tenderness (P less than .01) and protein extractability (P less than .15) were improved. No difference was observed in water-holding capacity between infused and control carcasses. Percentages of moisture fat-free (r = .85) and protein fat-free (r = -.97) were highly correlated to moisture-protein ratio. Moisture percentage of the fat-free tissue was shown to be a more consistent indicator of added moisture in infused whole carcasses compared with moisture:protein ratio and percentage of protein fat-free. Very low correlations were observed between tenderness, percentage of moisture, percentage of water-holding capacity, and ether-extractable fat. The economics of the infusion process to the beef industry is discussed.

The effect of inhaled salmeterol xinafoate, a long acting beta 2 agonist, on exercise induced asthma was studied in a double blind, crossover, and placebo controlled trial. Thirteen asthmatic children with a fall of at least 15% in their forced expiratory volume in one second (FEV1) after a standard exercise test on a motorised treadmill, on separate days performed the same test 1, 5, and 9 hours after a single dose of 50 micrograms salmeterol or placebo. FEV1 was measured before treatment, and before and for 30 minutes after each exercise test. After placebo the number of children with exercise induced asthma was: 10 at 1 hour, 11 at 5 hours, and 12 at 9 hours. Salmeterol prevented exercise induced asthma in all 13 children studied, at 1, 5, and 9 hours. Mean maximum falls in FEV1 after exercise were at 1 hour: salmeterol 2.7% and placebo 24.6%, 5 hours: salmeterol 5.3% and placebo 22.7%; and 9 hours: salmeterol 3.4% and placebo 26.6%. After salmeterol the mean increase in FEV1 was 17.8% at 1 hour, 19.6% at 5 hours, and 19.2% at 9 hours. Inhaled salmeterol prevents exercise induced asthma and produces significant bronchodilatation for at least 9 hours.

Responses to the house dust mite during infancy may be important determinants of asthma in susceptible individuals. This study assessed early IgG subclass antibody responses to Dermatophagoides pteronyssinus in children of atopic parents. Sixteen atopic and 15 non-atopic children were selected from a birth cohort, and atopic status was established according to follow up over the first two years. IgG1 and IgG4 antibodies to D pteronyssinus were measured by enzyme linked immunosorbent assay at 7 days and 3, 6, 12, and 24 months. In all children D pteronyssinus IgG1 fell at 3 months (indicating maternal antibody loss), rose progressively to 12 months, and waned at 24 months. D pteronyssinus IgG4 was only detectable at 7 days. Children who were atopic by 2 years and therefore at greater risk of asthma, tended to have higher D pteronyssinus IgG1 at 6 and 12 months. These data suggest greater exposure or responsiveness to dust mite during infancy than in the second year.

Sputum samples from 13 children with cystic fibrosis (CF) were analyzed for leukotrienes (LTs) LTB4, LTC4, LTD4, and LTE4. Distribution of LTB4 appeared to be normal, and of cysteinyl-LTs log normal. Total cysteinyl-LT levels, of which on average 75% was LTE4, were nearly 10 times higher than in earlier studies. Log LTE4 and total cysteinyl-LT levels correlated with the overall severity of pulmonary disease assessed by Chrispin-Norman chest radiograph score (Log LTE4: r = 0.701, r2 = 49.1%, P = 0.008. Log total cysteinyl-LTs: r = 0.715, r2 = 51.1%, P = 0.006). There was no apparent relationship between LTB4 levels and Chrispin-Norman chest radiograph score, nor between the level of any of the LTs and age or organism cultured from sputum. These findings suggest that the cysteinyl-LTs may be involved in the pathophysiology of pulmonary disease in CF.

This study investigates the early humoral immune response following natural exposure to an inhalant antigen (Dermatophagoides pteronyssinus) in 36 babies, from birth until 1 year of age. The total IgG and subclass 1 and 4 D. pteronyssinus-specific antibody levels were assayed in sera collected at 7 days, 3 and 12 months by ELISA. After an initial fall, due to the progressive loss of maternal antibodies, an IgG specific response to D. pteronyssinus was seen between 3 and 12 months. This was restricted to the IgG1 subclass when the values at 12 months were significantly higher than those detected at the third month (P less than 0.001, paired t test). No D. pteronyssinus-specific IgG4 antibody was detected in any subject at any of the time points tested. The present study demonstrates that inhalant as well as food antigens are able to stimulate the immune system during the first year of life and that the antibodies produced are of the IgG1 subclass.

Functional residual capacity (FRC) was measured at 6-monthly intervals for at least 2 years in 42 young asthmatic children. Over the 2-year period FRC decreased in the 42 children from a median of 136% to 117% of that predicted for height (P less than 0.05). These changes in FRC were associated with a reduction in the number of children receiving no regular treatment (ten at recruitment, 0 at 2 years), P less than 0.05, and an increase in the number of children receiving inhaled steroids (ten at recruitment and 29 at 2 years), P less than 0.01. Twenty-five children were hyperinflated at recruitment (FRC greater than 120% of that predicted for height) with median FRC 152% compared to only 16 children at 2 years median FRC 117%, P less than 0.01. We conclude that FRC decreases as asthmatic children get older but some children, worryingly and despite increased use of prophylactic therapy, remain chronically overdistended which may put them at serious risk of chronic obstructive airways disease in later life.

This follow-up study of 191 babies investigated the development of food allergy in an unselected population and its relationship to total and antigen-specific IgE and IgG subclass levels. Sensitization to egg, as indicated by a positive skin test or RAST, was found in 5% of 1-year-old babies, but none of the babies in this series fulfilled the clinical criteria for immediate-type milk allergy. For both bovine casein (CAS) and egg albumin, the IgG response was largely restricted to IgG1 in contrast to the predominant IgG4 response to these antigens that is found in adults. The level of IgG4, but not IgG1, antibody to CAS and ovalbumin (OV) was lower in some of the babies compared with that of their mothers (N = 166; p less than 0.05, Student's paired t test). However, there was no difference in the total serum IgG subclass levels between mothers and babies. These results demonstrate that, in the population of babies studied, (1) type I hypersensitivity to egg occurred in 5% of 1-year-old babies, (2) the predominant IgG subclass of antibodies to CAS and OV in babies is IgG1, and (3) in the 22% of babies, there was substantially (greater than 1000-fold) less IgG4 antibody to CAS and OV than in their mothers, suggesting specific exclusion of some IgG4 antibodies.

Nocturnal symptoms are common in young asthmatic children. Such symptoms may be caused by increased impairment of lung function when they adopt the supine posture. Thirty one children aged 2.8-8.3 years were studied, of whom 20 had asthma (10 with frequent nocturnal symptoms) and 11 had no respiratory problems (control subjects). Peak expiratory flow (PEF) was measured with a Wright's peak flow meter and functional residual capacity (FRC) by a helium gas dilution technique after 30 minutes of lying supine; the values were compared with FRC measured sitting and PEF standing. Peak flow fell significantly on adoption of the supine posture in the asthmatic children, but there was no difference in this fall between the asthmatic children with and without nocturnal symptoms. FRC also fell on adoption of the supine posture, but the decrease in FRC was significant only in the control children and the asthmatic children without nocturnal symptoms. The failure to find a greater fall in PEF or a greater change in FRC on adoption of the supine posture among asthmatic children with nocturnal symptoms suggests that mechanisms other than increased impairment of lung function are responsible for nocturnal asthma.

Functional residual capacity (FRC) can be assessed reliably in young children using a helium gas dilution technique. The aim of the present study was to determine if differences in lung volume are found in asthmatic children of different ethnic origins. Eighty-eight children were studied, 53 of Caucasian origin and 35 of Afro-Caribbean origin. Their median age was 6.1 years (range, 5.3-9.0 years). FRC measured by helium gas dilution is reported as a percentage of predicted for height, using a published regression equation as well as regression equations appropriate for the ethnic origin of the child. In the majority of both groups FRC was elevated above the ethnically appropriate regression equation for healthy children. The Caucasian children apparently had higher FRCs than the Afro-Caribbean children if comparing the absolute lung volume, and if lung volume was expressed as percent of predicted for height, by a regression equation uncorrected for ethnic origin (P less than 0.02). This difference disappeared when ethnically appropriate regression equations were used. We conclude that lung volumes are similar in asthmatic children of different ethnic origin and that it is important to use ethnically appropriate regression equations.

1. Leukotrienes (LTs) are potent pro-inflammatory mediators with actions relevant to the pathophysiology of cystic fibrosis (CF), including increased mucus production, bronchoconstriction, leucocyte chemotaxis, and increased vascular permeability. We have therefore investigated the potential role of LTs in children with CF. Leukotriene E4 levels were assessed in the urine of 30 normal (N) children (aged 1.3-12.7 years) and 30 CF children (1.6-14.3 years). Sputum from 13 of the CF children was analysed from LTB4, LTC4, LTD4, and LTE4. LTs were separated by reversed-phase h.p.l.c. and quantitated by radioimmunoassay. 2. Urinary LTE4 levels were log normally distributed, with geometric mean values (95% confidence intervals) of N: 88.4 (71.3-111) pmol mmol-1 creatinine (n = 30), and CF: 112 (70.6-177) pmol mmol-1 creatinine (n = 30; P greater than 0.05). Of the CF subjects, 33% had urinary LTE4 levels above 200 pmol mmol-1 creatinine, compared with 3.3% of the N children. 3. In sputum, mean (+/- s.e. mean) LT concentrations were (pmol g-1), LTB4: 44.3 +/- 10.8, LTC4: 4.9 +/- 1.3, LTD4: 1.8 +/- 0.9, and LTE4: 67.7 +/- 18.9 (n = 13). 4. Urinary LTE4 levels correlated significantly with sputum LTE4 levels (r = 0.673, P = 0.012), and with sputum levels of total cysteinyl-LTs (r = 0.660, P = 0.014). 5. In conclusion, total cysteinyl-LT content in sputum is 10-fold higher than previously reported, consisting primarily (91%) of LTE4. The high levels of LTE4 and LTB4 in sputum suggest involvement of LTs in the pathophysiology of CF. Urinary LTE4 levels may prove useful as a marker for cysteinyl-LT production in sputum.

Peak flow rate is used in young children to assess bronchodilator response and monitor asthma status at home. Frequently the best of only three peak flow manoeuvres is reported. The aim of this study was to assess if this was sufficient to give the maximum peak flow rate and to determine the reproducibility of the measurement. Thirty nine children aged between three and ten years were recruited. Peak expiratory flow rate (PEFR) was measured six times in each child at two minute intervals. Less than half (13 of 39) of the children made their maximum blow in the first three manoeuvres. The maximum peak flow from the second set of three blows was a median of 7% greater than that from the first three blows. The coefficient of variation of the measurement was 8.8% suggesting a change in PEFR greater than 17.6% is necessary to demonstrate a response to bronchodilator. We conclude three peak flow manoeuvres are insufficient in the majority of young children to demonstrate the maximum peak flow.

In a randomised controlled trial 38 asthmatic children aged 2-11 yr who had not received regular oral or inhaled steroids during the previous year, were treated with a standard regime of nebulised salbutamol and intravenous aminophylline plus either hydrocortisone and oral prednisolone for 5 days, or placebo. The children were observed throughout their hospital stay and for 3 months afterwards. There was a greater fall in heart rates in the steroid treated group on the second day of treatment (mean diff. 16 beats/min) and at discharge (mean diff. 13 beats/min); p less than 0.025. Peak Expiratory Flow Rates recorded in 26 children, 13 in each group, showed more improvement on day 2 in those given steroids (mean diff 16% predicted); p less than 0.05. This difference was not apparent at discharge but 9 children treated with steroids were clinically wheeze-free when they left hospital compared with 3 in the placebo group, p less than 0.05. There were no differences in respiratory rate, pulsus paradoxus and arterial oxygen saturation. Trends in duration of hospital stay and relapse rate during the succeeding 3 months favoured active treatment. These findings support the use of systemic corticosteroids in addition to high dose bronchodilators to treat 'non steroid dependent' children hospitalised with acute severe asthma.

About 1% of infants are admitted to hospital with acute bronchiolitis; 85% of cases are caused by infection with Respiratory Syncytial Virus (RSV). The pathophysiological changes during the acute illness are inflammatory obstruction in the small airways with submucosal cellular infiltration, epithelial necrosis and mucous plugging; FRC increases and dynamic compliance falls. Failure to respond to bronchodilator drugs suggests that muscle spasm contributes relatively little to the airway narrowing. Affected infants become increasingly dyspnoeic and hypoxic for 3-4 days then spontaneously improve. After an attack of acute bronchiolitis up to 75% of children have recurrent lower respiratory tract symptoms, many continue to have hyperinflated lungs and bronchial hyperresponsiveness. In the majority, symptoms of cough and wheezing have subsided by the time they start school, but abnormalities of small airway function are detectable at least 13 years later. Children with a genetic predisposition to atopy do not appear to have an increased risk of developing bronchiolitis. Evidence of genetic predisposition to bronchial hyperresponsiveness in those with persistent wheezing is controversial. There is little to suggest that neonatal lung damage or an adverse home environment are important factors in determining susceptibility to post-bronchiolitis wheezing. IgE antibodies to RSV, and leukotriene C4, are found more frequently in the respiratory secretions of infants who wheeze during and after bronchiolitis than in those who do not. The possibility of viral-induced alteration of the immune response at the time of infection needs further investigation.

Measurements made from the Research Platform FLIP provide some of the first direct observations of three-dimensional flow within the surface mixed layer of the ocean. Relatively narrow regions of downwelling flow were found within the mixed layer, in coincidence with bands of convergent surface flow. At mid-depth in the mixed layer, the downwelling flow had magnitudes of up to 0.2 meter per second and was accompanied by a downwind, horizontal jet of comparable magnitude. There is some evidence that these motions transport heat and phytoplankton within the mixed layer.

Adult male New Zealand rabbits were subjected to a 28-day fast (food deprivation). Various blood biochemical parameters, as well as organ and individual skeletal muscle (semitendinosus and longissimus dorsi) weights, were determined. Additionally, the effect of fasting upon individual skeletal muscle functions was assessed. The calcium activated sarcoplasmic factor (CASF) isolated from the fasted rabbits was compared with the same enzyme isolated from ad lib fed rabbits. The fasted rabbits yielded greater amounts of CASF of a slightly higher specific activity than the same enzyme derived from ad lib fed rabbits. However, the enzymes from both treatments exhibited similar activities on intact myofibrils, as demonstrated by phase contrast microscopy and SDS-polyacrylamide gel electrophoresis., (Copyright © 1978. Published by Elsevier Ltd.)

The effect of salt level and nitrite on botulinal safety of smoked whitefish was investigated. An average water-phase (wp) salt concentration of 4.4% inhibited outgrowth of Clostridium botulinum type E spores (10 3 spores/g) for over 35 d in temperature-abused (27°C) smoked whitefish. Incorporation of nitrite (220 mg/kg) during brining to the smoked salted (4.4%, wp) whitefish inhibited toxin production for 56 d at 27°C. An average salt concentration of 6.2% (wp), with or without nitrite, totally inhibited toxin production for the duration of the study (83 d). The effect of pH and water activity in temperature-abused smoked whitefish as a means of controlling toxin production by C. botulinum type E spores was evaluated.

Serial measurements of functional residual capacity (FRC) by helium gas dilution were made in young asthmatic children over a 3 month period. Eight children were recruited during hospitalization for an acute asthma attack and eleven during routine outpatient attendances. Both groups of children had FRC's greater than 120% of that predicted for height at recruitment. Although the children denied symptoms throughout the three month follow-up period the majority remained hyperinflated. These results demonstrate a striking difference between objective and subjective assessment of respiratory function in young children. The significance of this persistent abnormality and its relationship to other lung function indices needs urgent investigation.

Several experiments were completed to further evaluate use of α-tocopherol-coated salts as inhibitors of N-nitrosamine formation in fried bacon. Studies with dry-cured bacon prepared with various levels of α-tocopherol indicated that the chemical did not contribute to formation of N-nitrosodimethylamine (NDMA). N-Nitrosopyrrolidine levels for the α-tocopherol-treated bacon samples were generally below 5 μg/kg, which represents an average reduction of approximately 70%. Experiments were also done to evaluate the role of lecithin as a possible precursor of NDMA in brine-cured bacon. At concentrations used to disperse α-tocopherol in the curing brine, lecithin did not contribute to NDMA formation in bacon prepared with α-tocopherol-coated salts.

Oceanographic Engineering of the Woods Hole Oceanographic Institution and the Massachusetts Institute of Technology, Woods Hole, MA 02543. Oceanographers have long sought to verify the theoretical Ekman transport relation, which predicts that a steady wind stress acting together with the Coriolis force will produce a transport of water to the right of the wind. In situ measurements of wind and ocean currents provide a detailed view of this phenomenon. By separating the wind-driven current from the measured total current and by averaging over a long record, it is found that the observed transport is consistent with theoretical Ekman transport to within about 10 percent. In this case the wind-driven transport is strongly surface trapped, with 95 percent occurring in the upper 25 meters as a result of fair summer weather.

Hyposensitisation with Dermatophagoides pteronyssinus tyrosine absorbate in asthmatic children with bronchial sensitivity to D. pteronyssinus was effective in a 12-month double-blind controlled clinical trial. Compared with controls, treated children used a smaller quantity of drugs while maintaining clinical and lung function improvements. In most children who improved there was no change in immediate response to D. pteronyssinus on bronchial provocation test, but the late reaction was lost in half the patients and these showed the greatest improvement in symptoms.

In 1980, SOFAR (sound fixing and ranging) floats were tracked acoustically in the western North Atlantic entirely by means of moored autonomous listening stations. During a 5-month period 17 float trajectories were obtained in the eastern (45 degrees to 65 degrees W) Gulf Stream and subtropical gyre interior at depths of 700 and 2000 meters. These mid-depth trajectories suggest a time-varying Gulf Stream with instances of both a narrow, swift, westward recirculation south of the stream and a northeastward penetration into the Newfoundland Basin. A hundredfold increase of eddy kinetic energy was observed at 2000 meters from the gyre interior (south of 30 degrees N) to the Gulf Stream.

Objective: To determine whether the inhaled corticosteroid budesonide, given by a Nebuhaler spacing device, was effective in prophylaxis of asthma in preschool children., Design: Double blind, placebo controlled, random order crossover trial with two week practice run in period., Setting: Outpatient clinic referrals in secondary referral centre., Patients: 39 children aged 2-6 years selected for the following: able to use Nebuhaler; parents able to complete record card; poorly controlled asthma (defined); not already on systemic or inhaled steroids. Eleven withdrew for various reasons not connected with intolerance to budesonide. Age, sex, other atopies, and symptoms during run in period were similar in the 28 children who completed the trial and in the 11 who withdrew., Interventions: Budesonide 200 micrograms or placebo (both one puff) given twice daily during 6-week treatment or control periods, using Nebuhaler after prior training. Three week "washout" at crossover. Compliance monitored by weighing canisters. Patients withdrawn if their acute attacks required treatment with systemic steroids., End Point: Control of asthma., Measurements and Main Results: Peak expiratory flow rate measured twice daily where cooperation allowed. Diary of symptoms and concomitant drug use kept daily. Results showed mean peak flow significantly higher (12% in mornings, 14% in evenings) in second three weeks of intervention compared with control period (95% confidence intervals 6.3-17.3% and 7.2-21.0%). Supplementary bronchodilator drugs reduced by 50% during intervention periods., Conclusions: Budesonide given by Nebuhaler is effective prophylaxis for preschool children with frequent asthma.

Forty-seven children with chronic asthma, aged 2 to 6 years, completed a double-blind, placebo-controlled, crossover trial of ketotifen, 1 mg twice daily, in the prophylaxis of asthma. The study period covered two 24-week periods preceded by a 4-week run-in and separated by a 4-week washout. When symptoms, concomitant medication, frequency of acute exacerbations, and parental and physician preferences were analyzed, there were no significant differences between active and placebo treatments. The results suggest that ketotifen has no place in the management of young children with frequent asthma.

We have measured simultaneous arterial (Pao2) and transcutaneous oxygen tension (tcPo2) in 13 children, aged 8 months to 10 years, with respiratory disease. A Radiometer TCM2 transcutaneous oxygen monitor was used. At an electrode temperature of 44 degrees C the regression equation was tcPo2 = 0.9 Pao2 -10 and at 44.5 degrees C tcPo2 = 0.9 Pao2 -8. The 95% confidence limits were +/- 13 torr at both temperatures. We also studied the usefulness of the method in monitoring trends in oxygenation in individual patients. In six children paired observations were made on five or more occasions and in these tcPo2 followed changes in Pao2 accurately. We conclude that this technique is not sufficiently reliable for predicting arterial values, but in individual patients it accurately reflects trends in oxygenation.

The similarity, that has been suggested by other investigators, between the kinase activating factor (KAF) and the calcium activated sarcoplasmic factor (CASF) of rabbit skeletal muscle is extended through a comparison of enzyme activities. Proteolytic activity on casein, the ability to activate skeletal muscle glycogen phosphorylase b kinase, inhibition by bovine heart KAF inhibitor and effects on myofibrillar integrity were examined using these two skeletal muscle proteases and a typical bacterial protease isolated from Pseudomonas perolens (ATCC 10757). The study demonstrated that the skeletal muscle proteases have more in common with each other than either protease has with the bacterial protease. The ability to influence the integrity of the myofibril was demonstrated by phase-contrast microscopy and SDS polyacrylamide gel electrophoresis. The KAF and CASF demonstrated similar effects that again differed from the bacterial protease effects., (Copyright © 1980. Published by Elsevier Ltd.)

We conducted a randomized, single-blind, crossover trial to compare two sustained release theophylline preparations. Fifty-nine chronic asthmatics, aged 7-14 years, were randomly allocated to receive Slophyllin (SP) twice daily followed by Uniphyllin (UP) taken as a single dose at bedtime, or UP followed by SP. Two 4-week periods on therapeutic doses of each preparation were compared. Thirty-six patients completed the study. Eight were non-compliant, seven defaulted and eight withdrew because of theophylline related side-effects (seven on UP). Symptom scores, beta-agonist usage, compliance by pill counts, evening peak flow rates and maximal expiratory flow-volume curves were similar on both treatments. Blood levels of theophylline at 11 am and morning peak flow rates were significantly higher on UP. UP may be more helpful for patients with early morning symptoms, but is associated with an increased frequency of severe side effects.

A simple and accurate objective test for monitoring lipid oxidation in poultry products is needed. Thiobarbituric acid (TBA) values of cooked poultry meat were determined by a distillation method and by a modified extraction method. Perchloric acid was used in the extraction method to release TBA reactive substances from the meat. The maximum absorption wavelength of the TBA-malonaldehyde complex was 531 nm. The TBA values for cooked chicken and turkey were highly correlated (r = .91) for both the extraction and distillation methods. Sensory scores of warmed-over flavor in precooked poultry were highly correlated with TBA values in both the distillation (r = .83) and extraction (r = .85) methods. Results indicate that the extraction method is faster, easier to perform, and as accurate as the distillation method for monitoring lipid oxidation in poultry.

Staphylococcus aureus strains 265 and 243 which produce enterotoxins A and B, respectively, were inoculated into meat being made into Genoa salami in the amount of 10 3 , 10 5 , and 10 7 , cells/g. No lactic starter culture was added. Samples were taken at different stages of processing to determine the microbial populations, percentage moisture, total acidity, pH, and enterotoxin content. Staphylococcal populations varying from about 10 7 to 5 × 10 8 /g were detected during tempering of the salami. Enterotoxin A was detected in surface but not in core samples of salami inoculated with 10 5 and 10 7 S. aureus 265 cells/g. However, no enterotoxin B was detected in the salami inoculated with S. aureus 243, which requires a relatively high a w for enterotoxin production. Staphylococcal counts were higher in surface samples than in core samples, attributable to the difference in oxygen, but there was no significant difference in microaerophilic lactic Kid bacteria in different portions of the salami.

Two Nebuhaler techniques were compared by measuring the response to terbutaline 0.25 mg in 13 asthmatic children. Five breaths each sufficient to operate the Nebuhaler valve resulted in greater bronchodilatation after 10 minutes (P less than 0.05) than two deep inspirations from residual volume each held for 5 seconds. The peak responses were similar and both methods produced significant bronchodilatation compared with placebo. Either method is satisfactory in children but the former is easier to perform.