Cough as the sole manifestation of airway hyperreactivity

1989 ◽  
Vol 103 (7) ◽  
pp. 680-682 ◽  
Author(s):  
A Frans ◽  
J Van Den Eeckhaut
Keyword(s):  
Allergic Rhinitis ◽  
Respiratory Symptoms ◽  
Challenge Test ◽  
General Medicine ◽  
Airway Hyperreactivity ◽  
Bronchial Reactivity ◽  
Inhaled Steroids ◽  
Reactivity Test ◽  
History Of ◽  
Predominantly Female

Abstract The authors report 18 patients who presented to the ENT department with isolated cough, which had begun one month to 14 years previously. As the ENT examination was negative, the patients were referred to the Department of General Medicine where a bronchial reactivity test with acetylcholine was found to be positive, leading to a diagnosis of airway hyperreactivity. The group was predominantly female (15/18) and atopy was rare; indeed, only one patient, who had a history of allergic rhinitis, was found to be atopic. Bronchodilators and inhaled steroids cured or helped the cough in 16/18 patients. When a patient presents with chronic cough without other respiratory symptoms it is important to consider a diagnosis of airway hyperreactivity and to confirm this with a challenge test of bronchoconstriction

scholarly journals NSAID-exacerbated respiratory disease (N-ERD): a population study

2022 ◽  
pp. 00462-2021
Author(s):  
Heidi Andersén ◽  
Pinja Ilmarinen ◽  
Jasmin Honkamäki ◽  
Leena E Tuomisto ◽  
Hanna Hisinger-Mölkänen ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Family History ◽  
Respiratory Disease ◽  
Respiratory Symptoms ◽  
Adult Population ◽  
Population Sample ◽  
Occupational Exposures ◽  
Older Age ◽  
Cumulative Exposure ◽  
History Of

BackgroundNonsteroidal anti-inflammatory drugs (NSAIDs) may exacerbate respiratory symptoms. A recent EAACI position paper recommended the use of an acronym, N-ERD (NSAID-exacerbated respiratory disease), for this hypersensitivity associated with asthma or chronic rhinosinusitis (CRS) with or without nasal polyposis. Our aim was to estimate the prevalence of N-ERD and identify factors associated with N-ERD.MethodsIn 2016, a cross-sectional questionnaire survey of a random adult population of 16 000 subjects aged 20–69 years was performed in Helsinki and Western Finland. The response rate was 51.5%.ResultsThe prevalence was 1.4% for N-ERD, and 0.7% for AERD. The prevalence of N-ERD was 6.9% among subjects with asthma and 2.7% among subjects with rhinitis.The risk factors for N-ERD were older age, family history of asthma or allergic rhinitis, long-term smoking and exposure to environmental pollutants. Asthmatic subjects with N-ERD had a higher risk of respiratory symptoms, severe hypersensitivity reactions and hospitalisations than asthmatic subjects without N-ERD. The sub-phenotype of N-ERD with asthma was most symptomatic. Subjects with rhinitis associated with N-ERD, which would not be included in AERD, had the least symptoms.ConclusionWe conclude that the prevalence of N-ERD was 1.4% in a representative Finnish adult population sample. Older age, family history of asthma or allergic rhinitis, cumulative exposure to tobacco smoke, secondhand smoke, and occupational exposures increased odds of N-ERD. N-ERD was associated with significant morbidity.

Sequential degranulation of eosinophils induced by antigen or autocoids in allergic humans

1986 ◽  
Vol 44 ◽  
pp. 354-355
Author(s):  
Kate W. Sjoerdsma ◽  
W. James Metzger
Keyword(s):  
Allergic Rhinitis ◽  
Bronchoalveolar Lavage ◽  
Allergic Asthma ◽  
Skin Test ◽  
Positive Skin Test ◽  
Positive Skin ◽  
Human Eosinophil ◽  
Asthmatic Patients ◽  
Allergic Asthmatic ◽  
History Of

Eosinophils are important to the pathogenesis of allergic asthma, and are increased in bronchoalveolar lavage within four hours after bronchoprovocation of allergic asthmatic patients, and remain significantly increased up to 24 hours later. While the components of human eosinophil granules have been recently isolated and purified, the mechanisms of degranulation have yet to be elucidated.We obtained blood from two volunteers who had a history of allergic rhinitis and asthma and a positive skin test (5x5mm wheal) to Alternaria and Ragweed. Eosinophils were obtained using a modification of the method described by Roberts and Gallin.

scholarly journals Asthma prevalence and associated factors among lebanese adults: the first national survey

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Zeina Akiki ◽  
Danielle Saadeh ◽  
Rita Farah ◽  
Souheil Hallit ◽  
Hala Sacre ◽  
...  
Keyword(s):  
Allergic Rhinitis ◽  
Family History ◽  
Respiratory Diseases ◽  
Fruits And Vegetables ◽  
Asthma Prevalence ◽  
Cluster Sampling ◽  
Cross Sectional ◽  
Current Asthma ◽  
Chronic Respiratory Diseases ◽  
History Of

Abstract Background No national research has yet explored the prevalence of asthma among adults in Lebanon. This study aims to evaluate the prevalence of physician-diagnosed asthma and current asthma, and their determinants among Lebanese adults 16 years old or above. Methods A cross-sectional study was carried out using a multistage cluster sampling. The questionnaire used collected information on asthma, respiratory symptoms, and risk factors. Results The prevalence of physician-diagnosed asthma was 6.7% (95% CI 5–8.7%), and that of current asthma was 5% (95% CI 3.6–6.9%). Chronic symptoms such as cough, wheezing, and shortness of breath were worst at night. Factors positively associated with physician-diagnosed asthma were a secondary educational level (adjusted OR, aOR = 4.45), a family history of chronic respiratory diseases (aOR = 2.78), lung problems during childhood (15.9), and allergic rhinitis (4.19). Additionally, consuming fruits and vegetables less than once per week (3.36), a family history of chronic respiratory diseases (3.92), lung problems during childhood (9.43), and allergic rhinitis (8.12) were positively associated with current asthma. Conclusions The prevalence of asthma was within the range reported from surrounding countries. However, repeated cross-sectional studies are necessary to evaluate trends in asthma prevalence in the Lebanese population.

A Useful Diagnostic Method for Drug-induced Pneumonitis

1994 ◽  
Vol 22 (03n04) ◽  
pp. 329-336 ◽  
Author(s):  
Akira Kawasaki ◽  
Yutaka Mizushima ◽  
Hitoshi Kunitani ◽  
Masanobu Kitagawa ◽  
Masashi Kobayashi
Keyword(s):  
Bronchoalveolar Lavage Fluid ◽  
Challenge Test ◽  
Lavage Fluid ◽  
Peripheral Blood Lymphocytes ◽  
Lymphocyte Stimulation Test ◽  
Drug Induced ◽  
Chief Complaints ◽  
History Of ◽  
Chest X Ray

A 51 year-old male was admitted to our hospital with chief complaints of fever, dry cough and dyspnea. Chest X -ray films and his history of taking Chinese medicine for liver dysfunction were suggestive of drug-induced pneumonitis. Lymphocyte stimulation test (LST) to causative Chinese medical drugs of Sho-saiko-to and Dai-saiko-to was negative with peripheral blood lymphocytes (PBL), but was positive with Iymphocytes from bronchoalveolar lavage fluid (BALF). In vivo challenge test for Sho-saiko-to was positive. The LST with BALF-lymphocytes proved to be very useful in making a diagnosis of drug-induced pneumonitis.

scholarly journals Relation of Airway Responsiveness to Methacholine to Parent and Child Reporting of Symptoms Suggecting Asthma

1996 ◽  
Vol 3 (2) ◽  
pp. 115-123 ◽  
Author(s):  
JM FitzGerald ◽  
DE Fester ◽  
MM Morris ◽  
M Schulzer ◽  
FE Hargreave ◽  
...  
Keyword(s):  
Sensitivity And Specificity ◽  
Roc Curve ◽  
Airway Hyperresponsiveness ◽  
Respiratory Symptoms ◽  
Respiratory Illness ◽  
Airway Responsiveness ◽  
Methacholine Challenge ◽  
Cut Point ◽  
The Past ◽  
History Of

BACKGROUND:The lack of a relationship between airway responsiveness and respiratory symptoms in epidemiological studies of children may, in part, reflect inaccuracies in symptom reporting or inadequate knowledge by the parent of the child's symptoms.OBJECTIVE:To relate airway responsiveness to methacholine in children with symptoms of respiratory illness in the child as reported by the parent and as reported by the child.POPULATION:Eight- to 10-year-old (n=290) randomly sampled schoolchildren.SETTING:Seven randomly selected schools in Ontario.METHODS:Parents completed a mailed questionnaire regarding the child's respiratory health. Children completed a similar interview-administered questionnaire at school and underwent methacholine challenge testing by the tidal breathing method.RESULTS:The cumulative prevalence of a history of physician-diagnosed asthma was 9.0%, and of any wheezing it was 25.5%. A further 9% of children reported wheezing not documented by their parent. Of 229 children consenting to methacholine challenge, 78 (34.1%) showed airway responsiveness in the range generally associated with asthma in adults (provocation concentration of methacholine causing a 20% fall [PC20] in forced expired volume in 1 s [FEV1] 8 mg/mL or less); half of these children had no history of respiratory symptoms reported by the parent. The sensitivity of airway hyperresponsiveness defined by a cut-point for PC208 mg/mL or less in relation to any history of recurrent wheezing reported by the parent was 48% and did not improve if only symptoms within the past year were considered (sensitivity 44%); the specificity of the test for parent-reported symptoms ever was 71%, and 68% in those with symptoms in the past year. None of these sensitivities or specificities was increased by using symptoms reported by the child or by combining parent and child reported symptoms. Receiver operating characteristic (ROC) curves for sensitivity and specificity of the methacholine test were constructed for parent and child reports of symptoms. For all symptom strata, the cut-point of PC20producing optimal balance of sensitivity and specificity was between 4 and 8 mg/mL. A parental questionnaire positive for physician-diagnosed asthma was strongly related to methacholine response, producing an ROC curve with an area significantly different from 0.5 (P=0.006), as did all parent-reported wheezing (P=0.009). If the child reported asthma, there was an equally strong relationship, with a positive ROC curve (P=0.001), as there was for all child-reported wheezing (P=0.048).CONCLUSIONS:Airway hyperresponsiveness to methacholine in children relates closely with asthma and wheezing reported by either the parent or the child. In addition, the results confirm that respiratory symptoms and airway hyperresponsiveness are common in Canadian children, and that airway hyperresponsiveness may be found in children with no history of respiratory illness either at present or in the past.

Epidemiology of Physician-Diagnosed Allergic Rhinitis in Childhood

PEDIATRICS ◽  
1994 ◽  
Vol 94 (6) ◽  
pp. 895-901
Author(s):  
Anne L. Wright ◽  
Catharine J. Holberg ◽  
Marilyn Halonen ◽  
Fernando D. Martinez ◽  
Wayne Morgan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Allergic Rhinitis ◽  
Immunoglobulin E ◽  
Age At Onset ◽  
First Year ◽  
Healthy Children ◽  
Early Introduction ◽  
Maternal Cigarette Smoking ◽  
History Of ◽  
First Year Of Life

Objective. To investigate the natural history of and risk factors for allergic rhinitis in the first 6 years of life. Methods. Parents of 747 healthy children followed from birth completed a questionnaire when the child was 6 years old. Data were obtained regarding physician-diagnosed allergic rhinitis (PDAR), associated symptoms, and age at onset. Risk-factor data were taken from earlier questionnaires, and data regarding immunoglobulin E (IgE) and skin-test reactivity were obtained at age 6. Results. By the age of 6, 42% of children had PDAR. Children whose rhinitis began in the first year of life had more respiratory symptoms at age 6 and were more likely to have a diagnosis of asthma. Early introduction of foods or formula, heavy maternal cigarette smoking in the first year of life, and higher IgE, as well as parental allergic disorders, were associated with early development of rhinitis. Risk factors for PDAR that remained significant in a multivanate model included maternal history of physician-diagnosed allergy (odds ratio: 2.2, 95% confidence interval: 1.35-3.54), asthma in the child (4.06, 2.06-7.99), and IgE greater than 100 IU/mL at age 6 (1.93, 1.18-3.17). The odds for atopic as opposed to nonatopic PDAR were significantly higher only among those with high IgE and those who had dogs. Conclusion. Allergic rhinitis developing in the first years of life is an early manifestation of an atopic predisposition, which may be triggered by early environmental exposures.

Foreign Body Aspiration: Potential Cause of Coughing and Wheezing

1988 ◽  
Vol 10 (2) ◽  
pp. 59-63
Author(s):  
H. James Holroyd
Keyword(s):  
Foreign Body ◽  
Respiratory Symptoms ◽  
Foreign Bodies ◽  
Pediatric Population ◽  
Congenital Defects ◽  
Natural Tendency ◽  
History Of ◽  
Possible Cause ◽  
Cardiopulmonary System ◽  
Infants And Young Children

As many as half of routine ill-patient visits in pediatrics practice involve respiratory symptoms. It is not surprising that we see so much coughing and wheezing when we consider that children are still developing immunologically and are, therefore, more susceptible to infection. In early life, most of these infectious diseases occur in the respiratory and gastrointestinal tracts. In addition, the gradual exposure of the constitutionally allergic child to environmental allergens pre-disposes to the development of respiratory symptoms. Childhood is also a time for congenital defects of the cardiopulmonary system to become apparent. A sometimes overlooked cause of respiratory symptoms in infants and young children—and one that can become rapidly and severely complicated if misdiagnosed—is the aspiration of foreign bodies. Aspiration or ingestion of foreign bodies remains a significant cause of morbidity and mortality in the pediatric population. Children between 8 months and 4 years of age are at highest risk. Not all cases of aspiration are of the acute, obstructive variety, and pediatricians should consider a foreign body as a possible cause of coughing and wheezing even when no definite history of aspiration is obtained. Children of course are curious and their natural tendency is to reach out and explore new objects. Bringing objects to their mouths to taste and to test textures is common.

OUR CHALLENGES FOR THE 70'S President's Address, 1970

PEDIATRICS ◽  
1971 ◽  
Vol 47 (2) ◽  
pp. 465-469
Author(s):  
Russell W. Mapes
Keyword(s):  
American Academy ◽  
General Medicine ◽  
Vice President ◽  
Medical Community ◽  
Great Promise ◽  
Quality Health Care ◽  
American Academy Of Pediatrics ◽  
Quality Health ◽  
History Of ◽  
Organized Medicine

For any national organization striving to keep pace with increasingly diverse responsibilities and objectives, there are appropriate times when that organization must pause, reflect, and project before moving forward to meet the goals to which it has dedicated its programs and priorities. This year marks the 40th anniversary of the American Academy of Pediatrics. It was June 23, 1930 that 35 pediatricians met in Harper Hospital in Detroit to establish the Academy as the organization to speak for the interests and health of children, as well as the interests of its pediatric members. This year also marks the beginning of a new decade, a decade which holds great promise for the future of pediatrics but a decade which also presents significant challenges which we must meet if we are to deliver quality health care to all children. The American Academy of Pediatrics is indeed fortunate to be able to draw from the accomplishments of a progressive history of achievement, distinguished by the vision of its early founders. In the 1920's the medical community widely predicted that pediatrics was disappearing as a specialty, that in a few years it would merge into the field of general medicine. Concern was also expressed that pediatrics was not sufficiently represented in the echelons of organized medicine and, consequently, the cause of child health was not being served adequately. To pediatricians like Isaac A. Abt, the first president of the Academy, to John L. Morse, its first vice-president, and to Clifford G. Grulee, the Academy's pioneering executive director, these were very real challenges, but they were not causes for pessimism or defeatism.

Screening for Cow Milk Allergy in Infants and Preschool Children

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Zeinab Awad El-Sayed ◽  
Hanan Mohamed Abdel-Lateef ◽  
Rasha Hassan El-Owaidy ◽  
Shady Sarwat Shaker
Keyword(s):  
Preschool Children ◽  
Challenge Test ◽  
Cow Milk ◽  
Diagnostic Tools ◽  
Milk Allergy ◽  
Cross Sectional ◽  
Oral Challenge Test ◽  
Egyptian Children ◽  
Cow Milk Allergy ◽  
History Of

Abstract Background Cow milk allergy (CMA) is the third most common food allergy that triggers anaphylactic reactions. Lactose intolerence, infantile colic and gastroesophageal reflux are the most common conditions which overlap with CMA causing both over and underdiagnosis. There are no wide population based epidemiological studies for the prevalence of CMA among Egyptian children. We sought to evaluate the prevalence of CMA among infants and preschool children and to correlate the parental reporting of CMA to the available diagnostic tools. Methods We conducted a cross sectional study that included 800 Egyptian children aged 3 months -5 years, who were enrolled consecutively from the primary care units and outpatient clinics of Children’s Hospital, Ain Shams University. Detailed history taking and clinical examination were done and those with suggestive history of CMA were subjected to further evaluation including skin prick test (SPT) and oral challenge test (OCT). Results The study comprised 390 girls (48.8%) and 410 boys (51.2%). Their weight centiles ranged between 5th and 97th percentiles, with median (IQR)=25(5-50) percentiles and mean(SD)=36.1(31.9). CM was introduced at age of 1-12 months, mean (SD): 9 (6) months with median (IQR): 12 (9-12) months. Forty (5%) subjects had suggestive history of CMA, 32 of whom completed their evaluation. The diagnosis of cow milk allergy was confirmed in 8/40 children (20%), comprising 1 % of the whole study sample. CMA was probably excluded at the time of the study in 21 subjects (52.5%), while diagnosis remained undetermined in 11/40 cases (27.5%) (8 refused to undergo SPT & OCT while 3 were lost to follow up). Conclusion The prevalence of CMA in Egyptian infants and preschool children is estimated to be around 1 % with possible overestimation of cow milk allergy diagnosis according to parental reports.

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