Search

The data obtained in a retrospective survey of the use and effectiveness of sodium cromoglycate (Lomudal; Fisons) therapy in 635 children and young adults support the findings of other long-term studies that this drug is effective and safe in the treatment of children and young adults with clear evidence of allergy contributing towards their asthma. Its administration by Spinhaler can be commenced successfully at 4 years of age or even younger and continued for as long as is required. The drug is worth a therapeutic trial in any patient with asthma requiring regular medication to control symptoms. The absence of demonstrable allergy does not entirely preclude a favourable response. Once a patient's asthma has been stabilized, sodium cromoglycate enables concomitant therapy (especially with beta 2-adrenergic stimulants and corticosteroids) to be reduced.

A new technique for the administration of a bronchodilator aerosol, fenoterol, in young children with asthma is described. Rapid and effective bronchodilatation can be obtained in many patients simply by directing the jet of the bronchodilator aerosol onto the buccal mucosa. This method will frequently obviate the need for painful or potentially dangerous injections of adrenaline or aminophylline as a first-line treatment in children with acute attacks of asthma.

Forty-four children with perennial allergic rhinitis who had failed to respond to conventional therapy, including sodium cromoglycate insufflation and hyposensitization, were treated with beclomethasone aerosol given intranasally. The study was conducted in a double-blind manner, the patients being allocated active drug or placebo for a 3-week period, followed by a 1-week rest period. The treatments were then crossed over for a period of 3 weeks. After this all children were put on active drug and followed-up at monthly intervals for a period of 3 months. Results were graded as either success of failure, and success had to be an unequivocal vote for the active drug by the patient, parent, and doctor. An overall success rate of 77% was obtained and no untoward or toxic effect was noted in any child. Tetracosactrin tests in 5 children remained normal at the end of the study period. We found intranasal beclomethasone dipropionate to be the most effective drug we have used for treating perennial allergic rhinitis in children.

Sensitivity to house-dust and the mites Dermatophagoides pteronyssinus and D. farinae was the commonest cause of asthma in children living in the Cape Peninsula. Of 103 asthmatic children examined, 65,5% had positive skin tests to these allergens. Only a small number of the children were sensitive to pollens, feathers, moulds or food. The median serum IgE level was 496 U/ml, with a range of 18-15972 U/ml, and the median blood eosinophil count was 691/microliter (range 93-8 159) in 102 of the children.

A prospective study was undertaken to determine the factors precipitating acute severe asthma in children attending the Red Cross War Memorial Children's Hospital, Cape Town. A comparison in terms of recent exposure to possible precipitating factors was made between 40 known asthmatics presenting with acute severe asthma and 40 known asthmatics who were clinically well. Exposure to known allergens had occurred in 7 cases. The time of onset of symptoms bore no relationship to meteorological changes in temperature, humidity or average pressure. Drug compliance in both groups was of the order of 50%. The majority of severe asthma attacks were associated with infection of the respiratory tract. The importance of infection as a precipitating factor in a severe asthma attack is discussed with reference to the cholinergic, adrenergic and immunological mechanisms.

Evidence of helminthic intestinal parasites was found in 97,0% of stools of 544 Xhosa schoolchildren living in Cape Town. The commonest parasite was Trichuris trichiura, which infested 89,9% of the children. In contrast, only 9,8% of 387 Xhosa children living in the Tsolo district, Transkei, had evidence of intestinal parasites in their stools, Hymenolepis nana being the commonest. In spite of the unsatisfactory sanitary conditions in the Tsolo area compared with those in Guguletu, Cape Town, where all sewage is waterborne, few rural children were infested. The high prevalence of infestation in the Guguletu children suggests extensive contamination of the soil in the area by parasitic ova. In view of the magnitude of the extent of parasitic infestation in the Guguletu children, a vigorous and sustained programme of medication and education will have to be undertaken if the problem is to be resolved.

An epidemiological study was undertaken to determine the prevalence of asthma in young urban and rural black (Xhosa) children. One thousand three hundred and seventy five children were studied, 694 from a Cape Town african township and 671 from a rural area in Transkei. The exercise tolerance test which required free range running at maximum effort for 6 min was used to identify asthmatic subjects. A fall of 15% or more in the post-exercise FEV1 and PEFR values was regarded as a positive result. Twenty-three children were found to be asthmatic, twenty-two from the city area, but only one from the country, giving a prevalence figure for asthma of 3.17% in the first group and 0.14% for the second. Possible reasons for these differences are discussed. The exercise tolerance test was found to be a useful tool for epidemiological studies of asthma.