ASTHMA IN INFANTS AND SMALL CHILDREN

Family psychological factors in relation to children's asthma status and behavioral adjustment at age 4

The objectives of this study were to determine whether family psychosocial factors influenced asthma development by age 4, and whether family factors and early wheezing illness were associated with behavioral adjustment at age 4. Participants were 98 children enrolled in an intervention study at 9-24 months and followed to age 4. Baseline evaluations assessed infants' respiratory illness severity, family psychosocial characteristics, and parental risk factors for asthma development. Active asthma categorization at age 4 utilized both parent report and objective data. Parents completed the Child Behavior Checklist (CBCL). Caregiver single-parent status, a composite of baseline family stresses, and early wheezing illness severity were associated with active asthma at age 4. The contribution of prenatal smoke exposure and early hospitalization to active asthma varied with racial/ethnic group membership. Maternal mental health and family stresses predicted CBCL scores at age 4, whereas early illness severity and hospitalization were unrelated to CBCL scores. CBCL scores were not elevated for children with active asthma at age 4. Family factors consistent with a negative emotional environment were associated with both active asthma and adjustment problems at age 4, suggesting that both outcomes may be influenced by a common factor.

Assessing respiratory function in young children: Developmental considerations

The purpose of this review is to provide practitioners and clinical investigators with an update on methods of assessing respiratory function in young children. The importance of this topic is presented in light of the natural history of asthma, as well as maturational changes that occur early in life in terms of airway development. Models of disease are cited to support the concept that injury of the mammalian airway early in postnatal life might have far-reaching consequences in terms of control of airway caliber and responsiveness. The methods currently available to measure respiratory function in our younger patients are outlined. The ability of children to perform the maneuvers necessary for this testing is considered as a function of age. Areas in which research and development are needed are highlighted.

[Identification of new diagnostic categories within bronchial asthma and COPD. A review of traditional classifications]

The overlapping of function test results and clinical symptoms of airway diseases makes it difficult to differentiate sub-categories of diagnoses. Our aim was to identify "occult" categories within the traditional diagnostic labels for bronchial asthma and chronic bronchitis. We studied 211 patients with those diagnoses by lung function testing (spirometry), variability of obstruction (bronchodilator test, peak expiratory flow, and bronchial challenge testing), atopy (prick test, total serum IgE), biological parameters (eosinophil count), frequency of smoking and symptoms. Multivariant analysis was used to group the data (Quick Cluster) and reclassify the subjects based on the selected parametric clusters with factorial analysis of the principal components. This analysis allowed us to identify four types of patients by diagnosis (atopic asthma, asthmatic bronchitis, simple chronic bronchitis and hyperresponsive chronic bronchitis) which we consider to represent the diagnostic categories with clinical relevance and which would overlap and be partially overshadowed by the diagnoses of bronchial asthma and chronic bronchitis.