Factors associated with asthma control in 121 preschool children

BACKGROUND AND OBJECTIVE

There are controversial data about risk factors for uncontrolled asthma in preschool children. Objective: This study aims to explore the association between clinical and functional parameters and the lack of asthma control in preschool children.

METHODS

Children 3-5 years-old with asthma and healthy controls were recruited. A questionnaire was used to identify the potential risk factors of uncontrolled asthma as defined by GINA (Global INitiative for Asthma) criteria. Lung function and bronchial reversibility were evaluated through impulse oscillometry (IOS) and spirometry. Adjusted odds ratios (OR) were estimated based on multivariable generalized additive regression models. The discriminative ability of the models was measured by the area under the receiver operating characteristic curve (AUC).

RESULTS

121 children were included, 107 of which had asthma and 14 were healthy controls. Fifty-three patients (50%) had uncontrolled asthma. After adjustment, the variables associated with an increased risk of lack of control were: "More than 3 flare-ups in last 12 months", "moderate to severe rhinitis", "relative variation in post-bronchodilator FVC and FEV1". The AUC of the final models that included variation of FVC or FEV1 were 0.82 and 0.81, respectively. R5-20, R5-20% and AX z-score values of the healthy group were lower than those of children with asthma.

CONCLUSION

In preschool children, clinical and functional parameters are associated with uncontrolled asthma. More studies are needed to confirm usefulness of the IOS.

Primary chemotherapy with sequential docetaxel followed by docetaxel and epirubicin in large operable breast cancer

Primary chemotherapy is increasingly used in patients with large operable breast cancer. Docetaxel and epirubicin are the most active agents in breast cancer treatment.

PURPOSE

To evaluate clinical response rate, breast conserving surgery and pathological response rate in patients with large operable breast cancer treated with docetaxel followed by docetaxel and epirubicin as primary chemotherapy.

PATIENTS AND METHODS

Patients with operable breast cancer more than 3 cm in the longest diameter with T2N0, T2N1 and T3N0 disease were enrolled. Patients were treated with three cycles of docetaxel 100 mg/m2 followed by three cycles of docetaxel 75 mg/m2 and epirubicin 90 mg/m2 prior to surgery.

RESULTS

Sixty-five patients were enrolled between 09/2002 and 12/2005. The median age was 48.9 years and 72.3% were premenopausal. Median tumour size was 4.26 cm, 10.8% were T3 tumours and 38.5% had clinical positive lymph nodes. Of the tumours 58.5% were grade 1/2, 33.9% ER positive and 21.5% c-erb negative. All six cycles were administered to 62 patients; six cycles were delayed and five had dose reductions. Complete clinical response occurred in 41.5% of patients and partial response in 49.2%. Breast conserving surgery was performed in 30% of patients however it was feasible in 57%. Complete pathological response occurred in both primary tumour and nodes in 28%, and in 34% just in the primary tumour. Nine percent of cases had neutropenia and 7.7% febrile neutropenia, and two cases had a hypersensitivity reaction to docetaxel. One associated treatment death occurred.

CONCLUSION

Docetaxel followed by epirubicin and docetaxel as primary chemotherapy results in a high clinical and pathological response rate. The majority of adverse events were predictable and manageable.