Infants are at increased risk of developing asthma after acute bronchiolitis. We assessed the hypothesis that cytokine production is related to the development of asthma after bronchiolitis. The smoking history and the presence of atopy or asthma in parents or siblings were recorded and blood mononuclear cell interferon (IFN)-gamma and interleukin (IL)-4 production in response to IL-2 were assessed in 32 infants hospitalized for bronchiolitis and in a subgroup (n = 19) in which pulmonary function tests were performed approximately 4.9 mo later. The presence of asthma was determined by the Delphi consensus method 2 yr after hospitalization. Infants were classified as follows: asthma absent (A, n = 14), possible (Po, n = 9), or probable (Pr, n = 9). Infants with possible and probable asthma had lower IFN-gamma production at the time of bronchiolitis and a trend to lower IFN-gamma production 4.9 mo later when compared with those who had no asthma. At the time of bronchiolitis, IFN-gamma production was: 123 +/- 31 versus 34 +/- 20 versus 21 +/- 14 pg/ml, A versus Po versus Pr (p = 0.02, ANOVA) and 4.9 mo after bronchiolitis, IFN-gamma production was: 147.3 +/- 45 versus 47.4 +/- 30 versus 22.3 +/- 32 pg/ml, No versus Po versus Pr (p = 0.08 ANOVA). IL-4 production did not differ between groups. Infants who went on to develop asthma had more parent smokers (21.4% versus 55. 6% versus 55.6%, A versus Po versus Pr, p < 0.04), lower VmaxFRC (122 +/- 18 versus 77 +/- 7 versus 67 +/- 8% predicted, A versus Po versus Pr, p < 0.02), lower PC40 histamine (6.4 +/- 3.3 versus 1.2 +/- 0.6 mg/ml, A versus Po+Pr, p < 0.03) but no increase in atopy or asthma in their family. Significant positive correlations were found between IFN-gamma production at the time of bronchiolitis and VmaxFRC (r = 0.606) or PC40 histamine (r = 0.648) 4.9 mo after bronchiolitis. Lower IFN-gamma production at the time of bronchiolitis is an indicator of lower pulmonary function and increased responsiveness to histamine 4.9 mo after bronchiolitis and is related to the development of asthma after bronchiolitis in infants.
The objective of the present document is to review the impact of new information on the recommendations made in the last (1999) Canadian Asthma Consensus Guidelines. It includes relevant published studies and observations or comments regarding what are considered to be the main issues in asthma management in children and adults in office, emergency department, hospital and clinical settings. Asthma is still insufficiently controlled in a large number of patients, and practice guidelines need to be integrated better with current care. This report re-emphasises the need for the following: objective measures of airflow obstruction to confirm the diagnosis of asthma suggested by the clinical evaluation; identification of contributing factors; and the establishment of a treatment plan to rapidly obtain and maintain optimal asthma control according to specific criteria. Recent publications support the essential role of asthma education and environmental control in asthma management. They further support the role of inhaled corticosteroids as the mainstay of anti-inflammatory therapy of asthma, and of both long acting beta2-agonists and leukotriene antagonists as effective means to improve asthma control when inhaled corticosteroids are insufficient. New developments, such as combination therapy, and recent major trials, such as the Children's Asthma Management Project (CAMP) study, are discussed.
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