Bronchial responsiveness to mannitol has been assessed using multiple forced expiratory maneuvers which are difficult for many children. We determined if responsiveness to mannitol can be assessed in children using effort-independent impulse oscillometry (IOS). Subjects with asthma, 8-21 years old, underwent a mannitol bronchial provocation test. IOS resistance (R5 and R20) values and FEV(1) were measured at baseline and after each dose of mannitol. The mannitol challenge was positive with a 15% fall in FEV(1) or a > or = 10% fall in FEV(1) between doses of mannitol. There was a significant correlation between the change in FEV(1) and the change in IOS R5. Subjects with a positive challenge had a mean decrease in FEV(1) of 18.4% +/- 5.9% had a mean increase in R5 of 34.8% +/- 15%. There was no significant change in R20. Subjects with a negative challenge had no significant change in FEV(1), R5, or R20 from baseline. Using effort-independent IOS to assess airflow obstruction with a mannitol challenge is a useful alternative to FEV(1) in patients that have difficulty with spirometry tasks. A > or = 25% increase in R5 indicates a positive challenge.
Recently there has been increased recognition of Hemophilus influenzae as a cause of pneumonia in adults. Although ampicillin-resistant strains of Hemophilus influenzae have been a major problem in pediatric practice, such strains have not previously been noted to be a significant problem in the treatment of adult pneumonia. We report 5 cases of pneumonia caused by beta-lactamase-producing strains of Hemophilus influenzae. These organisms were susceptible to chloramphenicol but resistant to ampicillin. Cure was achieved by treatment with chloramphenicol after the initial treatment with ampicillin had failed. The ability of a microbiology laboratory to isolate and to test routinely for ampicillin-resistant strains is an important factor in the successful treatment of Hemophilus influenzae infections.
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