Læknablaðið : fylgirit - 01.08.2002, Blaðsíða 29

ABSTRACTS / 21 ST
NORDIC CONGRESS OF ALLERGOLOGY
10. Gíslason T, Janson C, Vermeire P, Plaschke P, Björnsson E, Gíslason D, et al.
Reported gastroesophageal reflux during sleep and respiratory symptoms - A
population study of young adults in three European countries. Chest 2002; 121:
158-63.
11. Berg S, Hybbinette JC, Gíslason T, Ovesen J. Intrathoracic Pressure Variations
in Obese Habitual Snorers. The Journal of OtoLaryngology 1995; 24:238-40.
12. Kerr P, Shoenut JP, Miller T. Nasal CPAP reduces gastroesophageal reflux in
obstructive sleep apnea syndrome. Chest 1992; 101:1539-44.
13. Okada S, Ouchi Y, Teramoto S. Nasal CPAP and weight loss improve swallowing
reflex in patients with obstructive sleep apnea syndrome. Respiration 2000; 67:
464-6.
14. Bruno G, Graf U, Andreozzi P. Gastric asthma: an unrecognised disease with an
unsuspected frequency. J Asthma 1999; 36: 315-25.
R 6 - Compliance in childhood asthma
Jónasson G
Most physicians who treat asthma in children are undoubtedly well
aware of the fact that drug compliance in asthma therapy is
generally poor, but some may think that even if this is the case, it
surely does not apply for the vast majority of their own patients.
However, physicians do not (unfortunately!) have any special
ability to assess drug adherence of their patients. This statement is
partly based on the fact (as some studies have shown) that patients
with poor compliance have no special observable characteristics
that help to identify them.
It is therefore likely that clinicians overestimate patient com-
pliance, and at times fail to realize that non-compliance is the most
common reason for inadequate treatment response in children
receiving therapy with inhaled corticosteroids. This in turn some-
times resulting in hospital admission due to acute asthma. Non-
compliance is also considered to be an important cause of asthma
mortality.
In clinical trials intended to assess the efficacy of a certain inter-
vention such as drug treatment, patients are selected by means of
specific inclusion criteria. Subjects should be interested in
participating and willing to comply with the rules of the trial. In
return the patient receives regular follow-up, attention and
motivation, which again can result in increased compliance during
the trial. When conclusions are to be drawn from such controlled
trials it is important to monitor patient compliance in an objective
way. This can be important regarding both the assessment of a
possible dose-response effect (including side effects) of a given
treatment, as well as general conclusions to be drawn from the trial.
163 children (7-16 years, 56 girls/107 boys) with mild asthma
were included in a double blind, randomised study. After a two-
week run-in period, the children received inhaled budesonide 100
mg or 200 mg daily, and/or placebo for 12 weeks. All patients used
daily diary cards throughout the study. Compliance was also
assessed by counting the number of remaining doses in the inhalers
returned at the end of the study. Results from 160 patients were
analysed. Mean compliance according to the diary was 93%,
whereas estimated mean compliance when counting remaining
doses in the inhaler was 77%. This discrepancy increased con-
siderably as the measured compliance decreased.
122 children from the same study group were included in a
follow-up study for 24 months and their drug adherence assessed by
counting the number of remaining doses in the inhaler when the
study medication was returned at six months intervals. A statisti-
cally significant decrease in measured drug adherence was found
from three to nine months and further to 24 months reaching mean
values of 40.6% and 46.9% for inhaled morning and evening medi-
cation respectively. Drug adherence declined more rapidly in the
placebo group (compared to active treatment) and this difference
became significant after two years of treatment.
Measured drug adherence diminishes significantly when treating
children with mild asthma in a long term trial. This emphasises the
importance of monitoring compliance in clinical trials.
R 7 - T Lymphocyte-Mediated Changes in Airway Smooth
Muscle Responsivenes Are Attributed to Induced
Autocrine Release and Actions of Interleukin (IL)-S
and IL-IB
Hákonarson H
Bi-directional stimulatory cross-talk was recently found to exist
between activated T cells and ASM cells, a process that involves co-
ligation of specific cellular adhesion/co-stimulatory molecules thal
results in the induction of pro-asthmatic-like changes in ASM
responsiveness.
In this study we examined whether the cooperative intercellular
signaling between activated T cells and ASM cells is coupled to the
induced expression and actions of IL-5 and IL-IB
Agonist-induced constrictor and relaxant responses were
examined in ASM segments exposed to resting and anti-CD3-
activated T cells, in the absence and presence of either an IL-5mAb
or the rhlL-lra. In addition, mRNA and protein expression of IL-
5 and IL-IB were assayed under control and anti-CD3-stimulated
conditions.
We found that relative to inactive T cells, incubation of ASM
tissues with anti-CD3-activated T cells induced pro-asthmatic-like
changes in agonist-mediated ASM responsiveness. This T cell-
induced perturbation in ASM responsiveness was ablated by
pretreating the tissues with either IL-5r mAb or IL-lra. Moreover,
exposure of ASM cells to anti-CD3-activated T cells elicited an
initial increased mRNA expression and release of IL-5, followed
by an enhanced expression and release of IL-16, and the induced
release of these cytokines was prevented in ASM cells that were
pretreated with IL-5r mAb.
Collectively, these observations provide new evidence demon-
strating that exposure of nai've ASM cells to activated T cells
induces the sequential release of IL-5 and IL-IB from the ASM
cells, and that the latter cytokines act in an autocrine manner to
elicit the pro-asthmatic phenotype of altered ASM responsiveness.
R 8 - A protective immune response - experience from
the field of pneumococcal vaccines
Sigurðardóttir SÞ, Jónsdóttir I
Streptococcus pneumoniae (pneumococcus) is an important cause
of morbidity and mortality among infants and young children.
Protection against pneumococcal infection is by opsonization of
pneumococci with serotype-specific polysaccharide antibodies and
complement, leading to phagocytosis and killing by polymorpho-
nuclear leukocytes. Children less than two years of age are unable
to produce protective antibodies to most of these polysaccharides
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