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T K Ninan

Publications and source records attributed to T K Ninan.

10 recordsLinked to original sources
PubMed2000

The changing picture of childhood asthma.

Although the last four decades have seen substantial progress in the understanding of the pathophysiology of asthma, the working clinician's main tool in establishing the diagnosis of asthma is a good and accurate clinical history. In the older child, the history is complemented by pulmonary function tests, including measures of bronchial lability. After nearly three decades of increasing hospital admissions for childhood asthma, the 1990s have seen a small reduction in overall admissions. The increase in hospital admissions is explained only partly by the rising prevalence of asthma. The associated morbidity due to the disease has increased quite considerably over the last three decades. International studies assessing asthma prevalence across different parts of the globe using identical methodologies has shown considerable differences in asthma prevalence between the East and the West as well as within countries. The burden of paediatric asthma on the child, the family and society is increasing as we move into the new millennium.

Asthma↗
PubMed1995

Persistent nocturnal cough in childhood: a population based study.

A cross sectional epidemiological study was carried out to investigate the validity of persistent nocturnal cough (PNC) as an independent marker of childhood asthma. A screening questionnaire on respiratory symptoms was applied to 4003 children attending primary schools in Aberdeen, after which 799 symptomatic children and a random selection of 229 asymptomatic children were invited to attend for a diagnostic interview. Six hundred and seven (359 boys and 248 girls) symptomatic children and 135 asymptomatic children (57 boys and 78 girls) were selected from the screening questionnaires. Of 607 children with respiratory symptoms when interviewed, 27 (nine boys and 18 girls) had isolated PNC, and 97 (51 boys and 46 girls) had multiple symptoms (polysymptomatic asthma). The incidence of prematurity was highest in the group with PNC (19%). The prevalence of hay fever in children with PNC (11%) was similar to that of the asymptomatic group (15%) and less than that in the group with polysymptomatic asthma (41%). Eczema was twice as common in the PNC (19%) as in the asymptomatic children (10%) but only half as common in the polysymptomatic asthma group (35%). The prevalence of a parental history of hay fever was similar in all three groups. The prevalence of a parental history of eczema was similar in the PNC (7%) and asymptomatic (7%) groups but higher in the polysymptomatic asthma group (22%). The prevalence of a history of parental asthma was 30% in children with PNC, 13% in the asymptomatic group, and 42% in those with polysymptomatic asthma. The parents of three (11%) children with PNC were aware of a diagnosis of asthma; two of these children (7%) were on inhaled bronchodilator treatment and one (4%) was on a slow release theophylline preparation. Using a stepwise discriminant analysis procedure, in 18 (67%) children with PNC predicted membership was in the asymptomatic group and only nine (33%) children with PNC were grouped into the polysymptomatic asthma category. It is concluded that the clinical features of children with PNC resembled those of the asymptomatic population more closely than those of the polysymptomatic asthmatic population. In this age group PNC, in the absence of wheeze, shortness of breath or tightness in the chest, is likely to be a manifestation of atypical or hidden asthma in only a minority of cases.

Asthma↗
PubMed1993

Is exercise testing useful in a community based asthma survey?

BACKGROUND: In hospital clinics exercise challenge is used as a simple, non-invasive, non-pharmacological test for asthma in childhood. Little is known of its value in a community setting. An exercise test was therefore evaluated as an adjunct to a respiratory questionnaire in the course of an asthma survey. METHODS: From a cohort of 4003 primary school children, 607 of 799 with respiratory symptoms answered a detailed respiratory questionnaire. From the same cohort 135 of 229 randomly selected asymptomatic children were also interviewed. A stratified selection of one in four of the children interviewed was then invited to take part in a six minute cold air enhanced exercise challenge test; 128 symptomatic and 26 asymptomatic children attended. RESULTS: Bronchial hyperreactivity, a fall of FEV1 > or = 10% at five, 10, or 15 minutes following the exercise challenge, was identified in 15 of 128 symptomatic children and in one of 26 asymptomatic children. Bronchial hyperreactivity was found in only one of three children with frequent shortness of breath and one of five with frequent wheeze. It was found in 13 of 58 children whose parents were aware of the diagnosis of asthma; in 10 of 26 children who were on regular prophylactic treatment; in only 11 of 70 children with a history of exercise induced symptoms; and seldom in children with mild symptoms. Gestational age and ventilator support in the neonatal period were significant predictors of bronchial hyperreactivity. CONCLUSIONS: Exercise testing enhanced by cold air adds very little to a well designed respiratory questionnaire in community studies of asthma in childhood.

Adolescent↗
PubMed1993

Effects of high doses of inhaled corticosteroids on adrenal function in children with severe persistent asthma.

BACKGROUND: Childhood asthma generally responds well to inhaled corticosteroids within the dosage range recommended by the manufacturers, but it is sometimes necessary to use higher doses--that is, above 400 micrograms/day--a practice which has become more widespread recently. Whereas the lack of adrenal suppression in children given inhaled corticosteroids in normal doses is well documented, little is known about the effects of higher doses. METHODS: The effects on adrenal function of high dose (above 400 micrograms/day) inhaled corticosteroids were evaluated by measuring cortisol concentration in the morning and performing a short tetracosactrin test in 49 children taking budesonide (mean age 9.2 years (range 4 to 16 years) and 28 children taking beclomethasone dipropionate (10.2 years (5 to 13 years)). Twenty three non-asthmatic children (8.9 years (4.9 to 13 years)) who were under investigation for short stature served as controls for the study. RESULTS: Compared with controls mean basal cortisol concentration was lower in children taking budesonide and beclomethasone dipropionate (control 401 (26.8) nmol/l, budesonide 284 (22) nmol/l, beclomethasone dipropionate 279 (23.2) nmol/l). Sixteen of the 49 children taking budesonide had subnormal basal cortisol concentrations compared with seven of the 28 taking beclomethasone dipropionate. Mean stimulated cortisol concentrations were lower in children taking inhaled corticosteroids than in controls, with no difference between those taking budesonide or beclomethasone dipropionate. CONCLUSIONS: Adrenal suppression occurs in some children who are given inhaled corticosteroids in doses greater than 400 micrograms/day. It may therefore be advisable to try alternative treatments before such doses are used.

Administration, Inhalation↗
PubMed1992

Respiratory symptoms and atopy in Aberdeen schoolchildren: evidence from two surveys 25 years apart.

OBJECTIVE: To estimate changes in the prevalence of respiratory symptoms and the reported diagnoses of asthma, eczema, and hay fever in primary school children in Aberdeen between 1964 and 1989. DESIGN: Determination of incidence prevalence and prevalence from survey data. SETTING: Aberdeen, Scotland. PARTICIPANTS: 2743 primary school children (aged 8-13) from 1964 and 4003 [corrected] from 1989. MAIN OUTCOME MEASURES: Survey data on whether, according to the parent or guardian, the child wheezed or was troubled with shortness of breath; the number of episodes of breathlessness in the past year; and whether asthma, eczema, or hay fever had ever been diagnosed. RESULTS: Questionnaires were completed by the parents of 2510 children in 1964 and 3403 children in 1989. The prevalence of wheeze rose from 10.4% in 1964 to 19.8% in 1989, and the prevalence of episodes of shortness of breath increased from 5.4% to 10.0%. In both surveys wheeze and shortness of breath were more prevalent in boys than in girls. The reported diagnosis of asthma rose from 4.1% to 10.2%, hay fever from 3.2% to 11.9%, and eczema from 5.3% to 12%. The proportion of boys suffering from eczema rose from 47.7% to 60.0%. Hay fever showed a similar increase, from 49.4% to 60.1%, in boys over the 25 year period. Though the parents of a higher proportion of children with wheeze were aware of the diagnosis of asthma in 1989, because of the increased prevalence of wheeze the absolute number of parents of wheezy children who were not aware of a diagnosis of asthma increased from 7.4% to 9.6% of the population studied. CONCLUSION: The higher diagnosis rate for asthma is due not simply to changes in diagnostic fashion but reflects an increase over the past 25 years in the prevalence of respiratory symptoms, which in turn may reflect a more general change in the prevalence of atopy, the increase in which was particularly noticeable in boys. This increase explains some of the increase in hospital admission rates for children with asthma.

Adolescent↗
PubMed1992

Asthma, inhaled corticosteroid treatment, and growth.

To evaluate the effects on growth of inhaled corticosteroid treatment (ICT) and of the quality of control of asthma, height velocity was studied in 58 prepubertal children attending a specialist asthma clinic because of chronic asthma that was difficult to control. The height velocity standard deviation (SD) score was maximal when the asthma was well controlled both before (0.01) and after (-0.07) starting ICT. It was least when the asthma was poorly controlled both before (-1.50) and after (-1.55) starting ICT. The effectiveness of control correlated significantly with the height velocity SD score, both before and after ICT was started. No evidence was found that the administration of ICT has an adverse effect on growth.

Administration, Inhalation↗