The relationship between atopy and bronchial hyperresponsiveness (BHR), both key features of asthma, remains to be clarified. BHR is commonly evaluated by bronchial challenges using direct and indirect stimuli. The aim of this study was to investigate the degree of BHR to methacholine (direct stimulus) and adenosine 5'-monophosphate (AMP) (indirect stimulus) according to the presence and degree of atopy in children with asthma. We performed a retrospective analysis of data from 120 children presenting with a diagnosis of asthma. These children were characterized by skin-prick tests (SPTs), spirometry and bronchial challenges with methacholine and AMP. Atopy was defined by at least one positive reaction to SPTs, and its degree was measured using serum total IgE levels, number of positive SPTs and atopic scores (sum of graded wheal size). A provocative concentration causing a 20% decline in FEV(1) (PC(20) ) was determined for each challenge. Patients with atopy(n=94) had a significantly lower AMP PC(20) than non-atopic patients (n=26), whereas methacholine PC(20) was not different between the two groups. Among the patients with atopy, there was no association between methacholine PC(20) and any atopy parameter. In contrast, a significant association was found between AMP PC(20) and the degree of atopy reflected in serum total IgE, number of positive SPTs and atopic scores (anova trend test, p=0.002, 0.001, 0.003, respectively). AMP responsiveness was associated with the presence and degree of atopy, whereas such a relationship was not observed for methacholine responsiveness. These findings suggest that atopic status may be better reflected by bronchial responsiveness assessed by AMP than by methacholine.

Th2 cytokine IL-5 and CC chemokine eotaxin are thought to be key regulators of eosinophils in bronchial asthma. However, their involvement in children with stable asthma (SA) has not been determined. We investigated the roles of IL-5 and eotaxin in eosinophil degranulation in children with SA. Induced sputum was obtained from 30 SA, 21 allergic rhinitis (AR), and 22 non-atopic healthy control (HC) children. We measured sputum levels of IL-5, eotaxin, and eosinophil indices [percentage eosinophils, eosinophil-derived neurotoxin (EDN), and eosinophil- cationic protein (ECP)]. We also examined correlations of IL-5 and eotaxin with eosinophil indices. Sputum percentage eosinophils and EDN and ECP levels were significantly higher in the SA group than in the HC group, while only the sputum EDN and ECP levels were significantly higher in the AR group than in the HC group. Unexpectedly, sputum levels of IL-5 were not significantly different among the three groups; however, the levels of eotaxin were higher in the SA group when compared to the HC group. No significant correlations were found between IL-5 and percentage eosinophils, EDN, or ECP levels; in contrast, eotaxin levels correlated significantly with percentage eosinophils (R­= 0.638; p = 0.0001), EDN (R­= 0.522; p = 0.003), and ECP levels (R­= 0.630 and p = 0.0002). The elevated levels and good correlations of eotaxin with sputum eosinophil indices, and no elevation or correlation of IL-5 with these indices, suggest that CC chemokine eotaxin may play a more important role in eosinophil degranulation in children with SA.

Swyer -James syndrome (SJS) is a rare, constrictive bronchiolitis characterized by a unilateral hyperlucent lung, resulting from an insult to the lower respiratory tract. 1 Typical symptoms include recurrent pulmonary infections, chronic cough, wheezing and exertional dyspnea. 2 Known etiologies include infection (particularly adenovirus and Mycoplasma pneumoniae ), 3 aspiration, and toxic inhalation. Although the clinical and radiologic features of measles pneumonia and its sequela have been described, 4 SJS, as a sequela of measles infection, has been rarely reported. 5, 6 We report a case of post-measles SJS with fi nger clubbing and pulmonary hypertension improved by surgery in a 5-year-old Korean boy. Case reportA 5-year-old Korean boy was admitted to Department of Pediatrics, Inje University Sanggye Paik Hospital due to wheezing and exertional dyspnea with mild suprasternal retractions. At the age of 23 months he had been admitted to the intensive care unit of a local hospital for acute pneumonia with severe respiratory failure caused by measles during an outbreak that occurred in 2000 -2001, in Korea. After the episode of measles pneumonia he had a history of recurrent pulmonary infections with wheezing, exercise intolerance and blue discoloration of lips and nails. During the next 3 years he suffered from a progressive, decline in exercise tolerance. There was no family history of pulmonary tuberculosis and his living conditions were not unusual.On admission physical examination indicated obvious fi nger clubbing, pectus carinatum with mild suprasternal retractions, expiratory wheezes and rales in bilateral lower lung fi elds. Routine laboratory work-up was as follows: white blood count, 21 510 cells/mm 3 (cell differential: neutrophils, 74.2%; lymphocytes, 17.3%; monocytes, 5.4%); hemoglobin level, 12.2 g/dL; and normal serum electrolytes. Room-air, arterial blood gasses were PaO 2 , 50 mmHg; PaCO 2 , 53 mmHg; and pH 7.33. Sputum and blood cultures were negative for bacteria, fungi and viruses. Sputum smears tested negative for acid-fast bacilli.Chest X-ray showed total collapse with saccular bronchiectasis in the right lung and a left lung that was hyperlucent with decreased vascularity and air-trapping. Furthermore, there was herniation of the left upper lobe into the right hemithorax. Highresolution computed tomography (HRCT) demonstrated saccular bronchiectasis in the right lung and air-trapping in the left lung ( Fig. 1 ). The diameter of the left pulmonary artery was enlarged (12 -14.5 mm) while the right pulmonary artery diameter was decreased (12 -11 mm) on contrast enhanced CT scan, owing to compensatory hypertrophy of the left lung ( Fig. 2 ). These clinical and radiologic fi ndings suggested a diagnosis of SJS.Bronchoalveolar lavage (BAL) was performed by instilling 1 mL/kg saline solution into a segmental bronchus of the right middle lobe three times. The differential cell count in BAL fl uid indicated a signifi cant increase in neutrophils (21%macrophages, 13% lymphocytes, 60% neutrophils, ...