The outcome of childhood asthma was studied in 101 adults who came from a group of 119 asthmatic children (85%) 6 to 14 yr of age who had originally been investigated between 1966 and 1969. Changes in respiratory symptoms, spirometry, and airway responsiveness to histamine in childhood and adult life were analyzed. It was found that 43 of the 101 adults (43%) had current symptoms; 29 of the 43 (67%) were receiving maintenance therapy. In the first study, 83 of the 101 children (82%) showed a response on inhalation of histamine (PC10-histamine less than or equal to 16 mg/ml). The number of subjects in the second study who still had a PC10-histamine less than or equal to 16 mg/ml fell to 29, suggesting that airway responsiveness decreases from childhood to adulthood. During the second survey (in adults), 25 of the 43 (59%) subjects with current symptoms and four of the 58 (7%) without respiratory symptoms responded to histamine. Adults with current symptoms had a significantly lower %FEV1 in both childhood and adulthood than did adults without current symptoms; %FEV1 was not different in females and males or in smokers and nonsmokers in either the first or the second survey. The outcome of childhood asthma is primarily predicted by the initial degree of bronchial obstruction (p = 0.041) and airway responsiveness to histamine (p = 0.050), and does not appear to be related to sex, smoking habits, or age of onset of respiratory symptoms.

No abstract

Inhaled corticosteroid has been shown to be effective in the management of asthma. However, there is a lack of studies that assess the effect of cessation after long-term treatment with inhaled corticosteroid. This question was addressed in 28 children with stable asthma, aged 11 to 18 yr of age, who had completed 28 to 36 months of treatment with inhaled corticosteroid (budesonide 200 micrograms 3 times/day) and inhaled beta-2-agonist (salbutamol 200 micrograms 3 times/day). The children were randomized in a 1:2 ratio in a double-blind study either to continue budesonide (n = 8) during a period of 6 months or to decrease the dose of budesonide (n = 20) within 2 months, followed by placebo for 4 months. Treatment with salbutamol 600 micrograms daily was continued in both groups. Eight children from the tapering-off group withdrew, mainly due to symptoms of asthma, compared with none in the continuous treatment group. Five patients in the tapering-off group experienced exacerbations for which prednisolone was given, compared with none in the continuous treatment group. After tapering-off, symptoms of asthma and additional bronchodilator use increased, and both FEV1% predicted and PD20 histamine (provocation dose of histamine causing a 20% fall in FEV1) decreased, whereas these all remained unchanged in the group that continued treatment with inhaled corticosteroid. We conclude that in this study long-term treatment with 600 micrograms budesonide daily suppressed underlying mechanisms of asthma, but did not cure the disease.

We studied the prognosis of childhood asthma in a cohort of 406 children 8 to 12 yr of age when enrolled. Subjects were followed for a mean of 14.8 yr after their initial evaluation, with a follow-up rate of 86%. The mean age at follow-up was 24.7 yr. We assessed the predictive value of sex and various childhood variables on the outcome of symptoms and medication use in adulthood. Although only 19% of subjects were still under a physician's supervision at the time of follow-up, 76% had respiratory symptoms, 32% used maintenance medication, and 22% used medication intermittently. The incidence of cigarette smoking was disturbingly high (33%). In adulthood, women were more likely than men to have symptoms (85 versus 72%, respectively). The childhood symptom severity and the childhood degree of bronchial responsiveness in combination with a low %FEV1 were also related to the outcome of asthma in adulthood. The high prevalence of symptoms in adults at follow-up coupled with the low rate of physician supervision and medication usage suggest that more aggressive treatment may be indicated in asthmatic children.

In w 1 wird gezeigt, dal] --falls man zwei Linien beiderseits der Zink-K-Kante miteinander vergleieht --man einen mel]baren Unterschied in deren Intensit~ts-verh~ltnis fOr Reflexionen an den beiden verschiedenen 111-Fl~chen der Zinkblende erwarten kann. Dieser Unterschied h~ngt zusammen mit dem polaren Charakter der Zn S und wird verursaeht durch die Tatsaehe, dal3 die Phasendifferenz zwischen Prim~rwelle und Streuwelle ffir Streuung an Zink anders ist als fOr Streuung an Sehwefel. In w 2 werden MeBresultate gebracht, welehe den in w 1 erw~hnten Effekt sieherstellen. Den ZnS-Kristall kann man sieh aufgebaut denken aus Doppelschichten in der 111-Richtung, bestehend aus je einer Zn-Netzebene und einer S-Netzebene in einer Distanz yon einem VierteI der Gitterkonstante. Es wird nun an natorlichen Kristallfl~ehen gezeigt, dal~ die gl~nzende, gut entwlckelte 111-Fl~ehe die S-Atome der Doppelsehichten aul3en hat, w~hrend die matte, weniger gut entwiekelte Fl~che die Zn-Atome au~en hat. In w 3 werden die Resultate piezoelektrischer Untersuchungen gegeben. Bei Druck senkrecht zu den 111-Fl~chen wird die gl~nzende Fl~che (Sehwefel aul]en) positiv. In w 4 wird alas ZahlenmateriaI yon w 2 eingehend diskutiert. Es zeigt sich, dal3 es nStig ist anzunehmen, da~ nicht nur die Amplitude, sondern auch die Phase der von Atomen gestreuten RSntgenwellen eine Funktion des Ablenkungswinkels sei. Es wird die Abh~ingigkeit der Phase bei Streuung an Zink von Linien in der N~he der Zink-K-Kante abgesch~tzt. Diese Abseh~tzung wird in qualitativer Ubereinstimmung mit der Erfahrung gefunden. w 1. Einleitung.Gelegentlich einer n~heren Diskussion fiber die Ofiltigkeit des F riedelschen Satzes yon der Symmetrie der R Sntgeninterferenzen hat schon Ewald* die Behauptung ausgesprochen, dal3 dieser Satz nicht mehr zu gelten braucht, wenn man die individuellen Phasenunterschiede zwischen den an den verschiedenen Atomsotten gestreu~en Sekund~rwellen mi~ der Primarwelle in Betracht zieht.Diese Phasenunterschiede lassen sich nun for eine bestimmte Atomart in halbklassischer Weise leicht absch~tzen. Wenn n der (ira allgemeinen komplexe) Brechungsquotient einer nm" aus der betrachteten Atomart aufgebauten Substanz ist, E die elektrische Feldst~rke, D die dielektrisohe * P. P. Ewald und C. Hermann, ZS. f. Kris~. 65, 251, 1927. Ein ,,Beweis", den Ewald anf~ngiieh ffir die Richtigkeit des Friedelsehen Satzes gegeben hat (Physica 5, 363, 1925), wurde spfiter von ihm, durch eine Bemerkung der Herren N. H. Kolkmeyer, A. Karssen und J.M. Bijvoet dazu veranlal]t, widerrufen (Physica 6, 336, 1926). 23*