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孩子医学英语English:Children's healthcare is an essential aspect of pediatric medicine, focusing on the unique physiological, psychological, and developmental needs of young patients. Pediatricians are trained to diagnose and treat a wide range of childhood illnesses, from common colds and ear infections to more serious conditions such as asthma, diabetes, and cancer. In addition to providing medical care, children's healthcare professionals also play a vital role in promoting preventative measures, such as vaccinations, nutrition education, and injury prevention. Their goal is to ensure that children not only recover from illness but also thrive in their overall growth and development.Chinese:儿童的医疗保健是儿科医学的重要方面，专注于年幼患者独特的生理、心理和发育需求。
儿科医生接受过培训，能够诊断和治疗各种儿童疾病，从普通感冒和耳部感染到更严重的疾病，如哮喘、糖尿病和癌症。
除了提供医疗护理外，儿童医疗保健专业人员还在促进预防措施方面发挥着至关重要的作用，如疫苗接种、营养教育和预防意外伤害。
学龄前儿童获病几率英语阅读理解It's quite common for preschoolers to get sick occasionally. Their immune systems are still developing and learning to fight off different kinds of germs. That's why they might catch a cold or the flu more often than adults.Parents often worry when their little ones fall ill, but it's actually a natural part of their growth. The keyis to keep them hydrated, give them plenty of rest, and ensure they're eating well when they're feeling up to it.With kids in preschool, there's also the risk of catching something from their classmates. Shared toys, snacks, and close contact can all spread germs. But that's okay! It's a part of learning how to navigate social interactions and build resilience.To reduce the chances of illness, parents can encourage good hygiene habits like regular handwashing. Teaching kids to cover their mouths when coughing or sneezing also helps.And making sure they get enough sleep and eat a balanced diet strengthens their immune systems.Remember, every kid is different. Some may seem to catch every bug going around, while others seem to breeze through preschool without much trouble. It's all part of the journey and there's no need to panic if your child gets sick. With a little TLC and time, they'll be back to their playful selves in no time.。
中医儿科学哮喘简答题英文回答：1. Define asthma in children according to TCM.Asthma in children, according to TCM, is characterized by recurrent wheezing, coughing, chest tightness, and dyspnea. It is caused by a combination of internal and external factors, including inherited deficiencies, exogenous pathogenic factors, and imbalances of Qi, Yin, and Yang.2. What are the most common types of asthma in children according to TCM?The most common types of asthma in children according to TCM are:Qi deficiency asthma: Characterized by wheezing, coughing, and shortness of breath that is worse in themorning or after exertion.Yin deficiency asthma: Characterized by dry cough, sore throat, and night sweats.Yang deficiency asthma: Characterized by cold limbs, fatigue, and wheezing that is worse in the cold.3. What are the main treatment principles for asthma in children according to TCM?The main treatment principles for asthma in children according to TCM are:Dispelling exterior pathogens: Using herbs to clear heat and toxins from the lungs and airways.Strengthening the immune system: Using herbs to tonify Qi, Yin, and Yang and improve resistance to external pathogens.Regulating Qi and blood circulation: Using herbs topromote the smooth flow of Qi and blood throughout the body.Nourishing the lungs and kidneys: Using herbs to strengthen the lungs and kidneys, which are essential for respiratory health.4. What are some common herbs used to treat asthma in children according to TCM?Some common herbs used to treat asthma in children according to TCM include:Ephedra: Dispels exterior pathogens and opens the airways.Licorice: Strengthens the immune system and reduces inflammation.Ginseng: Tonifies Qi and improves energy levels.Astragalus: Tonifies Qi and Yin and strengthens the immune system.Rehmannia: Nourishes Yin and strengthens the kidneys.中文回答：1. 中医儿科学中如何定义哮喘？中医儿科学认为哮喘是一种以反复发作的喘息、咳嗽、胸闷、气促为主要表现的疾病。
西医儿科术语英文翻译以下是常见的西医儿科术语英文翻译：1. 儿科：Pediatrics2. 儿童生长发育：Child Growth and Development3. 新生儿：Neonate4. 婴儿：Infant5. 学龄前儿童：Preschool Child6. 学龄儿童：School-aged Child7. 青春期：Adolescence8. 儿童营养：Child Nutrition9. 母乳喂养：Breastfeeding10. 配方奶喂养：Formula Feeding11. 断奶：Weaning12. 幼儿急疹：玫瑰疹：Rubella13. 水痘：Varicella14. 手足口病：Hand-foot-mouth Disease (HFMD)15. 流行性感冒：Influenza16. 中耳炎：Otitis Media17. 急性上呼吸道感染：Acute Upper Respiratory Infection (URI)18. 支气管肺炎：Bronchopneumonia19. 支原体肺炎：Mycoplasma Pneumonia20. 百日咳：Pertussis21. 儿童哮喘：Asthma in Children22. 过敏性鼻炎：Allergic Rhinitis23. 肠道寄生虫病：Intestinal Parasitic Diseases24. 微量元素缺乏症：Trace Element Deficiency25. 维生素缺乏症：Vitamin Deficiency26. 新生儿黄疸：Neonatal Jaundice27. 新生儿窒息：Neonatal Asphyxia28. 新生儿败血症：Neonatal Sepsis29. 肠套叠：Intussusception30. 小儿肺炎：Pneumonia in Children31. 小儿腹泻病：Diarrhea in Children32. 小儿营养不良：Malnutrition in Children33. 小儿肥胖症：Childhood Obesity34. 小儿糖尿病：Diabetes Mellitus in Children35. 小儿先天性心脏病：Congenital Heart Disease in Children36. 风湿热：Rheumatic Fever37. 川崎病：Kawasaki Disease38. 幼年特发性关节炎：Juvenile Idiopathic Arthritis (JIA)39. 儿科重症监护病房（PICU）：Pediatric Intensive Care Unit (PICU)40. 新生儿重症监护病房（NICU）：Neonatal Intensive Care Unit (NICU)41. 儿童生长发育评估：Child Growth Assessment42. 儿童免疫接种计划：Child Immunization Schedule43. 儿童心理咨询与治疗：Child Psychological Counseling and Therapy44. 儿童康复治疗：Child Rehabilitation Therapies45. 儿童行为问题咨询与治疗：Child Behavioral Issues Counseling and Therapy46. 儿童疫苗接种咨询与指导：Child Vaccination Counseling and Guidance47. 新生儿筛查项目：Neonatal Screening Programs48. 小儿危重症管理技术：Critical Care Management in Children49. 儿科药理学和药物治疗学：Pediatric Pharmacology and Therapeutics50. 小儿外科手术技术：Pediatric Surgical Techniques。
导致儿童过度肥胖的影响英语作文The Impact of Childhood ObesityChildhood obesity has become a major health concern in many countries around the world. It is a condition where a child has excessive body fat which can lead to serious health problems in the future. There are several factors that contribute to the rise in childhood obesity, including poor diet, lack of physical activity, genetics, and socio-economic factors.One of the main causes of childhood obesity is poor diet. Many children today consume high-calorie, low-nutrient foods such as fast food, sugary drinks, and snacks high in sugar and fat. These foods not only contribute to weight gain but also lack essential nutrients that are important for healthy growth and development. Overeating and consuming large portion sizes are also common factors that lead to obesity in children.Lack of physical activity is another major factor that contributes to childhood obesity. With the rise of technology and screen time, many children spend hours each day sitting in front of a computer, television, or smartphone. This sedentary lifestyle leads to a decrease in physical activity and an increase in weight gain. Children should be encouraged to engage inregular physical activity such as playing sports, riding bikes, and running around outdoors.Genetics can also play a role in childhood obesity. Some children may be more predisposed to gaining weight due to their genes. However, genetics alone is not the sole cause of obesity and can be influenced by other factors such as diet and lifestyle choices.Socio-economic factors can also contribute to childhood obesity. Families with lower incomes may have limited access to healthy foods and resources for physical activity. Fast food and processed foods are often cheaper and more convenient than fresh fruits and vegetables, making it difficult for some families to make healthy choices.The impact of childhood obesity can have far-reaching consequences on a child's health and well-being. Children who are overweight or obese are at a higher risk for developing chronic diseases such as type 2 diabetes, high blood pressure, heart disease, and certain types of cancer. They may also experience psychological effects such as low self-esteem, depression, and social isolation.Preventing childhood obesity requires a multi-faceted approach involving parents, schools, healthcare providers, andpolicymakers. Parents play a critical role in modeling healthy eating habits and promoting physical activity for their children. Schools can support healthy choices by providing nutritious meals, incorporating physical education into the curriculum, and creating environments that promote health and wellness.Healthcare providers can help by educating families about the risks of childhood obesity, monitoring growth and development, and providing resources for healthy living. Policymakers can implement policies that support access to healthy foods, safe spaces for physical activity, and education on nutrition and wellness.In conclusion, childhood obesity is a complex issue that requires the collective effort of families, communities, and policymakers to address. By promoting healthy eating habits, encouraging physical activity, and raising awareness about the risks of obesity, we can help children lead healthier lives and prevent the long-term consequences of this epidemic.。
描述哮喘的作文英语Asthma is a chronic respiratory condition that affects millions of people worldwide. It is characterized by inflammation and narrowing of the airways, which can cause symptoms such as wheezing, shortness of breath, chest tightness, and coughing. Asthma can be triggered by various factors, including allergens, air pollution, respiratory infections, exercise, and stress.Asthma is a common condition that can affect people of all ages, but it is most commonly diagnosed in childhood.It is estimated that around 300 million people worldwide suffer from asthma, and the prevalence of the condition is increasing, particularly in urban areas. In addition, asthma is more common in developed countries, where environmental factors such as air pollution and allergens are more prevalent.The exact cause of asthma is not fully understood, but it is thought to be a combination of genetic andenvironmental factors. People with a family history of asthma or allergies are more likely to develop the condition, and exposure to certain environmental factors can trigger the onset of symptoms. In addition, there is evidence to suggest that early childhood exposure to allergens and respiratory infections can increase the risk of developing asthma.The symptoms of asthma can vary from person to person, and can range from mild to severe. Some people may only experience occasional symptoms, while others may have persistent symptoms that significantly impact their daily life. Common symptoms of asthma include wheezing, shortness of breath, chest tightness, and coughing, particularly at night or early in the morning. In severe cases, asthma can be life-threatening and may require emergency medical treatment.The diagnosis of asthma is based on a combination of medical history, physical examination, and lung function tests. These tests can help to determine the severity of the condition and identify potential triggers. Oncediagnosed, asthma can be managed through a combination of medication and lifestyle changes. Medications for asthma include relievers, which provide quick relief of symptoms, and preventers, which reduce inflammation and prevent symptoms from occurring. In addition, people with asthma are often advised to avoid known triggers, such as allergens and air pollution, and to maintain a healthy lifestyle, including regular exercise and a balanced diet.Despite the challenges of living with asthma, many people are able to lead full and active lives with theright management and support. However, it is important for people with asthma to be aware of the potential risks and to seek medical advice if they experience worsening symptoms. With proper management and care, most people with asthma are able to control their symptoms and prevent asthma attacks.In conclusion, asthma is a common and chronic respiratory condition that affects millions of people worldwide. It is characterized by inflammation and narrowing of the airways, which can cause symptoms such aswheezing, shortness of breath, chest tightness, and coughing. Although asthma can be challenging to live with, with the right management and support, most people with asthma are able to lead full and active lives.。
异丙托溴铵雾化吸入辅助治疗儿童哮喘的可行性廖九祥 林进生 彭锦英广东省遂溪县人民医院，广东遂溪 524300[摘要] 目的 探讨异丙托溴铵雾化吸入辅助治疗儿童哮喘的可行性。
方法 选择2016年12月～2018年6月于我院确诊哮喘并进行治疗的患儿130例，按照随机对照分类法分为研究组（n=73）和对照组（n=57）。
对照组患儿采用布地奈德加沙丁胺醇雾化吸入进行治疗，而研究组在此基础上加用异丙托溴铵。
治疗一周后观察两组患者治疗效果、症状评分、肺功能评价指标、嗜酸性粒细胞百分比、C反应蛋白及血清IgE指标及不良反应发生情况之间的差异。
结果实验组患者治疗好转率明显高于对照组（P＜0.05）；实验组患者治疗后咳嗽及哮鸣音症状评分明显低于对照组（P＜0.05），但两组患者喘息症状评分差异无统计学意义（P＞0.05）；实验组患者治疗后FEV1，PEF及FEV1/FVC均明显高于对照组（P＜0.05）；实验组患者治疗后Eos%、CRP及IgE指标均明显低于对照组（P＜0.05）； 两组患儿治疗中均未出现不良反应。
结论 异丙托溴铵雾化吸入辅助用于儿童哮喘治疗能有效缓解患者症状，缩短治疗周期，其临床应用效果较好，值得推广。
[关键词]异丙托溴铵；布地奈德；沙丁胺醇；哮喘；儿童[中图分类号] R725.6 [文献标识码] A [文章编号] 2095-0616（2019）06-85-04Feasibility of aerosol inhalation of ipratropium bromide in adjuvant treatment of children with asthmaLIAO Jiuxiang LIN Jinsheng PENG JinyingDepartment of Pediatrics,Suixi People's Hospital,Suixi 524300,China[Abstract] Objective To explore the feasibility of aerosol inhalation of ipratropium bromide in adjuvant treatment of children with asthma. Methods 130 children with asthma who were diagnosed and treated in our hospital from December 2016 to June 2018 were selected.They were divided into study group (n=73) and control group (n=57) according to the randomized controlled classification method.Children in the control group were treated with aerosol inhalation of budesonide and salbutamol.Children in the study group were treated with ipratropium bromide on basis of it.After one week of treatment,the differences in curative effects,symptom score,evaluation index of lung function,eosinophil percentage,C-reactive protein,serum IgE and adverse reactions between the two groups were observed. Results The improvement rate of treatment in the experimental group was significantly higher than that of the control group (P＜0.05).The scores of cough and wheezing symptoms in the experimental group were significantly lower than those in the control group (P＜0.05),but there was no significant difference in the asthmatic symptom score between the two groups (P＞0.05).After treatment,FEV1,PEF and FEV1/FVC in the experimental group were all ignificantly higher than those in the control group (P＜0.05).After treatment,Eos%,CRP and IgE indexes in the experimental group were all significantly lower than those in the control group (P＜0.05).No adverse reactions occurred in the treatment of children in the two groups. Conclusion Aerosol inhalation of ipratropium bromide in adjuvant treatment of children with asthma can effectively relieve the symptoms of patients and shorten the treatment cycle.The clinical application effect is better and it is worth promoting.[Key words] Ipratropium bromide;Budesonide;Salbutamol;Asthma;Children哮喘是临床上比较常见的小儿呼吸系统疾病，其症状以咳嗽、发作性喘息等呼吸道反应为主，继而诱发患儿呼吸困难，严重影响患儿生活学习，甚至导致患儿死亡[1]。
圣诞树综合症的英语科普文章Tis the season for twinkling lights, festive cheer, and... Christmas tree syndrome? Yes, you heard that right. As the holiday season approaches, many households bring home the centerpiece of their celebrations—a fragrant, freshly-cut Christmas tree. But did you know that along with the joy it brings, it can also introduce a unique set of health effects that some people refer to as "Christmas tree syndrome"?It's not the tree itself that's the culprit, but the microorganisms that can thrive in the damp environment of the tree's stand. When a tree is cut, it loses its ability to transport water, but it doesn't stop producing sap. This, combined with the water in the stand, creates a perfect breeding ground for bacteria and mold, which can release spores into the air.These spores can cause a range of symptoms, from mild to severe, depending on the individual's sensitivity. For some,it might just be a bit of a tickle in the throat or a runny nose. For others, especially those with pre-existing respiratory conditions or allergies, it could lead to more serious issues like coughing, wheezing, or even asthma attacks.But fear not, festive friends! There are ways to enjoyyour Christmas tree without falling victim to this holiday hazard. First and foremost, choose a tree that has beenproperly stored and is not excessively damp. When you bringit home, give it a good shake outdoors to dislodge any loose spores before bringing it inside.Next, keep the tree stand watered, but not excessively. A tree can drink up to a quart of water in the first 24 hours, so make sure the stand is filled to help the tree stay fresh but not create a swampy environment that encourages mold growth.Ventilation is key. Make sure your home is well-ventilated, especially in the room where the tree is displayed. An open window or a room with good air circulation can help disperse any spores before they become a problem.Lastly, maintain your tree. Keep it watered and check for any signs of mold. If you notice any discoloration or a musty smell, it's time to take action. You can use a gentle, tree-safe disinfectant to clean the area, or if the mold is extensive, you might need to consider replacing the tree.So, as you deck the halls and trim the tree this holiday season, remember to be mindful of Christmas tree syndrome. With a little care and attention, you can keep your celebrations bright and your home healthy. Happy holidays!。
流鼻血太阳发烧了的幼儿英语作文英文回答：A young child with a bloody nose and fever in the sunis a cause for concern. The blood may be a sign of a more serious medical condition, such as a nosebleed or head injury. The fever may be a sign of an infection or other medical condition. The sun can also be harmful to a child with a fever, as it can lead to dehydration and heatstroke.It is important to seek medical attention immediatelyif your child has a bloody nose and fever in the sun. The doctor will be able to determine the cause of the symptoms and provide appropriate treatment.In the meantime, there are a few things you can do to help your child:Stop the bleeding by pinching the child's nose for 10-15 minutes.Give the child plenty of fluids to drink.Keep the child out of the sun.Monitor the child's temperature and seek medical attention if it rises above 101 degrees Fahrenheit.中文回答：一个在太阳下流鼻血且发烧的幼儿令人担忧。
英语六级阅读试题：儿童处方药有多安全英语六级阅读试题：儿童处方药有多安全英语六级阅读在考试中占有分数的比例很大，拿下阅读基本上英语六级考试就成功了一半，以下是yjbys网店铺整理的关于英语六级阅读试题：儿童处方药有多安全，供大家备考。
How Safe Are KIDS' Prescription Drugs?Drugs prescribed to children and adolescents have been much in the news lately.Health Canada has issued warnings about some drugs that both patients and physicians trusted,and it has withdrawn others from the market.What's going on?Parents should understand these complicated and confusing issues.How Are Prescription Drugs Approved in Canada?When a pharmaceutical company has a new drug.it applies to Health Canada for a licence to sell it.Based oninformation the company provides,including the results of clinical trials,the drug is either approved or the application is rejected.Is There a Difference in the Way Drugs Are Approved for Children and Adults?Normally.drugs are tested in adults first.Dr.Denis Daneman.a clinical investigator at The Hospital for Sick Children in Toront o,says,“we have to be remarkably careful because children are physiologically different than adults and are seen by physicians as a highly vulnerable group.”What Happens Once a Drug Is Approved?“Once approved,” explains Daneman.“it's available on the market and doctors can prescribe it for any indication they'd like to.” Even if it has not been tested specifically in children.he says.“physicians may start to use it either in small trials or whatwe call off-label (use of a prescription drug to treat a condition for which the drug has not been approved) in children.”How Common Is Off-label Use?Dr.Michael Rieder. director of the Adverse Drug Reaction Clinic at the Children's Hospital of Western Ontario,says,“drugs commonly used in children，such as antibiotcs and asthma drugs,are tested in children.” But,he says,“there is a misconception that children take only those drugs.We did a study looking at a million kids in Canada over a year.It turns out they used l,400 different drugs,of which 60 percent have not been tested,or approved for use in children.”If a Drug Is Safe in Adults,Why Do You Need to Test It in children?Health Canada's Dr.Siddika Mithani says.“children are not small adults.”Their physiology is different.That goes for adolescents.too.Dr.Eric Wookltorton.an Ottawa-based family physician who writes a column on adverse events for the Canadian Medical Association Journal,says,“Depo Provera is an injectable birth-control product used by women of all ages.No one thought to test it in adolescents until recently.T eenagers arelaying down bone density and this drug decreased bone density.”Are Older Drugs Safer?“If I were to use a medication off-label that's been around for some time,I'd be less concerned about it.” advises Dr.Peter Nieman.a Calgary pedia trician.“But if you use a medication that's being promoted as che best thing since sliced bread,and you know it's fairly new and are using it off-label,you are a bit nervous.”How Many Side Effects Are Reported?In 2004 Health Canada received 10,238 reports of adverse reactions in people of all ages.The number of reports has been increasing since 1999,when just under 6,000 were sent in.However.Dr.Bruce Carleton.of the pharmaceutical outcomes program at the Children's and Women's Health Centre of British Columbia，says,“95 percent of negative reactions are never reported.”Wooltorton explains:“how do you track the more minor,long-term side effects,the ones where kids are a little bit stunted in growth or they are having learning problems in school.There's no regulation and no financial incentive to report anything at all.”Should We Be More Careful with Some Drugs?Dr.Jack Uetrecht,a Canada Research Chair in adverse drug reactions,advises extra caution with drugs that affect the central nervous system.“The effects and long-term outcomes of giving these types of drugs aren't totally understood. Make sure the appropriate tests are given to make as clear a diagnosis as possible.and that the appropriate treatment is given based on that diagnosis.Talking to the patient for a few minutes and prescribing a drug would not be the best method.If there is a severe clinical problem and a clear clinical benefit,then the benefit is worth the risk.”Can Side Fffects Be Prevented?If your child has had a reaction to a drug in the past,an allergist can advise if she is still allergic.and if so,what could be used instead.Genome Canada is funding an $8.4-million research project that may helpprevent side effects in the future.led by Carleton and geneticist Michael Hayden,director of the Centre for Molecular Medicine and Therapeutics.It is looking for genetic markers that would signal if a child was at risk for an adversereaction.“There are genetic differences in the way a lot of physiological processeshappen in the human body,”says Carleton.“It makes sense that those differences would affect the way we process drugs.Therefore,understanding when that situation exists would help us to construct better guidelines.”What Should You Ask About Your Child's Prescription?First,be sure it is really necessary,says Wooltorton.“A lot of children don't always need prescriptions for a lot of things.Ear infections are an example of when antibiotics are sometimes,but not always,necessary.But there is a tendency in our society to want our kids to be like us.We want to get back to work.We want them to get back to school.We want a quick fix.But‘how wi11 we know the drug is working?'A child with asthma,for example,is usually given a couple of medications.One will be to open the airways.He should feel better after the First dose.If he doesn't,we have a problem.The other medication is used to reduce inflammation.This will decrease the number of acute breathless episodes,but it takes time to have an effect.”Find out how long your physician has been using the drug,says Rieder,and what the experience has been like.Your doctor may know quite a lot about the drug, even if it is being used off-label.What Should Parents Watch Out for?Dr.Michael Kramcr,of the Canadian Institutes of Health Research,says you sh ould contact your physician“ifyour child is very sleepy or is agitated and unable to sleep.You should also be concerned about any rashesthat cause blistering or hivcs.”When you pick up a medication at the drugstore,it often comes with a listof potential side effecfs.Maura MacPhee,who teaches in the School of Nursing at the University of British Columbia,says,“this is generic information.Before leaving the physician's office,makesure you know what side effects are the ones you need to worry about with your child.”How Safe Is the System?In the last 25 to 30 years,we have seen significant advances in the treatment of childhood leukemia.“WhenI was training 30 years ago,”says Daneman,“childhood leukemia had an 80-percent mortality rate;now the survival rate is better than 80 percent.”Another important development:More drugs are being tested now in children.Daneman says:“if you look at the number of studies that go on,there are many more in the last five to eight years than there were 20 0r 30 years ago.”1.Which of the following is requested by Health Canada before it permits a drug to be sold?A) The aize and the weight of the drug.B) The suggested price of the drug.C) The results of clinical trials of the drug.D) The production budget of the drug.2.Who is seen by Dr.Denis Daneman as a highly vulnerable group?A) Pregnant women.B) Children.C) Elderly people over 70.D) Middle-aged men.3.How many kinds of drugs are now used by children off-label?A) 840.B) 60.C) 1400.D) 560.4.Depo Provera is a drug that can result inadolescents'_____________.A) stomach upsetB) low blood pressureC} high cholesterolD) decreased bone density5.Some minor and long-term side effects were not reported due to______________.A) patients' ignoranceB) lack of financial incentiveC) doctor's irresponsibilityD) shortage of health workers6.Dr.Jack Uetrecht is most concerned about drugs' side effect on________________.A) the nervous systemB) the digestive systemC) the respiratory systemD) the skeleton system7.Dr.Jack Uetrecht suggests that an accurate diagnosis is the basis of________________.A) appropriate treatmentB) prescribing a new drugC) avoidance of side effectsD) feasible medical tests8.The project funded by Genome Canada hopes to prevent adverse reactionsafter identifying relevant______________.9.If a child with asthma suffers acute breathless episodes,he should take medicine to________________.10.When buying a medicine in a drugstore or getting it froma physician,parents need to watchout for its__________________.。
考研英语阅读理解模拟试题：医学（14）Watching a child struggle to breathe during an asthma attack is frightening for any parent. So it is only natural that most moms and dads will try just about anything——including spending a lot of money——to keep an attack at bay. Trouble is，more than half of parents are trying strategies that simply don’t work and wasting hundreds of dollars in the process，according to a study published last week in the Journal of Allergy and Clinical Immunology.The report，based on interviews with the parents of 896 asthmatic children in 10 different cities，contained some good news. Eighty percent of parents had a handle on at least one of the triggers that worsened their children’s asthma. After that，however，many parents seemed to go astray，t aking precautions that weren’t helpful “and made little sense，” according to Dr. Michael Cabana，a pediatrician at the University of Michigan’s C.S. Mott Children’s Hospital，who led the study.One of the most common mistakes was to buy a mattress cover to protect against dust mites for a child whose asthma was exacerbated instead by plant pollen. Many of those parents then neglected to do what would have helped a lot more：shut the windows to keep pollen out. Another was using a humidifier for a child who was allergic to dust mites；a humidifier tends to be a place where dust mites like to breed.With those allergies，a dehumidifier works better.Worst of all was the number of smokers with asthmatic children who didn’t even try to quit or at least limit themselves to smoking outdoors rather than just moving to another room or the garage. Second-hand smoke has been proved，over and over again，to be a major trigger of asthma attacks. Many smoking parents purchased expensive air filters that have wha t Cabana called “questionable utility.”Part of the problem，Dr. Cabana and his colleagues believe，is that parents are bombarded by television ads that encourage them to buy products such as air and carpet fresheners，ionizers and other remedies that are often expensive but medically unnecessary. And doctors may not always take the time，or have the time，to explain to parents what will and won’t work in their child’s particular case. For example，allergies are usually a problem for older children with asthma，while kids 5 and younger more frequently have trouble with viral respiratory infections. So make sure you understand what’s really triggering your child’s asthma. And remember，the best solutions are not always the most expensive ones.注（1）：本文选自Time，8/30/2004，p67；注（2）：本文习题命题模仿对象2004年真题Text 11. What does the study by Dr. Michael Cabana indicate？[A]Parents are eager to cure of their children‘s disease.[B]Many parents are wasting money for their children‘s frightening disease.[C] Many parents fail to find the effective way for their children‘s disease.[D]Parents feel worried about their children‘s disease.2. Which of the following is not the trigger of asthma attacks？[A]Humidifier.[B]Second-hand smoke.[C]Plant pollen.[D]Dust mites.3. The expression “to keep an attack at bay” （Line 3，Paragraph 1）most probably means ________.[A]to ease the attack[B]to lessen the attack[C]to continue the attack[D]to prevent the attack4. Why are the parents in such a dilemma？[A]The doctors are not responsible enough.[B]Parents are influenced much by ads.[C]Parents are ignorant of the disease.[D]The quality of medical products is not good.5. Which of the following is true according to the text？[A]Parents shouldn’t spend too much money on the children.[B]The expensive products are not always good.[C]To know the real trigger of the disease is very important.[D]Parents often make mistakes.答案：CADBC。
导致儿童过度肥胖的影响英语作文英文回答：Childhood obesity has become a growing concern in recent years, with many factors contributing to this issue. One of the main causes of excessive weight gain in children is an unhealthy diet. Many kids today consume a high amount of processed foods and sugary drinks, which are loaded with calories and lack essential nutrients. This not only leads to weight gain but also increases the risk of developing chronic diseases such as diabetes and heart disease.Another factor that contributes to childhood obesity is a sedentary lifestyle. With the advancement of technology, children are spending more time in front of screens, whether it be watching TV, playing video games, or using smartphones and tablets. This decrease in physical activity leads to a decrease in calorie expenditure, resulting in weight gain. Additionally, the lack of outdoor play and participation in sports further exacerbates the problem.Moreover, the influence of advertising and marketing cannot be ignored. Companies often target children with advertisements for unhealthy foods and beverages, using attractive packaging and catchy slogans to entice them. These advertisements create a desire for these products and make it difficult for children to make healthy choices. As a result, they are more likely to consume these unhealthy foods, leading to weight gain.Furthermore, the role of parents and caregivers is crucial in preventing childhood obesity. They play a significant role in shaping children's eating habits and promoting physical activity. If parents provide a healthy and balanced diet at home and encourage their children to engage in regular exercise, it can greatly reduce the risk of obesity. On the other hand, if parents themselves have poor eating habits and lead a sedentary lifestyle, it sets a bad example for their children and increases the likelihood of them becoming overweight.In conclusion, childhood obesity is influenced byvarious factors including unhealthy diet, sedentary lifestyle, advertising, and parental influence. To address this issue, it is important to promote healthy eating habits, increase physical activity, regulate advertising of unhealthy foods, and educate parents on the importance of leading by example. By taking these measures, we can help prevent and reduce childhood obesity.中文回答：儿童过度肥胖是近年来日益关注的问题，许多因素导致了这个问题的出现。
一、阅读理解文章大意：本文主要介绍了中国24节气之一——立夏，以及与立夏节气相关的四个传统习俗，比如人们会进行称重、吃鸡蛋、孩子们会将煮蛋挂在胸前，此外人们在这一节气还会吃些清凉可以润心的食物。
1. 请认真阅读下面短文，从短文后的选项中选出能填入空白处的最佳选项。
选项中有两项为多余选项。
The traditional Chinese solar calendar divides the year into 24 solar terms（节气）. Start of Summer, the 7th term of the year, signals the transition of seasons. On this day, the sun rays reach an angle of 45 degrees to the earth. 1 . But in northern China weather remains fine.Here are four things to learn about the Start of Summer.The custom of weighing people at the Start of Summer originated from the Three Kingdoms Period（220-180）. 2 . After lunch on the day of Start of Summer, the young and old took turns to get weighed while the person calculating the weight would offer good wishes.In ancient China, a round egg symbolized a happy life. And people believe eating eggs on the day of Start of Summer would bring good health.3 . That’s how the original “tea egg” was created. Today tea egg has become a traditional snack in China.On the day of Start of Summer, parents will prepare boiled eggs and put them in a knitted bag before hanging them on their child’s chest. They believe that it will help the children stay away from summer diseases. When at school, children gather together to play egg competitions. 4 .According to Chinese traditional medicine, Start of Summer is a key time to moisten（使湿润）the heart. 5 . V egetables, such as cucumber, tomato and celery and fruits that include watermelon, pear and strawberry are top choices.A．It is an important time for the harvest of summer crops like wheatB．They crash each other’s eggs in pairs and the one whose egg is not broken winsC．Food rich in vitamins and cool in nature is highly recommendedD．And the temperature will rise quickly during this periodE．They put leftover tea into boiled water together with eggsF．Later people added spices to the eggs to make them taste deliciousG．It was thought this practice would bring health and good luck to the people weighed2. Have you ever talked back to your teachers? 1 Y ou need to stand up and say hello to the teacher when he or she enters the classroom.Y ou should pay attention all the time in class, and should take an active part in different activities. And you should speak to your teachers politely at any time.2 If your teacher doesn’t accept late homework, do yours on time. Sometimes the classroom rules seem to be too strict.3 The betterthe learning environment is, the better you will study.4 Given the chance, most teachers want to be your friends. So don’t keep yourself away from teachers.5 However, don’t forget thatno matter how good friends you are, they are still your teachers and should be respected.根据短文内容，从短文后的选项中选出能填人空白处的最佳选项。
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吸二手烟有损儿童的动脉Passive smoking causes lasting damage to children's arteries, prematurely ageing their blood vessels by more than three years, say researchers.研究人员称，吸二手烟会对儿童的动脉造成持续伤害，使他们的血管老化三年以上。
The damage - thickening of blood vessel walls - increases the risk of heart attacks and strokes in later life, they say in the European Heart Journal.In their study of more than 2,000 children aged three to 18, the harm occurred if both parents smoked.Experts say there is no "safe" level of exposure to second-hand smoke.The research, carried out in Finland and Australia, appears to reveal the physical effects of growing up in a smoke-filled home - although it is impossible to rule out other potentially contributory factors entirely.Hidden damageUltrasound scans showed how children whose parents both smoked developed changes in the wall of a main artery that runs up the neck to the head.While the differences in carotid intima-media thickness were modest, they were significant and detectable some 20 years later when children had reached adulthood, say the investigators.Study author Dr Seana Gall, from the University of Tasmania, said: "Our study shows that exposure to passive smoke in childhood causes a direct and irreversible damage to the structure of the arteries."Parents, or even those thinking about becoming parents, should quit smoking. This will not only restore their own health but also protect the health of their children into the future."The results took account of other factors that might otherwise explain the association, such as whether the children went on to be smokers themselves, but the findings remained unchanged.However, if only one parent smoked the effect was not seen - possibly because exposure was not as high.Dr Gall said: "We can speculate that the smoking behaviour of someone in a house with a single adult smoking is different. For example, the parent that smokes might do so outside away from the family, therefore reducing the level of passive smoking. However, as we don't have this type of data, this is only a hypothesis."Regardless, experts say all children should be protected from second-hand smoke.Doireann Maddock, senior cardiac nurse at the British Heart Foundation, said: "The negative health effects of passive smoking are well known, but this study goes a step further and shows it can cause potentially irreversible damage to children's arteries increasing their risk of heart problems in later life.。
［1］赵茜,刘齐荣，代华,等•成都市城乡基层医疗机构住院医疗服务对比分析［J］•华西医学,2017,32(8):1162-1167.⑵张怡青，王高玲•基于嫡权-TOPSIS法的我国基层医疗卫生机构服务能力差异性分析［J］.中国卫生事业管理,2018,35(7)：509-512.［3］杨梓铉，廖晓阳,张从勇，等•成都市基层医疗机构诊疗量现状及影响因素分析［J］.华西医学,2017,32(8):1153-1157.［4］刘浩然,汤少梁.基于TOPSIS法与秩和比法的江苏省基本医疗服务均等化水平研究［J］.中国全科医学,2016,19(7):819-823.［5］张金梦，程梦菲，于贞杰.基于TOPSIS法和RSR法评价山东省基层医疗卫生机构服务水平［J］.中国卫生统计,2019,36(2)：277-279.⑹范焰.TOPSIS法与秩和比法模糊联合对卫生事业管理质量的综合评价［J］.中国医院统计,2000(4):214-216.［7］黎黎,郑张伟•推进家庭医生签约服务的现状及建议［J］.世界最新医学信息文摘,2019,19(51):45-46.4&［8］周明华，张青锋，冯毅•贵州省少数民族地区卫生资源配置及服务利用差异性分析［J］.中国卫生经济,2019,38(6)：45-48.［9］马天娇，李晶华，张莉，等.基于TOPSIS法和RSR法的长春市某区基层医疗卫生服务质量评价［JJ.医学与社会,2019,32(3)：49-52.［10］李萍•基层医疗卫生机构改革与财政投入现状分析［J］•财会学习，2015(17):208-209.［11］黄虎•浅谈财政投入对基层医疗机构长期发展的重要性［J］.现代交际,2013(12):11-12.(收稿日期：2020-03-05)平喘止咳贴联合孟鲁司特钠治疗儿童喘息性支气管炎的疗效观察钱龙娣(扬州大学附属医院，江苏扬州225000)【摘要】目的探讨平喘止咳贴联合孟鲁司特钠治疗儿童喘息性支气管炎的临床疗效。
雅思考试阅读核心认知词-医学健康篇advent [ˈædvent] n.到来，出现acupuncture [ˈækjupʌŋktʃə（r）] n.针刺疗法，针灸afflict [əˈflɪkt] v.使苦恼；折磨ailment [ˈeɪlmənt] n.疾病allergy [ˈælədʒi] n.过敏反应，过敏anatomy [əˈnætəmi] n.解剖学；解剖antidote [ˈæntidəʊt] n.解毒药artery [ˈɑːtəri] n.动脉；要道arthritis [ɑːˈθraɪtɪs] n.关节炎asthma [ˈæsmə] n.哮喘症athlete [ˈæθliːt] n.运动员；擅长运动的人audio [ˈɔːdiəʊ] a.听觉的；声音的autoimmune [ˌɔːtəʊɪˈmjuːn] a.自身免疫的backbone [ˈbækbəʊn] n.脊柱；骨干，支柱bacterial [bækˈtɪəriəl] a.细菌的bruise [bruːz] n.挫伤v.受挫；擦伤bulk [bʌlk] n.大量a.大批的cardiology [ˌkɑːdiˈɒlədʒi] n.心脏病学cardiovascular [ˌkɑːdiəʊˈvæskjələ（r）] a.心血管的cervical [ˈsɜːvɪkl] a.子宫颈的；颈部的check-up [ˈtʃek ʌp] n.检查；体格检查chemotherapy [ˌkiːməʊˈθerəpi] n.化学疗法clinic [ˈklɪnɪk] n.门诊部；诊所complementary [ˌkɒmplɪˈmentri] a.补足的，补充的concur [kənˈkɜː（r）] v.同意，一致consultation [ˌkɒnslˈteɪʃn] n.咨询；磋商coordinate [kəʊˈɔːdɪneɪt] v.协调，调节；配合curative [ˈkjʊərətɪv] a.有疗效的defective [dɪˈfektɪv] a.有缺陷的，不完美的detection [dɪˈtekʃn] n.侦查；察觉deviance [ˈdiːviəns] n.异常者的行为/特征diabetes [ˌdaɪəˈbiːtiːz] n.糖尿病；多尿症diagnose [ˈdaɪəɡnəʊz] v.诊断；判断disfigure [dɪsˈfɪɡə（r）] v.毁容dizziness [ˈdɪzinəs] n.头昏眼花，眩晕domesticate [dəˈmestɪkeɪt] v.驯养；教化dose [dəʊs] n.剂量，一剂dubious [ˈdjuːbiəs] a.怀疑的；靠不住的dumb [dʌm] a.哑的，无说话能力的；不说话的，无声音的dynamic [daɪˈnæmɪk] a.动力的，活跃的dystrophy [ˈdɪstrəfi] n.营养障碍；营养不良elbow [ˈelbəʊ] n.肘；（衣服的）肘部embryo [ˈembriəʊ] n.胚，胚胎；事物的萌芽期emerge [ɪˈmɜːdʒ] v.出现；显露，（事实等）暴露emotion [ɪˈməʊʃn] n.感情；情绪epidemic [ˌepɪˈdemɪk] n.流行病；流行a.（疾病）流行性的esoteric [ˌiːsəˈterɪk] a.只有内行才懂的；难懂的essence [ˈesns] n.本质；精髓ethanol [ˈeθənɒl] n.乙醇excess [ɪkˈses] n.超越；过量a.过量的，额外的excessively [ɪkˈsesɪvli] ad.过分地；过度地exclusively [ɪkˈskluːsɪvli] ad.专有地，专门地exhaustive [ɪɡˈzɔːstɪv] a.详尽的；彻底的extract [ɪkˈstrækt] v.取出；提取[ˈekstrækt] n.摘录；提出物extraction [ɪkˈstrækʃn] n.提取，提炼；抽出，拔出；开采feeble [ˈfiːbl] a.虚弱的；无效的female [ˈfiːmeɪl] n.女子a.女（性）的；雌性的foetus [ˈfiːtəs] n.胎儿fungus [ˈfʌŋɡəs] n.真菌；霉菌gene [dʒiːn] n.基因gene recombination 基因重组germ [dʒɜːm] n.微生物；细菌；胚芽gland [ɡlænd] n.腺glow [ɡləʊ] n.灼热；色彩鲜艳v.发热；洋溢；绚丽夺目glutamate [ˈɡluːtəmeɪt] n.谷氨酸盐heal [hiːl] v.治愈，康复；调停healing [ˈhiːlɪŋ] n.康复，复原a.有疗效的hypnotic [hɪpˈnɒtɪk] a.催眠的n.安眠药inflammable [ɪnˈflæməbl] a.易燃的；易怒的influenza [ˌɪnfluˈenzə] n.流行性感冒instinct [ˈɪnstɪŋkt] n.本能，直觉；天性intensity [ɪnˈtensəti] n.强烈，剧烈；强度intestine [ɪnˈtestɪn] n.[pl.]肠a.内部的iris [ˈaɪrɪs] n.[pl.irises，irides]虹；（眼球的）虹膜jaw [dʒɔː] n.颌；颚liver [ˈlɪvə（r）] n.肝脏；居住者meagre [ˈmiːɡə（r）] a.痩的；（尤指食物）粗劣的meditation [ˌmedɪˈteɪʃn] n.冥想；沉思，深思melatonin [ˌmeləˈtəʊnɪn] n.褪黑激素mental [ˈmentl] a.心理的，精神的；智力的modify [ˈmɒdɪfaɪ] v.更改，修改；（语法上）修饰molecule [ˈmɒlɪkjuːl] n.分子mood [muːd] n.心情，情绪musculo-skeletal [ˈmʌskjʊləʊˈskelətl] a.肌与骨骼的neural [ˈnjʊərəl] a.神经的；神经系统的；神经中枢的neurotrophic [ˌnjʊərəˈtrɒfɪk] a.神经营养的；亲神经的；向神经的obesity [əʊˈbiːsəti] n.肥大，肥胖odour [ˈəʊdə（r）] n.气味organ [ˈɔːɡən] n.器官；机构organism [ˈɔːɡənɪzəm] n.生物，有机体paralysis [pəˈræləsɪs] n.瘫痪，麻痹parasite [ˈpærəsaɪt] n.寄生虫pathology [pəˈθɒlədʒi] n.病理学；病变preserve [prɪˈzɜːv] v.保护，维护；保存，保养；保鲜，贮存pharmaceutical [ˌfɑːməˈsuːtɪkl] a.制药的n.药物physician [fɪˈzɪʃn] n.内科医生，医师poisonous [ˈpɔɪzənəs] a.有毒的；恶毒的predatory [ˈpredətri] a.掠夺的，掠夺成性的；食肉的；捕食生物的pregnancy [ˈpreɡnənsi] n.怀孕，怀孕期prevention [prɪˈvenʃn] n.预防；防止；防范preventive [prɪˈventɪv] a.预防性的n.预防法psyche [ˈsaɪki] n.灵魂；心灵psychiatrist [saɪˈkaɪətrɪst] n.精神病学家；精神病医生psychology [saɪˈkɒlədʒi] n.心理学；心理特征quantitative [ˈkwɒntɪtətɪv] a.定量的；量的，数量的relentless [rɪˈlentləs] a.无情的，残酷的reproduction [ˌriːprəˈdʌkʃn] n.繁殖，生殖；复制；复制品respiratory [rəˈspɪrətri] a.呼吸的robust [rəʊˈbʌst] a.健壮的，强壮的sanitation [ˌsænɪˈteɪʃn] n.公共卫生；卫生设施sinew [ˈsɪnjuː] n.肌腱；[pl.]肌肉slumber [ˈslʌmbə（r）] v./n.睡眠span [spæn] n.跨距；一段时间v.持续；横跨spasmodic [spæzˈmɒdɪk] a.痉挛的；间歇性的specimen [ˈspesɪmən] n.标本speculation [ˌspekjuˈleɪʃn] n.猜测，推测；思索；投机买卖spine [spaɪn] n.脊柱stammer [ˈstæmə（r）] v.口吃n.结巴，口吃steady [ˈstedi] a.稳的；稳定的v.使稳定strain [streɪn] n.拉力；扭伤，拉伤；压力v.拉伤，扭伤；尽力；拉紧stroke [strəʊk] n.中风；用手划水；划桨v.抚摸succumb [səˈkʌm] v.屈服；因……死亡survive [səˈvaɪv] v.活下来；幸免于swap [swɒp] v./n.交换tablet [ˈtæblət] n.药片temper [ˈtempə（r）] n.情绪v.使缓和therapist [ˈθerəpɪst] n.（某种疗法的）治疗专家thigh [θaɪ] n.大腿toxin [ˈtɒksɪn] n.毒素，毒质uneasy [ʌnˈiːzi] a.心神不安的，担心的vary [ˈveəri] v.改变，变化；（使）多样化virus [ˈvaɪrəs] n.病毒waist [weɪst] n.腰，腰部wastage [ˈweɪstɪdʒ] n.消耗量；损耗womb [wuːm] n.子宫；发源地worm [wɜːm] n.蠕虫；[pl.]寄生虫，肠虫。
Clinical Investigatio nsRespiration2012;84:291–298DOI:10.1159/000341969Hydrogen Peroxide in Exhaled Breath Condensate in Asthmatic Children during Acute Exacerbation and after TreatmentC arlo Caffarelli a Elena Calcinai c Laura Rinaldi a Carlotta Povesi Dascola aLuigi Terracciano c Massimo Corradi baU O Clinica Pediatrica, and bS ezione di Medicina del Lavoro, Dipartimento di Medicina Clinica e Sperimentale,Università degli Studi di Parma, P arma , and cU O Pediatria, Ospedale Macedonio Melloni, M ilano , Italyafter pharmacologic treatment (median 0.303 M ; p = 0.001) compared to control values (median 0.045 M ). After treat-ment, exhaled H 2O 2 concentrations remained significantly higher in children with and without auscultatory wheezingthan in controls (p = 0.034 and p ! 0.001, respectively). EBC H 2O 2 levels in asthmatics before treatment did not differfrom those after treatment. No correlation was found be-tween H 2O 2 and forced expiratory volume in 1 s values. All asthmatics but one were atopics. C onclusions: In children with acute asthma exacerbation, exhaled H 2O 2concentra-tions in EBC are significantly elevated. In the short-term fol-low-up, H 2O 2 levels remain at high levels and are not corre-lated with lung function or improvement in symptoms. C opyright © 2012 S. Karger AG, Basel Intro ductio n E xhaled breath condensate (EBC), which is a fluid col-lected by cooling of exhaled air during tidal breathing, is a completely non-invasive method, easy to perform and applicable to children [1] . EBC contains a large number of molecules originating from the airways, which are ex-Key Wo rdsA sthma exacerbation ؒ Biomarkers ؒ Hydrogen peroxide ؒ Children ؒ Inflammation and oxidative stress ؒPaediatric allergyAbstract B ackground: In asthmatics, the concentration of hydrogen peroxide (H 2O 2) in exhaled breath condensate (EBC) has been found to be increased and to be related to airway in-flammation. O bjective: The aim of this study was to deter-mine whether in children with acute exacerbation, exhaled H 2O 2 levels could be influenced by treatment and linked to airway obstruction. M ethods: Twenty-two asthmatic chil-dren (mean age 9.4 years, range 6–14) with asthma exacerba-tion and 12 healthy children (mean age 11.7 years, range 7–15) were enrolled. Concentrations of exhaled H 2O 2before and after standard treatment for asthma attack were com-pared with those of controls and with clinical observation. Asthmatic children and controls underwent spirometry and skin prick tests to common aeroallergens. R esults:Exhaled H 2O 2 concentrations were significantly higher in children with asthma both before (median 0.273 M ; p ! 0.001) and Received: November 25, 2011A ccepted after revision: July 10, 2012Published online: September 27, 2012 Carlo CaffarelliU O Clinica Pediatrica, Dipartimento di Medicina Clinica e SperimentaleU niversità degli Studi di Parma, Via Gramsci 14I T–43100 Parma (Italy)T el. +39 052 170 2207, E-Mail carlo.caffarelli @ unipr.it ©2012 S. Karger AG, Basel 0025–7931/12/0844–0291$38.00/0 Accessible online at:/resCaffarelli/Calcinai/Rinaldi/Povesi Dascola/Terracciano/CorradiRespiration 2012;84:291–298292pired as bioaerosol [2, 3] , whose concentration cannot en-tirely be compared directly to information derived from bronchoalveolar lavage [4] . Despite methodological prob-lems, such as lack of reference values of biomarkers from healthy subjects, full standardization of the procedure or the sensitivity of the available assays [5] , markers in EBC have been proposed as a suitable method for the assess-ment of airway inflammation in asthmatic patients [6–9].Increased oxidative stress, defined as an imbalance be-tween oxidants and antioxidants, is involved in airwayinflammatory diseases including asthma[10].Activated inflammatory cells, especially eosinophils but also mac-rophages and neutrophils, generate several reactive oxy-gen species which consequently increase gene expression of inflammatory mediators, damage epithelial cells and increase bronchial hyperreactivity [11] . Superoxide anion (O 2 –) is rapidly metabolized by superoxide dismutase to form hydrogen peroxide (H 2O 2 ) which in the airways tends to evaporate in the exhaled air, and therefore, H 2O 2 in EBC may be considered a marker of oxidative stress. However, H 2O 2 is generated from a multiplicity of sourc-es including, but not limited to, inflammatory cells and has been associated with different lung diseases [12].Therefore, as a diagnostic means, H 2O 2 may lack specific-ity. Previous studies on exhaled H 2O 2 levels were per-formed mainly in clinically stable asthmatics, and au-thors reported that EBC H 2O 2values were generally high [13–15] and related to the number of eosinophils in spu-tum as well as to airway hyperresponsiveness intensity [16].T he treatment of children with acute asthma is based on asthma severity as assessed by clinical signs and symp-toms, measurement of pulse oximetry, pulmonary func-tion and blood gases[17] . These parameters do not take into consideration the degree of oxidative stress or in-flammation in the airways. In our study, we have investi-gated EBC H 2O 2levels in children with acute asthma ex-acerbation before and after a 7-day treatment. In addi-tion, we determined the relationship between exhaledH 2O 2concentrations and lung function parameters. M etho ds SubjectsW e conducted a study in children aged 6–14 years with physi-cian-diagnosed asthma, whose cases were followed at two hospi-tal-based out-patient asthma clinics. During periodical visits that were scheduled in the morning, children who had an acute epi-sode of asthma were consecutively enrolled in this longitudinal study between February and June 2008. Children admitted to thestudy had a history of physician-diagnosed asthma according tointernational criteria[17] . Briefly, diagnosis of asthma was based on recurrent symptoms such as breathlessness, wheezing, cough and chest tightness and was confirmed through follow-up, ob-serving the response to a bronchodilator and to anti-inflammato-ry treatment [17] . Children were required to have had at least three previous episodes of wheezing treated with inhaled bronchodila-tors. Reversibility of airflow limitation after short-acting  2-ago-nist administration was also measured by spirometry [17].Chil-dren were required to have a history of asthma exacerbations trig-gered by an acute upper respiratory tract infection or allergens. An acute upper respiratory infection was defined by a history of acute onset of rhinitis and/or otitis and/or sore throat with or without fever accompanied by erythema and/or mucosal swelling and/or purulent secretion.C hildren with a history of intermittent or mild-moderate per-sistent asthma were admitted to this study whether they were on a pharmacologic long-term treatment with inhaled steroids, long-acting  2-agonists or anti-leukotrienes or not. W e excluded all subjects who met the following criteria: severe asthma attack requiring hospitalization, bronchial provocation test in the last week, chronic upper respiratory infection, chronic cardiopulmonary disease, concurrent pneumonia, nasal polyps, obesity, gastro-oesophageal reflux and aspirin-induced asthma. Aspirin-induced asthma was excluded by a history of no temporal relationship between aspirin intake and asthma symptoms. Gas-tro-oesophageal reflux was excluded on the basis of clinical his-tory and physical examination[18] .A cute exacerbation was defined by evidence of wheeze, dys-pnoea, tachypnoea and/or use of accessory respiratory muscle, with/without desaturation in a child with a history of asthma, and no clinical evidence of lower respiratory tract infection (fever, fo-cal crepitations, pleuritic pain) [19] . Children who had taken sys-temic steroids in the last 3 weeks were excluded from the study.A group of healthy age-matched children without asthma and atopic diseases was enrolled as control group. Other inclusion cri-teria were no intake of corticosteroids in the last 3 weeks and no respiratory tract infections in the last 4 weeks. Skin prick test (SPT) results to aeroallergens in the control group were negative.Study DesignA t recruitment (visit 1), children underwent physical exami-nation. Oxygen saturation, heart rate and respiratory rate were recorded. D etails of current medication were requested. SPTs were performed. Asthmatic children were treated according to international guidelines [17] after collection of an EBC sample for H 2O 2 detection and lung function measurement. Briefly, 2–4puffs of short-acting  2-agonists were given every 20 min to 4 h in relation to the severity of the symptoms. The 4-hourly admin-istration was continued for 1 week. In case of a poor immediate response or a moderate-severe exacerbation [17] , inhaled ipratro-pium bromide and oral corticosteroids (prednisolone 1 mg/kg/day) were given for 7 days. Oxygen was administered if oxygen saturation was ! 95%. During the treatment period, the parents filled in a clinical diary of coughing and wheezing (score: 0 = none, 1 = mild, 2 = severe), as well as of drug administration. Par-ents were instructed to mark wheezing when the child had diffi-cult breathing and/or musical noise in the chest like a whistle. One point was assigned to each type of drug administered per day. Af-ter 1 week of treatment, children underwent a second visit andH ydrogen Peroxide in Acute Asthmatic Exacerbation Respiration 2012;84:291–298293performed collection of EBC and pulmonary function. The treat-ment was considered effective if a child had no symptom or sign of asthma and oxygen saturation was 195%.A control group of healthy children underwent EBC collec-tion, SPT and measurement of lung function. All the study pro-cedures were conducted in the morning. Each visit was performed independently by two physicians. In the case of disagreement, a third physician was consulted. The University Ethical Committee of Parma approved the protocol and all parents gave their in-formed consent.M ethodsE BC was collected and processed according to the American Thoracic Society/European Respiratory Society recommenda-tions [2], using commercial condensers. Ecoscreen (Jaeger, Hoch-berg, Germany) with a single-exit valve, in order to separate the expiratory flow from the inspiratory flow, was available for chil-dren recruited in Milan. Turbo-D eccs (Medivac, Parma, Italy) with a one-way valve and a reliable saliva trap, connected to a col-lecting vial (50 ml) by means of a tube [20, 21], was available for children enrolled in Parma. Each subject used the same type of condenser for both visits. The collecting temperature in Turbo-Deccs was –5 ° C, and in Ecoscreen, it is reported to be from –10 to –20 ° C. To each patient a nose clip was applied to exclude pos-sible contamination of nasal origin. The children breathed tidally through the mouth for 15 min or for a volume equal to 2 ml, while sitting comfortably. They kept their mouth dry during EBC col-lection by periodically swallowing excess saliva. The collection was stopped in case of cough or excessive saliva and was restarted when the episode has resolved. Each collection was performed 10 min after the last forced expiratory manoeuvre. For each patient,approximately 2 ml of EBC was collected in cooling vials. The col-lected EBC samples were stored at –80 ° C in polypropylene tubes until analysed. Samples were analysed no later than 1 month after the collection. Hydrogen peroxide was measured as previously described [22, 23],spectrofluorometrically using commercial kit Amplex Red Hydrogen Peroxide (Molecular Probes, Eugene, Oreg., USA). Salivary contamination was measured by means of the colorimetric detection of ␣-amylase (Infinity Amylase Re-agent, Sigma, Milan, Italy).L ung function measurement was performed according to the European Respiratory Society/American Thoracic Society guide-lines [24]using an electronic spirometer (Masterscope; Jaeger, Wuerzburg, Germany). Forced expiratory volume in 1 s (FEV 1), forced vital capacity (FVC), the FEV 1/FVC ratio, and forced expira-tory flow 25–75% (FEF 25–75) were expressed as percentage of predicted reference values. Patients did not receive inhaled bron-chodilators until at least 4 h before EBC collection and spirometry.S kin prick testing was performed with a panel of standardized common allergen extracts: birch, hazel, grasses, mugwort, alter-naria, cat epithelium, dog epithelium, pellitory and house dust mite. A positive SPT was defined as a wheal with a mean diameter of at least 3 mm greater than the saline control after 15 min [25].S tatisticsT he distribution of the variables was assessed by the Kolmogo-rov-Smirnov test; normally distributed variables are presented as the mean 8SD, and non-normally distributed variables as the median and interquartile range (IQR). Differences between con-tinuous variables were calculated by the Mann-Whitney test, the Wilcoxon signed rank test, the two-tailed Student t test or ANOVA when appropriate. The 2test or Fischer’s exact test were used to compare ordinary variables. Correlations were expressed as Spear-man’s correlation coefficient. A p value !0.05 was considered sta-tistically significant. A study group of at least 20 subjects and a control group of at least 10 subjects were determined to detect 1.25 SD difference at the 5% significance level with power 90%.R esultsT wenty-two asthmatic children with acute asthma ex-acerbation were consecutively enrolled. D emographic and clinical characteristics are shown in t able 1 . On the basis of medical history, physical examination and con-cordant SPT results, exacerbation was presumed to be due to seasonal allergen exposure in 16 cases and to upper respiratory tract infection in 6 cases. At visit 1, all chil-dren had wheezing documented by auscultatory wheeze, cough, shortness of breath and/or chest tightness and/or use of accessory respiratory muscle. At the second visit, 13 (61%) of the 22 patients were asymptomatic with a nor-mal chest auscultation. In the remaining 9 children, aus-cultatory wheeze was still present, without using acces-sory breathing muscles or dyspnoea. D uring the 7-day Table 1.Characteristics of the 22 asthmatic childrenMean age 8 SD, yearsMales/females9.482.7015/7Positive SPTGrassesHouse dust mitesAlternaria alternataDog epitheliumCat epitheliumAmbrosiaHazelBirchAspergillus fumigatusPellitoryPlantago lanceolata16 (72)12 (54)8 (36)8 (36)8 (36)5 (22)3 (1.3)3 (1.3)3 (1.3)2 (0.9)2 (0.9)At least one positive SPT21 (95) Monosensitized patients9 (41) Polysensitized patients13 (59)Long-term medicationsSalmeterol+fluticasone dipropionate7Fluticasone dipropionate2Montelukast1Figures in parentheses are percentages.Caffarelli/Calcinai/Rinaldi/Povesi Dascola/Terracciano/CorradiRespiration 2012;84:291–298294treatment, all patients received salbutamol, 12 ipratropi-um bromide and 5 oral steroids. In asthmatics, the mean symptom-drug score at day 1 was higher than that at day 7 (3.59 8 1.3 vs. 2.59 8 1.18; p = 0.005); this significant difference was also observed for symptoms alone (1.82 8 1.01 vs. 1.05 8 0.95; p = 0.006). At visit 2, the symptom-drug score was higher in children with wheezing than in those free of symptoms (p = 0.032). The maximum symp-tom score was 4 and the maximum symptom-drug scorewas 7. At the first visit, oxygen saturation was 96.9 80.014% (range 94–98) and at the second visit 97.6 80.007% (range 96–99; p = 0.726). The control group con-sisted of 12 healthy children (7 males, 5 females, with a mean age of 11.7 8 2.75 years, range 7–15). H 2O 2Concentrations A ll patients and controls performed a correct manoeu-vre for the collection of EBC, producing a sufficient quan-tity for the analysis of H 2O 2 . Salivary contamination was not detected in the EBC samples. At baseline and at visit 2, in children with asthma EBC, H 2O 2values were sig-nificantly higher than those detected in healthy control children ( t able 2). In asthmatics, there was no significant difference in EBC H 2O 2concentrations between visit 1 and visit 2 (p = 0.682). There was no statistically signifi-cant difference in EBC H 2O 2 values between the two con-densers used. At baseline, values of EBC H 2O 2obtainedwith Turbo-Deccs (n = 12, 0.195 M , IQR 0.144–0.379)were similar to those with Ecoscreen (n = 10, 0.625 M ,IQR 0.158–0.912; p = 0.15) and higher than those of con-trols (p = 0.007 and 0.001, respectively). At visit 2, H 2O 2 concentrations were 0.580 M (IQR 0.244–1.722) in chil-dren who used Ecoscreen and 0.180 M (IQR 0.117–0.412) in the 12 children who used Turbo-Deccs (p = 0.212). Atvisit 2, EBC H 2O 2concentrations in asthmatics obtained with Turbo-Deccs or Ecoscreen were significantly higher than in healthy control children (p = 0.006 and 0.01, re-spectively). T able 3 shows the comparison of exhaled H 2O 2con-centrations between children receiving inhaled cortico-steroids as long-term treatment and those who did not.At visit 2, exhaled H 2O 2concentrations were significant-ly higher in children with auscultatory wheezing (0.18 M, IQR 0.11–0.31) and in those free of auscultatory wheezing (0.71 M , IQR 0.13–0.88) compared with con-trols (p = 0.034 and p ! 0.001, respectively). However, there was no difference in H 2O 2 levels between asthmat-ics with auscultatory wheezing and those without (p = 0.061). Furthermore, in asthmatics with or without aus-cultatory wheezing, H 2O 2levels were not statistically dif-ferent from those detected at the first visit. At the secondvisit, there was no significant difference in H 2O 2concen-trations between asthmatics who received systemic ste-roids for exacerbation and those who did not (p = 0.224). There was no significant correlation between EBC H 2O 2concentrations and O 2 saturation (at baseline, r = 0.344, p = 0.117; at visit 2, r = –0.96, p = 0.671) or symptom-drug score (at visit 2, r = –0.126, p = 0.577).P ulmonary Function A t visit 1, in asthmatic children, pulmonary function values were significantly lower than those of healthy con-trol children (t able 4 ). At visit 2, asthmatic children had FEV 1 % predicted values similar to those of controls ( t a-ble 4 ). No significant differences were found in lung func-tion values between baseline and visit 2 ( t able 4 ). Both at visit 1 and visit 2, there was no correlation between FEV 1 % predicted values, FEF 25–75 % predicted values, FVC %predicted values and H 2O 2 levels, O 2 saturation or symp-tom-drug score. At the second visit, both in children withauscultatory wheezing and in those free of symptoms, no correlation was found between H 2O 2 levels and FEV 1%predicted values, FVC % predicted values, FEF 25–75%predicted values.Table 2. E xhaled H 2O 2 concentrations (M ) in controls and asth-matic childrenBefore treatmentAfter treatment 0.273, 0.142–0.6690.303, 0.122–0.7230.045, 0.017–0.0820.0010.001D a ta are presented as medians and IQRs.Table 3. H 2O 2 values (M ) in children who were on long-termtreatment with inhaled glucocorticosteroids and in controlsControl subjects (n = 12)0.045, 0.017–0.082a, b, c, f Inhaled glucocorticosteroidsYes (n = 9)No (n = 13)0.25, 0.16–0.49a, d 0.3, 0.14–0.81b, d0.24, 0.14–0.56e, f 0.38, 0.12–0.72e, cD a ta are presented as medians and IQRs.d, e p > 0.05; a, f p = 0.002; b p = 0.009; c p = 0.001.Hydrogen Peroxide in Acute Asthmatic ExacerbationRespiration 2012;84:291–298295Discussio nT he results of the present study show that mean levels of H 2O 2in EBC are significantly higher in children with asthma exacerbation than in normal control subjects andremained elevated after a 7-day treatment[17].I n agreement with our results, D ohlman et al. [15] found that 3 out of 4 children with acute exacerbation had higher EBC H 2O 2 concentrations than controls. Our re-sults extend previous findings by examining a greater number of patients. Furthermore, to our knowledge, this is the first report providing data on exhaled H 2O 2con-centration in the short-term follow-up of exacerbation.Dohlman et al.[15] reported no differences in exhaled H 2O 2 levels between asthmatic children with acute asth-ma and those with upper respiratory infections, not ac-companied by asthmatic symptoms. Our study design does not permit to exclude that a coexistent upper respi-ratory infection may have enhanced H 2O 2levels. Future research may clarify this issue. Our findings cannot be directly compared with earlier investigations of EBC H 2O 2 concentrations focused on asthmatics who were free of asthmatic symptoms. Consistent with previous observations, data showed significantly increased ex-haled H 2O 2levels in asthmatic children with [15]and without upper respiratory tract infections[14] as well as in adults[10, 16, 17] with asthma, even if there was an overlapping with the levels of controls[10, 14–16, 26].At variance, Robroeks et al. [27] found no difference in EBC H 2O 2 levels between childhood asthmatics and controls. Different methods used to detect EBC H 2O 2concentra-tions may explain these different findings.E BC collection is not yet fully standardized and sev-eral issues need to be considered in interpreting concen-trations of EBC constituents[2, 28] . For example, we fol-lowed the suggestion of collecting EBC 10 min or more after forced expiratory manoeuvers. However, there is no consensus in this recommendation [2] . At present, there is no evidence showing that changes in airway caliber cause any difference in mediator release or dilution ofEBC[29, 30] , but this question has not been studied sys-tematically. Another issue is the flow dependence of ex-haled H 2O 2levels. We are aware that, in one study only, exhalation flow influences the level of exhaled H 2O 2;at higher flows, exhaled H 2O 2concentration is lower, but with the low flows during tidal breathing, the effect isminor[31] . However, symptomatic children have higher breathing rates and may have higher minute ventilation,which could theoretically influence the results. We did not take into consideration the control of minute ventila-tion as it is not requested by the recommendation [2].We believe that if a bias could have been present because of that, it could probably have randomly affected the sam-ple. We think that this factor deserves attention, and therefore, we would like to standardize exhalation flow ventilation in the next studies, as shown by Franklin et al.[32] .A nother concern is the method employed to measure EBC H 2O 2. We used the fluorometric method [33, 34],even if the lack of established reference values has not permitted to ascertain sensitivity and specificity and hashampered the validation of measurements[35].However,data reproducibility has been shown in a previous studyby Goldoni et al.[20]. O nly speculative hypothesis may be offered to explain the reason for which treatment of asthma exacerbationdoes not affect exhaled H 2O 2levels. In asthmatic adults, EBC H 2O 2 is related to inflammatory cells, especially thenumber of eosinophils in the sputum[16].Furthermore, it is associated with neutrophils in mild but not in mod-erate asthma [10] . A meta-analysis of EBC H 2O 2 levels instable asthmatic patients[13] free of symptoms included 8 heterogeneous cross-sectional trials. It provided indica-tive evidence that patients treated with inhaled cortico-steroids had exhaled H 2O 2 concentrations which were significantly lower than those in steroid-untreated pa-tients. Furthermore, both steroid-treated and -untreatedasthmatics had higher levels of EBC H 2O 2than healthy subjects[13] . Along this line, Antczak et al. [36]showed that in asthmatic children, inhaled beclomethasone sig-nificantly reduced expired H 2O 2levels in comparison with placebo. These findings may be explained by the an-Table 4. L ung function in controls and asthmatic childrenFEV 1, % predicted Before treatment After treatment 112.5815.7594.9811.94a 101.4813.92a0.0040.135FEF 25–75, % predicted Before treatment After treatment 106.17819.7576.5818.25b 81.91819.33b<0.0010.001FVC, % predicted Before treatment After treatment104.66814.3384.36814.42c89.62815.77c0.0010.017D a ta are presented as the mean 8 SD.ap = 0.105; b p = 0.481; c p = 0.33.Caffarelli/Calcinai/Rinaldi/Povesi Dascola/Terracciano/CorradiRespiration 2012;84:291–298296ti-inflammatory properties of corticosteroids which in-hibit an oxidative burst of leucocytes and eosinophil re-cruitment to the airways. However, Horvath et al.[16] showed that asthmatic adults whose symptoms were not controlled by inhaled steroids had increased levels of EBC H 2O 2 that were not significantly different from those in stable steroid-naive asthmatics. Accordingly, we found that there was no relationship between systemic cortico-steroid administration and EBC H 2O 2levels during acute asthma exacerbations. These findings support the sug-gestion that corticosteroid succeeds in suppressing only a part of the airway inflammation [37] . Therefore, we may hypothesize that in acute exacerbation oxidative stress may continue after health restoration possibly because of persistent inflammation in the airways despite steroid treatment. However, the small number of children treat-ed with systemic corticosteroids and the design of the study do not consent to reach firm conclusions. On the other hand, it is possible that lack of variation in EBC H 2O 2 levels may depend on the short time between EBC collections.T he issue arises whether there is a correlation between FEV 1 values and exhaled H 2O 2 levels in asthmatic chil-dren. We have found that bronchodilator treatment was effective in producing relief of airway obstruction but notin changing exhaled H 2O 2levels. Therefore, we believe that H 2O 2levels do not reflect changes in airway caliber despite the fact that H 2O 2induces contraction of respira-tory smooth muscles[38] . Our findings are in agreement with prior reports showing no correlation between FEV 1and H 2O 2 both in healthy[39] and asthmatic children[15] as well as in adults [16] . On the contrary, Loukides et al.[10] found a significant inverse correlation between FEV 1 values and H 2O 2levels in steroid-naive adults with moderate asthma but not in those treated with inhaledsteroids. On the other hand, Antczak et al.[36] found an inverse correlation between FEV 1 and H 2O 2 in children treated with inhaled beclomethasone. Variations in study design may explain our different findings. Also, the se-verity of asthma may play a role. In our study, we includ-ed children with acute exacerbation who did not require admission. In these children, FEV 1 values are poorly cor-related with the degree of wheezing, clinical score andoxygen saturation[40] . Our findings of quite high lung function values may be explained by the fact that patients were probably visited at the onset of exacerbation and symptoms usually precede the lung function decline [41].A possible limitation of this study was that EBC was collected with two different devices. Two different con-densers were available: Turbodeccs and Ecoscreen wereused in children enrolled in Parma and in Milan, respec-tively. Previous studies have shown that data of Ecoscreen [42] and Turbo-Deccs[20] are both reproducible, but di-rect comparison between the two condensers by measur-ing H 2O 2 in EBC collected by the two systems in the same subject has not been done in the present study. However, the risk of bias was considered acceptable for many rea-sons. First, there is no clear evidence that H 2O 2levels may be influenced by condensing devices, probably due to its partial volatility. In fact, in a previous study, Rosias et al. [42] have found that median H 2O 2concentrations and reproducibility did not significantly differ between four different condensers. Regarding other substances, com-parison of pH values of fluid collected from two devices (Ecoscreen and RTube) has yielded conflicting results, and therefore, neither device is preferred over the other [43] . Second, it has been shown that the cooling tempera-ture influences levels of EBC constituents. It has been found that there was a statistically significant differencein H 2O 2 levels comparing the cooling temperature +5 and–5 °C but not comparing –5 and –10 °C.[20] . In the Tur-bo-Deccs, the cooling temperature is dysplayed and it wasset at –5 °C . The cooling temperature of Ecoscreen is not dysplayed, but it has been reported to be from –10 to–20°C . Therefore, we believe that a bias was not intro-duced by cooling temperature. Along this line, in our study, no statistically significant difference was observedcomparing exhaled H 2O 2levels from the two condensers used. However, we cannot exclude that a significant dif-ference may be reached with a larger group of patients. Third, in consideration of the lack of recommendations on the use of different condensers, we think that real-life situations are necessary to confirm or dismiss these un-solved points. Finally, the behavior of H 2O 2 in EBC can-not be explained on the basis of its chemical and physical properties, and the most probable explanation may be that some was produced by a radical reaction in the gas phase or during the condensation process in water, irre-spectively of the devices used[44] . A nother limitation of our study is the lack of random-ization and of a placebo group. However, it was neither ethical nor feasible to have a placebo group in this study. This weakness is partly balanced by the fact that physi-cians who visited children or performed spirometry wereunaware of H 2O 2results. An additional limitation is the heterogeneity of our population, especially with regard to the fact that both children who received inhalant steroid as maintenance treatment and steroid-naive patients were included in the study. Nonetheless, our data showed that H 2O 2 concentrations in EBC were not influenced by。
