DRUG THERAPY OF UPPER RESPIRATORY TRACT INFECTIONS EASINESS IN DOWNS: A SURVEY ON 328 PERSONS

Renato COCCHI MD, neurologist and medical psychologist

(Italian translation)

Abstract

This is a retrospective study of a consecutive series of 328 home reared Down Ss treated by drug therapy. Sample data: 188 M and 140 F; M/F ratio = 134.29; chromosomal diagnosis: standard trisomy 21 = 90.85%; mosaicisms = 3.66%; translocations = 3.66%; only clinical diagnosis: 1.83%; Average age at first consultation; 77.70 +/- 61.64 months; average age at last checkups; 116.60 +/-67.86 months; average therapy length: 48.04 +/- 43.58 months.

The reduction of upper respiratory tract infections (URTI) easiness after at least 1 year drug therapy had its score by the same 0-4 points scale scored during the first consultation.

The sample, as representative of the Italian population of Down Ss, had two age stratifications by two-years subsamples till 16 years inclusive, and one subsample for the age 16;1 and more years. The first stratification is for scores at first consultation, and the second one for scoring at last checkups.

This URTI easiness decreases up to 71.88% disappearance in the 4 subsamples from 2;1 to 10 years of age (.02 - .0009) till 16 years inclusive (80.77% disappearance), but it does not reach any significant level due to the superimposed age reduction effect (see: Cocchi, It. J. Intellect. Impair. 1997: 10: 143-149). More severe URTI forms, which in non-treated Downs Ss disappeared since 14;1-16 years, had a null rate since 8;1-10 years. Also the subsample of infants up to 2 years inclusive had a significant reduction of that easiness (.047), but scoring was made after average six-months therapy. A list of drugs in use at last checkups was provided with their daily doses.

Key words: Down's syndrome; Upper Respiratory Tract Infections; Easiness; Drug therapy.

Down's syndrome

Mental retardation

Immunity

Drug modulation of stress reactions

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In my previous research (Cocchi, 1997) I investigated the time-course of easiness to Upper Respiratory Tract Infections (URTI) in 510 non drug treated Downs, as reported at first consultation. Part of them followed drug therapies for different time length, so I can evaluate global therapy results on URTI easiness. The time-course of that easiness will have the comparison with non treated subjects.

Materials and methods

This second survey deals with the clinical records related to all subjects who took the prescribed drug therapy and had at least one checkup after the first visit. This makes a casual consecutive series of Downs that has its selection criterion on the fact that those Downs came back for checkups. As home reared and home living Downs they came from all parts of Italy to outpatients' consultations, between January 1979 and April 1997.

During their 1st consultation all these Ss had their easiness to URTI evaluated and recorded by severity, along with other signs and symptoms. This easiness was appraised with reference to the past 12 months (or, in children aged less than one year, with reference to past months) by recording according to a severity scale as follows:

(0) = as in a healthy child;

(1) = nasal catarrh usually present;

(2) = 1 + susceptibility to cough and cold with few feverish episodes;

(3) = 1 + 2 + easiness to tonsillitis, pharyngitis, bronchitis with moderate fever and limited need of antibiotics (up to four regimens per year);

(4) = 1 + 2 + 3 + high temperatures, occasional otitis and bronchial pneumonia, and frequent use of antibiotics (more than four regimens per year).

I used the same scoring's way during the first checkup or following checkups. From these checkups I collected the scores recorded during the last ones, but some cases came back only once for checkup.

The records about autistic or PDD DS Ss were discarded because we saw that this second heavier pathology can modify the URTI easiness (Cocchi and Bonaduce, 1988).

From the remaining records I collected: sex; chromosomal diagnosis; age at 1st consultation; age at last consultation; length of the drug therapy; scoring of URTI easiness at 1st consultation; the same at last checkup; drugs in use at the last checkup and their daily doses. I processed data by age intervals' statistics and I applied Chi Square Test, when suitable.

Results

Only 328 cards out of 510 fitted the criteria of this survey. They refer to home reared Downs coming from all Italy. Table 1 summarizes epidemiological data of these subjects, table 2 shows drugs in use at last checkups, and tables 3-11 present the URTI easiness scoring according to age intervals.

In graphics 1-5 I showed the time-course of URTI easiness and of each grade of severity, as recorded during the 1st consultation and the last checkup.

Table 1: Epidemiological and clinical data of the sample

 

No. of Ss

328

100.00%

M

188

57.31%

F

140

42.31%

M/F ratio

134.29

 

 

 

 

Chromosomal diagnosis

 

 

Standard trisomy 21

298

90.85%

Mosaicisms

12

3.66%

Translocations

12

3.66%

Unknown, only clinical diag.

6

1.83%

 

 

 

Age at 1st consult.: range (months)

4-410

 

Average +/- SD

67.70 +/-61.64

 

Age at last checkup: range

7-417

 

Average +/- SD

116.60 +/-67.88

 

 

 

 

Length of drug therapy: range

2-169

 

Average +/- SD

48.04 +/-43.58

 

As we can see in Table 1 the M/F ratio closely overlaps what we know for live born Italian infants. The distribution of the chromosomal diagnoses stays within the variance limits for Italian and International samples. For that we can maintain the sample here surveyed as a representative sample at least of the Italian population of Downs.


Table 2: Drugs in use at the last checkup

 

Drug in use

mg/die (*)

no. of Ss

%

Pyridoxine

75-150

267

81.40

Diazepam

1-2.5

237

72.26

S-adenosil-l-methionine

100

190

72.26

A polyvitaminc compound (BEROCCA)TM

1 cp x sett

189

57.93

L-glutamine

125-250

187

45.12

Folates

7.5

143

43.60

Pyritinol

50-100

139

42.38

Alpha-tocopherole

50

74

22.56

Vit. B1+B6+B12

125+125+500mcg

63

19.21

Bromazepam

0.5-1.5

59

17.99

Biotin

2.5-5

59

17.99

5-hydroxytriptofan

25-50

43

13.11

Arginine pidolas

250

42

12.80

L-glutamine + pemoline

45+5 - 90+10

41

12.50

Glycine(in BIOTASSINA)TM

200

34

10.37

Carnitine

500

34

10.37

Viloxazine

50-100

22

6.71

Delorazepam

0.5

18

5.59

Alpha-ketoglutarato of pyridoxine

300

18

4.00

Deanol

320

10

3.05

Oxazepam

7.5-15

9

2.74

Piracetam

800

7

2.13

Pantotenate

150

7

2.13

Amitriptyline+ perphenazine

10 + 2

6

1.83

Acetyl-carnitine

250

5

1.52

Clobazam

10

5

1.52

Taurine

500

3

0.91

Total

 

1802

 

(*) In many cases the drug was prescribed every second day, so the daily dose reports it as it was prescribed every day.

The average prescription summed up 5.49 drugs per person. Pyridoxine, alone or in combination with thiamine and cyanocobalamine, and a low dose benzodiazepine were always in it.

Tab. 3: Global comparison between initial and final scores

 

URTI easiness graduation

initial scores

final scores

 

No.of Ss

%

No. of Ss

%

Not present (0)

99

30.19

221

67.37

Present, mild (1)

37

11.28

35

10.67

moderatea (2)

49

14.94

30

9.15

severe (3)

97

29.57

32

9.76

profound (4)

46

14.02

10

3.05

Totals

328

100.00

328

100.00

Chi Square = 107.032 with 4 df and p < .0009

As a global survey, 69% of the sample presented URTI easiness at 1st consultation, with increased severity (grades 3-4) in 40% of them. At final scoring only about 33% of the same sample went along to present URTI easiness, but increased severity went down to less than 13% of them.

Tab. 4: Comparison between initial and final scores of age interval

up to 24 months (Average length of therapy: 5.94 months.)

 

URTI easiness graduation

initial scores

final scores

 

No. of Ss

%

No. of Ss

%

 

 

 

 

 

Not present (0)

24

24.49

10

58.83

Present, mild (1)

14

14.28

2

11.76

moderate (2)

17

17.35

1

5.88

severe (3)

26

26.53

1

5.88

profound (4)

17

17.35

3

17.65

 

 

 

 

 

Totals

98

100.00

17

100.00

Chi Square = 9.690 with 4 df and p < .047

The results on infants up to 24 months with average 6-month therapy, although significant, need caution. Nearly all of them went back to checkups nearly before one-year of therapy.

Tab. 5: Comparison between initial and final scores of age interval

from 25 to 48 months (Average length of therapy: 16.70 months.)

 

URTI easiness graduation

initial scores

final scores

 

No.of Ss

%

No.of Ss

%

 

 

 

 

 

Not present (0)

9

14.75

18

40.92

Present, mild (1)

5

8.20

6

13.63

moderate (2)

8

13.11

5

11.36

severe(3)

24

39.35

12

27.27

profound (4)

15

24.59

3

6.82

 

 

 

 

 

Totals

61

100.00

44

100.00

Chi Square = 13.302 with 4 df and p < .011

In this age interval no URTI easiness turned out from 15% to nearly 41% and increased severity went down from about 64% to a while more than 34%.

Tab. 6: Comparison between initial and final scores of age interval

from 49 to 72 months (Average length of therapy: 28.86 months.)

 

URTI easiness graduation

initial scores

final scores

 

No. of Ss

%

No.of Ss

%

 

 

 

 

 

Not present (0)

8

16.33

18

48.65

Present, mild (1)

7

14.28

4

10.81

moderate (2)

4

8.16

9

24.32

severe (3)

21

42.86

9

24.32

profound (4)

9

18.37

3

6.11

 

 

 

 

 

Totals

49

100.00

37

100.00

Chi Square = 21.838 with 4 df and p < .0009

In this age interval no URTI easiness turned out from about 16% to nearly 49%, while increased severity went down from about 61% to about 14%.

Tab. 7: Comparison between initial and final scores of age interval

from 73 to 96 months (Average length of therapy: 35.90 months.)

 

URTI esasiness graduation

initial scores

final scores

 

No. of Ss

%

No. of Ss

%

 

 

 

 

 

Not present (0)

10

38.45

30

71.43

Present, mild (1)

4

15.38

7

16.67

moderate (2)

3

11.54

3

7.14

severe (3)

8

30.76

1

2.38

profound (4)

1

3.85

1

2.38

 

 

 

 

 

Totals

26

100.00

42

100.00

Chi Square = 13.230 with 4 df and p < .011

In these children no URTI easiness turned out from about 38% to more than 71%, while more severe forms decreased from nearly 35% to less than 5%.

Tab. 8: Comparison between initial and final scores of age interval

from 97 to 120 months (Average length of therapy: 47.69 months.)

 

URTI easiness graduation

initial scores

final scores

 

No. of Ss

%

No. of Ss

%

 

 

 

 

 

Not present (0)

16

43.25

28

71.80

Present, mild (1)

1

2.70

4

10.25

moderate (2)

8

21.62

4

10.25

severe (3)

9

24.32

3

7.70

profound (4)

2

5.41

0

0.00

 

 

 

 

 

Totals

26

100.00

42

100.00

Chi Square = 11.304 with 4 df and p < .024

No URTI easiness got up from 43% to nearly 72%. More severe forms went down from 30% to less than 8%.

Tab. 9: Comparison between initial and final scores of age interval

from 121 to 144 months (Average length of therapy: 58.6 months.)

 

URTI easiness graduation

initial scores

final scores

 

No. of Ss

%

No.of Ss

%

 

 

 

 

 

Not present (0)

16

55.18

29

72.50

Present, mild (1)

3

10.34

6

15.00

moderate (2)

6

20.69

2

5.00

severe (3)

3

10.34

3

7.50

profound (4)

1

3.45

0

0.00

 

 

 

 

 

Totals

29

100.00

40

100.00

Chi Square = 6.158 with 4 ds and p < .189 NS

No URTI easiness increases from about 55% to 72.5%, while its grades 3-4 decrease from 14% to 7.5%. The variable of age starts having its weight so Chi Square does not reach the minimal significant level.

Tab. 10: Comparison between initial and final scores of age interval

from 145 to 168 months (Average length of therapy: 76.55 months.)

 

URTI easiness graduation

initial scores

final scores

 

No.of Ss

%

No.of Ss

%

 

 

 

 

 

Not present (0)

4

57.16

35

79.55

Present, mild (1)

1

14.28

3

6.82

moderate (2)

1

14.28

1

2.27

severe (3)

0

0.00

5

11.36

profound (4)

1

14.28

0

0.00

 

 

 

 

 

Totals

7

100.00

44

100.00

Chi Square = 10.129 with 4 df and p < .039

No URTI easiness goes from about 57% to nearly 80%, while its grades 3-4 go down from about 14% to 11.36%

Tab. 11: Comparison between initial and final scores of age interval

from 169 to 192 months (Average length of therapy: 79.81 months.)

 

URTI easiness graduation

initial scores

final scores

 

No.of Ss

%

No.of Ss

%

 

 

 

 

 

Not present (0)

6

54.55

21

80.77

Present, mild (1)

1

9.09

2

7.69

moderate (2)

1

9.09

1

3.85

severe (3)

3

27.27

2

7.69

profound (4)

0

0.00

0

0.00

 

 

 

 

 

Totals

11

100.00

26

100.00

Chi Square = 3.333 with 3 df and p < .465 NS

No URTI easiness goes from more than 54% to about 81%, while its severe grades go down from 27% to less than 8%.

 

Tab. 12: Comparison between initial and final scores of age interval

from 193 and more months (Average length of therapy: 69.15 months.)

 

URTI easines graduation

initial scores

final scores

 

No.of Ss

%

No.of Ss

%

 

 

 

 

 

Not present (0)

6

60.00

32

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