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Bronchial

astiima

is

one

disorders

of childhoodi}.

known

but

its

clinical mani

(1985ei)

e

'

T}IE

CHILDREN'S

ASTHMA

A

SURVEY

OF

ITS

EFFECTS

Shimpachiro

Ogi'wara,

RPT,

SRP,

ONC,

MCPA,

BPrl'*

Sandra

M.

Ogiwara,

CSP,

SRP,

Hrl-,

CPA,

BSc

(PT)*"

'

Michio

Hiratani,

MD#**

Kazuhiko

Mutoh,

MD**pt"

Jun-ichi

Ohtomo,

BA*****

ABS

[-RACT

The

children's asthma class

has

bccn

in

existence since

l9S2.

It

is

held

every spTing and

autumn at

Ioh

National

Infirmary

in

Kanazawa,

_Japan,

with

the co･opeTation

of

_{paediatricians,}

nurscs,

_{physiotherapists,}

and a

_physical

education

teacher.

In

order

to

investigate

the

eMcacy of

the

class a surv･ey was carried out,

It

was

found,

according _{to the respondents' replies,}

that

the

frequency

of asthmatic attacks

decreased

in

the

rnajoTity ofi

the

children,

and

_{participation}

in

sports or

_physical

activities-especially

the

_physical

eclucation class at

school

and

swimming-became regular,

In

addition,

tlie

children

became

more confident and outgoing, and

the

_parencs'

knowledge

and eficiency

in

managing

their

children

during

asthmatic attaclcs

improved,

The

expertise of

the

_{physiotherapists}

in

instructing

breathing

conLrol,

_positions

for

relaxation,

blowing

the

nose, and

_postural

drainage

formed

an

intc.crral

_part

of

the

class,

It

should,

howevcr,

be

considered that

the

subjective

improvement

of

the

bronchial

asthma must

be

the result of the

ifiteTaction

of modalities

offeTed

bv

each

'

d{scipline.

It

is

recommended

that

_{physiotherapists}

should

_get

inyolved

in

the

managemcnt of

bron-chial asthma as educators as svell as

therapists

with

the

establishment of an exercise

tolerance

training

_programme

in

a

_{physiotherapy}

clepartment.

Thus,

thosc

children with

bronchial

asthma

whese

_physical

fitness

is

lew

would Teadily

be

referrecl

to

it

by

thc

_physicians,

'

Key

words:

bronchial

asthma,

_{physiotherapy}

oE

the

most

common

Its

cause

is

still

un-festation

is

the

'

Ass6ciatc

Professor

of

Physical

Therapy,

Scheol

of

Health

Sciences,

University

of

Kanazawa,

Former

Physietherapist-in-charge

o £

the

ICti,

Edmonton

General

IIospital,

Canada.

Lectm/e,

Department

of

Paediatrics,

Faculty

of

Medicine,

University

of

Kanazawa,

Consultant

Pacdiatrician,

Ioh

National

Infir-lnarv,

'Social

X'Vorlcer,

Ioh

National

Infirmary,

(29>

# K,-#-*

as-*-.es*s,les

sensTtive reaction of

the

musclcs of

the

bron-clliolcs2)

resulting

in

constriction oS

the

airwa},s･

with

diMculty

in

breathing.

The

incidence

of

bronchial

asthma

in

Japan

is

approximately

one

per

cent

of

the

total

_{population3),}

with

4

to

6

per

cent of school children affected4) and

it

is,

increasing

_}rear

by

_year3).

Various

treatment

modalities arc

in

use

today;'

namely,

by

the

injection

or

inhalation

of a

broncliodilator5),

desensitisationO),

interval

first

two

are

fairly

simple

te

_prescribe

and

administer

because

they

are `passive'

in

nature.

By

"passive',

_the

authors'

definition

is

`minimal

physica]

involvement

on

the

_patient's

_part

in

the

procedure'.

Although

essential

to

the

treatment

regime,

these

_passive

modalities

alone

are

not

always satisfactory

to

both

the

_physician

and

the

patient.

In

contrast, `active'

_treatment

modali-ties-defined

by

the

authors

as

`active

physical

in-volvement on

the

_patient's

_part

in

the

_procedure'

-as

_for

example,

exercises,

require

the

children's

and,

_quite

eften,

the

_parents'

and

schoolteachers'

co-operation

and

_{participatien.}

Furthermore,

teaching

exercises

is

_primarily

the

domain

of

the

physiotherapist

in

the

hospital

setting, with

con-sequent

indication

for

_{physiotherapists}

to

_get

in-volved

in

the

_rpanagement

of

asthmatic.s.

Con-sequently,

_guestions

as

to

the

future

development

of

_{physiotherapy}

in

this

field

vis-i-vis

the

com-preEensive

approach

in

the

management of

bronchial

asthma stimulated

the

_prescnt

study.

'

REVIEW

OF

RELATED

LITERATURE

Physiotherapy

has

been

an

integral

_part

of

the

rnanagement

of

asthmatics

in

European

and

North

American

countries

for

many

_years.

Such

an

involvement

had

rarely

been

heard

of

in

this

･country

until recently when an asthma

pre-,gramme

and

its

result

were

reported

in

the

literature9).

This

article

described

details

of

the

class,

though

the

exact

role of

the

_{physiotherapist}

was relatively obscure.

Neither

did

it

mention

the

aspect

of

the

children's

exercise

tolerance,

theugh

this

topic

was not

the

theme

of

this

asthma

_programme,

either.

Although

it

has

been

shown

through

a residential

_programme

that

when

physical

exercise was

given

in

the

form

of

daily

interval

training

the

clinical state of

the

children

improved

significantly7).

Sessions

of

relaxed

breathing

did

not affect

the

physiological

parameters

of

severely

asthmatic

children,

though

it

was

suggested

that

there

was

a

tendency

for

the

magnitude

of

each

measure

to

_decreaseS).

DESC]UPTION

OF

THE

ASTHMA

PROGRAMME

A

children's

asthma

class

was

initiated

in

1982

by

_{paediatricians}

from

the

University

of

Kana-zawa

Hospital

and

Ioh

National

Infirmary

in

Kanazawa.

This

class was multidisciplinary

in

nature

and

was

organised

by

_{paediatricians}

spe-cialised

in

allergology,

together

with

_paediatric

nurses,

physiotherapists,

a

_physical

education

teacher

and several volunteers

including

student

physiotherapists.

Such

a

_programme

in

xvhich

physiotherapists

were

involved

was

the

first

of

its

kind

in

the

_Hokuriku

region

of

Japan,

Parents

130e

ldOO

Id30

1ij45

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1fi(]O

1630

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lboo14oo14301445151516oo 1630IT20hr

Fig.

1.

Sciiedule

of the asthma class

A:

lecture

by

the

paediatricians

B:

observation

of

the

class session conducted

by

the

physiotherapists

C:

_group

discussion

D:

instruction

by

the

_{physiotherapists}

on

breathing

control,

_positions

for

relaxation, coughing,

ing

nose,

and

_posture

E:

exercise session conducted

by

the

_physical

cation

teacher

F:

recreational activities conductcd

by

the

nurses

G:

individual

consultation

by

the

_{physiotherapists}

were

strongly

recommended

to

attend

with

their

children so

that

the

theme

of

the

class

was

ori-entated

towards

the

family

as a whole

including

child's

sibling(s)

and

grandparent(s)

rather

than

to

the

asthmatic alone.

The

_principal

aim

of

the

NII-Electronic Library Service

Survey:

and

immediate

management

during

the

acute

stage.

The

class

was

held

for

one session

on

Saturday

afternoon

during

spring

and

autumn,

and,

approximately

one month

later,

a

`refresher'

class wa$ repeated

to

reinforce

the

learning

proc-ess

on

the

_part

of

the

_{participants.}

The

class commenced with a

film

on

`Exercise-induced

Asthma'

attended

by

all

the

participants

<Fig.

1).

It

was

followed

by

the

_{paediatrician's}

lecture

te

the

_parents

in

which

aetiology,

patho-physiology,

prognosis,

and

the

treatment

of

asthma

were

explained.

During

this

_period

the

children

were

divided

into

three

_groups

accord-ing

to

their

school

_grade;

_{pre-schoolers}

to

_Grade

3,

Grade

4

to

6,

and

Grade

7

to

9.

Two

ph>rsio-therapists

instructed

eacli

_group

in

succesison on

how

to

control

their

breathing

during

an

asthmat-ic

attack with

the

aid of

diaphragmatic

and

pursed-lip

breathing,

the

_positions

of

relaxation

in

standing,

sitting,

and

lying,

how

to

clear

and

blow

tlie

nose

effectively,

and

how'

to

make a

productive

cough

without

inducing

bronchial

spasm.

The

childTen

were

then

joined

by

their

parents

and

the

instruction

was reviewed and

demonstrated

by

the

children

themselves

with

the

_{physiotherapists'}

explanation

why

each

ex-ercise

was

effective.

In

addition,

postural

drainage

was

shown

and

_practised

by

the

_pareiits

on

the

child,

_though

it

was not recommended

for

those

asthmatics

whose

cliests

were

free

of

secretion.

The

class closed with a

_{question-and-answer}

session

with

the

_physicians

_presiding

over

several

srnall separate

_group.-

Individual

instruction

was

given

at

the

same

time

by

the

_{physiotherapists}

to

those

_parents

and

asthmatics who would

benefit

most

from

it.

Paraller

to

tliis,

a

general

exercise

class

was

_participated

in

by

all

the

children

to

promote

a

feeling

of

well-being and

to

enjoy an exercise

session

under

controlled

conditions,

This

class was conducted

by

the

_physical

education

teacher

and was

designed

specifically

to

meet

the

asthma

_programme

(31)

needs

of

asthmatic

children

with emphasis en

thoracic

mobility,

_posture,

muscle strength,

and

fitness.

PUR?OSE

Chest

physiotlierapy

in

_general

and

the

physio-therapist's

role

are

nor

well

understood

nor

clearly

defined

amoi]g

the

health

care

profes-sionals

in

this

country.

It

is

sometimes

seen

in

hospitals

that

some

unqualified

_personnel

such

as

bonesetters

and

masseuses

are

_providing

chest

physiotherapy

isTithout

having

had

any

formal

instruction.

However,

this

service

is

not offered

in

many

hospita]s

and,

instead,

nurses are

trying

to

_provide

it

oiten

unsuccessfully.

This

is

due

to

the

relative

unavailability

of

physiotherapists'in

this

specialty and

the

unfamiliarity among

phy-sicians

in

the

management

of asthmatics utilising

the

expertise

of

the

_{physiotherapist}

as a

team

member.

To

investigate

the

eMcacy of

the

asthrna class, a survey was undertuken

in

the

winter

oE

1983/84.

MET}IODOLOGY

A

questionnaire

(Table

1)

to

be

answered on

behulf

oE

the

children was mailed

to

70

participat-ing

_parents

who attended

the

class

8

or

4

times.

Fourteen

cluestions were

_provided

and

the

decision

to

identify

the

_parent's

or

_guardian's

name was

left

to

the

respondents.

To

each

ques-tion,

respondents

were

asked

to

tick

an

appro-priate

answer

_provided

and,

if

necessat/y,

to

state

an

appropriate

reason(s).

No

atternpt

was

rnade

in

this

survey

to

_group

the

children

according

to

the

severity

of

asthma.

RESULTS

ANP

DISCUSSION

The

results were considered according

to

the

kind

of sample selected.

The

respondents were not random]y selected and were,

tlierefore,

not representative

of

all asthmatics.

The

findings

Table

1,Questionnaire

1

1

ii]

/

l

L

1!t/

1/lI･

l/1

l /

Please

answer the

following,

1.

Namc

of

the

_parent

or

_{guardian(optional):}

2.

Chilcl's

age and

_gcnder:

3.

Period

since

the

confirmation of

diagno$is:

4.

Frequency

eE asthmatic attack

before

the

_{participation}

in

the

class:

a)

daytime:

(

)

times

monthly

on

averag'e.

Attacks

occurcd mostly

in

(

b)

nighttime:

(

)

times

monthly

on

average.

Attacks

occured mostly

in

(

5.

NVas

the

astbma class useful

to

_you?

a)

Yes,

vcry much

b)

Yes,

_probabl}r

c)

No,

not at all

6.

P]ease

arrangc-i.

in

orcler of usefulness:

a)

fiIm

_presentation

b>

_{paediatricians'}

lectu'L'e

c>

breathing

control

d)

positions

for

relaxation

e)

_pestural

drainagc

_b

exercise

g>

group

discussion

7.

Dees

_your

child

_practise

bTeathing

control?

a>

Ycs,

regularly

b)

Yes,

occasionally c>

No,

not at all

Ifi

_your

answer

is

c>,

_please

indicate

the

reason

belew:

OHcr'She

foTgets

to

do

it

@HelShe

usually

_dees

not need

_it

@Other

8.

Is

_your

child now ablc

to

control

breathing

duTk'.,g

an asthmatic attack?

a)

Yes

b)

No

c)

Don't

know

If

your

answer

is

b),

_plcase

i-dicate

the

reason

_bclow:

@Too

distr

¢ssing

to

do

so

@Asthmatic

attacks are severe

@HelShe

coughs

too

mucli

@Takes

medication

immediately

@Lack

of

_practice

@Other

(Please

state

specifically)

9.

Compared

to

the

asthmatic attacks

last

_},car;

a)

[requency

of

the

attacks

in

daytime

has:

@increased

@remained

the

same

@decreased

b>

frequency

of

the

attacks

in

nighttime

has:

0decreased

@remained

the

same

@increased

10.

Does

_your

chi]d

_practise

any

ol

the

following

that

has

been

instructed

in

the

please

indicate

the

specific one(s);

a)

General

exercise

b>

`Fermata

singing' c)

ICanpu

masatsu

(rubbing

body

with a

dry

cleth)

d)

Other

exercise(s)

(please

specify)

If

he!she

does

not

_practise

any,

_please

indicate

the

reason(s)

from

(i)HefShe

has

forgotten

it

<them)

@HefShe

is

@Other(s)

(state

specifically)

Il,

Did

_you

carry out

_postural

drainage

whenever

_your

child

sounded

chestyP

a>

Ycs

b)

No

c)

He/She

did

not sound chesty at all

12,

Does

_your

child

_participate

in

a sport{s)

or

_physical

activity(ies) at

Ieast

once a

IS,

I4.

)

month)

month

(?lcase

specify)

class?

If

so,

down

the

the

fellowing:

too

_young

to

be

able

to

do

it

_(them)

Has

_)'our

attitude

towaTds

andfor

knowledge

of

bronchial

asthma

astlLma

class? a)

Yes

b)

No

If

_your

answer

is

a),

_please

indicate

below

in

what aspect

it

has

OMedication

@Manag'ement

during

asthmatic attacks

asthina

@Attitude

_towards

daily

llfe

@Physical

exercise

@Other(s)

(state

specifically)

If

_your

answcr

is

b),

_please

indicate

the

reason

bclow:

OI

already

know

most of

the

content of

the

_programme

@I

cannot

_put

my

knewledge

into

_practice

@I

hRve

my ewn way of managing

bronchial

asthma

@Other(s)

<statc

specifically)

Has

_),our

child's

attitude

towards

bronchial

asthma andfor

behaviour

a)

Yes

b)

No

If

_your

answcr

is

a),

_please

indicate

which

has

been

changed:

(DAttitude

towards

asthmatic attacks

@Behaviour

(Thank

you

very rnuch

for

_your

co-operation>

been

wcck?

changed

bythe

been

changed

@?rognosis

of

bronchial

'

@Hospitalization

been

changed?

-NII-Electronic Library Service

Survey:

were

thus

descriptive

of

this

specific sample

alone.

Seventy

per

cent

(49)

of

the

_{questionnaires}

out

of

7e

was

returned

and

analysed.

Of

these,

ele-mentary

schoolers

numbered

S7(76'91,),

pre-schoolers

9(18'%)

and

junior

high

schoolers

8

_(6%),

respectively.

The

number

of

boys

was

25

as

opposed

to

24

_girls.

Their

average uge was

9.9

_years

old

(range:

3-15).

All

the

respondents wrote

their

childrens' name on

the

_{questionnaiTe}

sheet, which was not

man-datory.

It

was not certain

if

this

had

inhibited

or

facilitated

the

answering

of

the

_questions.

The

only

_question

answered

by

all

the

respond-ents

was

_question

8,

Question

14

had

the

lowest

answer

rate

(59%),

Table

2.

Frequency

of asthmatic attacks

before

the

participation

in

the

class'

N..29

t

st,O

O.o

10j

3,6

O,5

10

Daytime(timesfmos･)N-24N'ighttime(times!'

mos.)N

11

.qverage1'Range

.4verage

i

Range

asthma

_programme

"

Most

of asthmatic attacks occured

during

spring and autumn.

The

number of asthmatic attacks varied widely

among

the

respondents

(Table

2).

In

this

Table

two

cases of

30

attacks

_per

month were

excluded

from

computation,

The

fact

that

asthmatic

at-tacks

occured more

during

the

night

than

the

day

and

that

these

were

_generally

seasonal

complied

with

the

textbook

description

of

this

conditioniO>.

:/nble

3,TLer..L,

t-rranged

lno:.

.d.,,r

.ci

usefulness.

.

.-

_..

Y･31

L

k,:lg:eill:?i::i:{{t'-l,liii"l:n/l･i&!i,iiiliise.g:,"iii!･i,:Fyy:lllili::t/L".[･l'ili]

The

highest

weighting

regarding

usefulness

of

the

_programme

went

to

_the

_lecture

_by

_the

paedia-tricians

foliowed

by

two

components

taught

by

the

_{physiotherapists}

(Table

S),

The

fact

that

this

_question

had

the

second

Iowest

answer

rate

(63'9,>

may

have

been

due

to

the

diMculty

in

weighting

each

itern

in

_preference

among

the

(33)

seven,

In

fact,

one respolldent stated

this

diM-culty

instead

of answering as required,

Ninety-six

per

cent

(47)

of

the

respondents

felt

the

class useful

(Question

5>.

The

results

generally

complied

with

the

_principal

aim

described

_previously.

The

reason

why

the

fi1rn

_presentation

was

placed

in

low

priority

may

have

been

because

it

was

made

in

Norway,

though

the

naratioll

was

in

_Japanese,

therefoTe,

it

may

have

been

d{ficult

for

the

_participants

to

relate

it

to

themselves.

Furthermore,

the

content

of

the

film

might also

have

affected

theiT

reaction;

that

is,

it

was

based

primarily

on

interval

training

which

was

not

part

of

this

_programme.

In

addition

to

this,

in

the

film

it

was

always

the

father,

not

the

mother,

who

took

immediate

care ef

their

child

during

an

asthmatic

attack,

whereas

in

this

country

these

roles are alrnost always

reversed.

There

seemed

to

_be

a

contradiction

concerning

the

answers

to

_questions

Z

8,

9

and

10

(Table

4,

5,

6,

and

7);

the

majority experienced

om

L.

_."

2z"6:)

I

re'nson for

'lio'

HelSheforgetsit

T(31X)

HelSheusual]y doesnot need it

7(31)

HEIShoistoo yeungtobe ahTe te 5(23)

EIislNer

condition isnot se serious 1(5)

nsLhmaLicattacks do not eccur because of regvlaT medicatlon

1(

5

)

TmpossibTe

tobreatheintbreughthe nose dueterhinitis

1(

5)

N-49

iiiiiii'!I:ile'ljiE::-il'g::'31iiiXr:?c

rhinitis

illl(

L, :AEil].".?.ILcattazks are very ra.r.epu

TabTe6.Compareatotbefrepvencyof esth"atic attacks ]nsLyeEr/

IncieuEed"emc]neeLhe same

1SLaytine

s't'i'c'k'g'Eaveno"cs-42) Nighttineattacks havenoRiEJI51

5C12:)1<ITX)F/ De:reased :-Z(T;･:･/, T"sy,]

l

.isai.).

'"'

]

..ggciT,7.)

1.

/'

11]1

rable

7.

Dees

yotir child prsctise any of

the

folle-ing

that

has

been

instructed

i.n

the

class?

N[45

Yes

No

26(58X)

the

reasoh

fer

`No'

forgotten

it

7(27X)

young

to

be

to

practise

4(]5

)

15{58)

"

_Included

postural and chest mobilisatien exercises and

Takefumi<stamping

veithone]s

feet

on

the

longitudinal

piece of a

bamboo

stick>

ed

asthmatic attacks

while

it

was

found

that

more

'thall

half

oE

the

children

had

not

_practised

breathing

control or exercises at all.

It

was

ex-pected

from

tiie

therapists'

viewpoint

that

tlie

more one

_practised

it,

the

less

frequent

would

become

thc

asthmEtic attacks.

It

shou]d,

there-forc,

be

considered

that

the

decrease

in

asthmatic

attacks

is

effected

bv

the

interaction

of

each

)

dality

_provided

in

the

class.

In

additio",

it

is

well

known

that,

as

the

child

_grows,

the

asthmatic

attacks

become

less.

It

is

very

diMcultg)

to

motivate

the

cliild

to

practisc

breathing

control

during

the

lull

_period

sirriply

because

heXshe

does

not

differ

_physically

from

any other

individual

at

this

time

and

does

not

feel

the

necessity

of

it.

Nevertheless,

ap-proximately

half

of

the

respondents

answered

positively

to

_question

8

_(Table

5)

and

the

_general

tendency

definitely

_pointed

towards

subjective

improvement

of

their

condition as shown

in

Table

6.

Regarding

the

respondents

who

indicated

the

rcason `too

young

to

be

able

to

_practise'

in

Table

4

and

7,

all

of

their

children

were

_{pre-schoolers}

er

S-

to

5-

_year-olds,

Generally

speaking,

`infants' under si]s

_yeurs

aTe not

suitable

fer

class-workll),

therefore,

they

should

be

treated

individually.

Likewise,

in

those

respondents who

indicated

the

reason `forgotten

_to

practise'

it

was not

cer-tain

whether

their

children

had

forgotten

the

techniques

or

they

had

somehow missed

op-portunities

to

_practise

despite

their

knowledge.

19(42X)

1

P]easestatespecificallyState

Kanpumasatsu6(31Z)Hasf

Genera1exercise3(16)Tooy

'FermataSingingt3(16)able

Other'exercrses*7(3T)Other

The

reason stated

for

`Others'

by

the

majority

was

that

their

childrens'

mild

condition

did

net

.

rant any

exerase.

Regarding

the

question

of

_postural

drainage,

48

respondents

answered

in

which

21

(44'%)

re-plied

positively

and

27(56%)

negatively.

The

negative answer

included

15(31%)

respondents

who

stated

that

their

children's

chest

always

sounded cleaT. rl'his confirmed

the

fact

that

some

asthmatics

were

free

of chest congestion

despite

their

condition.

As

far

as

sports

were

concerned

the

majority

felt

enthusiastic

and

took

_part

_iii

_tlie

regular

physical

education

class at school

(Table

8).

MoreoveT,

swimming-the

least

_provoking

of

asthmogenic

activities5)-was

_part

of

the

]eizure

time

_physical

activity

for

more

than

half

of

the

children,

Swimming

was recommendcd

by

the

class

instructors

and

the

result

showed

partici-pants'

compliance and

enhusiasm.

1'able

8.

Does your child noE participate ina sport(s) or _physic]]

activity(ies) at leastoncea"eek? h'--47

.t.t.ttt.t..t.t.t.t..tt...-..-...

7-tt

.-Yes

i

h'o' Please inthe spectone(s)

Cmthan

onc anspaer)

3gcs3x)

SEimming

3Z(E2L,)

Others

22(56Z,)

i17(44Z,)

lti11

"

_Included

_bnseball,

_{softbsll, roller skating,}

_badminton,

_soccgr,

i'ogging,

･t-nbTe

tennis, cycling, Kenda(jfipanesefepcing),soing toplay,skipping, rvbber-ropeiumping

Question

18

and

I4

dealt

with

the

attitude

of

the

_participants

in

which

the

majority

ariswered

positively

(Table

9

and

IO).

According

to

the

parents'

subjective

opinion

in

_question

14,

their

children

_generally

became

more

confident

and outgoing

(Table

IO),

It

cannot

be

denied

that

a

survey

such

as

this

-a

relatively weak

design

as

a

research

tool-might

have,

to

a

certain

extent,

limited

the

find-ings,

It

was

obviously

beyond

the

scope of

this

sur-vey

to

test

the

measure of

_physical

tolerance

against exercises,

for

the

format

ef

the

class

did

8QTZ}

1

NII-Electronic Library Service

Tab]e

9.

Has

yeur

bronchial

zsthma

Survey:

asthma

_programme

attitude

towards

andfor

kno-ledge

of

the

expertise

heen

chaneed"b{

the

asthma claSS?

NO=46

1'he

autllors

Yes45

{9EZ,)

In

what aspect

has

it

been

chan

(more

than

one anSxer)

1

:?",,

?,

E:::"I,a:::g,:si

li!mf

f.

//g

attacks

Medication

Table

IO.

Has

your child's attltude

toFards

brenchial

asthma andlor

behaviour

been

changed

by

the

asthma class?

N=29

Yes27

(93%)

l

_No

Change

of attitude

)･

Change

of

beh

2(7%)

aviour

j

ige･ez)"Il

vetL3oz)-iiot allow

this.

There

are a

lot

oi asthmatics

zvho

are

_physically

unfit

and

lack

a

great

deal

of

confidence

to

exeTcise.

The

major

cause

of

this

unfitness

is

the

fear

of

an

asthmatic attack on excrcising, which usually

leads

to

a vicious circle according

to

the

authors' observation.

Therefore,

an exercise

tolcrance

traiiiing

pro-gramme

shou]d

be

organised

by

_{phys{otherapists}

and

implemented

_preferably

in

a

hospital-based

physiotherapy

department.

Only

then,

the

authors

believe,

_the

management

of

asthmatics

can

become

comprehensive.

CONCLUSION

'

The

children's asthina class was

briefiy

described

to

explain a multidisciplinary approach

to

the

management

of

asthmatics,

A

survey

on

this

pro-gramme

was

copducted

for

the

_purpose

oE

in-vestigating

its

ethcacy.

The

findings

demonstrat-ed

the

usefu]ness

of

the

_prograrnrne

in

which

(35)

of

_{physiotharapists}

was employed.

recomrnend

that

_{physiotherapists}

should routinely

be

involved

in

this

field

as

edu-cators

as

well

as

therapists

and

that

a

compre-hensive

a$thma

_programme

including

exarcise

to]erance

training

should

be

estab]ished

so

that

the

_physicians

would

be

able

to

refer

their

patients

whenever

the

need

arises.

REFERENCES

1)

Nakayama,

Y,:

Inti'actable

asthma and

its

Ierns,

Bronchial

asthma

in

children,

Pacdiatrics

Mook

Ne.

2,

edited

by

K,

Baba,

et al.,

Kanehara

Publishing,

Co.,

1978,

pp.218-2SO.

Uapanese)

2)

Takishima,

T.:

Respiratory

diseases,

Japan

cal

Journal,

8124:

8-II,

1984.

_CJapanese)

8>

Nakamura,

S.:

Present

situation

and

_preblems

in

the

management of

bronchial

asthma,

Japan

Medical

Journal,

8015:

43,

19S3.

Uapanese)

4)

Mikawa,

H.:

CIinical

note on

bronchial

asthma,

Japan

Mcdical

Journal,

Sl28:

]2-l:'J,

1984.

nese)

5)

Bardan2,

E.

_J,:

Moclern

afipects

in

di:gnosis

and

treatment

of the asthmatic

_patient,

CIinical

Note

on

Respiratory

Diseases,

15:

S-18,

l976.

6)

Ncmoto,

T.:

Descnsitis2tion

for

children with

bronchial

asthma,

Japan

Medical

Journa],

g099:

130,

l983.

(Japanese>

7>

Mallinson

B,M.

ct al.:

Excrcfse

training

fer

children with astl]ma-Oiitpatient

_programme

and a residential expc/riment,

Physiotherapy,

67:

]06-le8,

198I.

8)

Legg'at,

E,A.,

ct al,:

Effects

of rclaxed

1)reathing

on circulatory and respiratory

_parameters

in

veTely asthmatic children,

Physiotherapy

Canadu,

S3:

S66-S70,

I981.

9)

Koga,

R.:

Rchabilitation

for

bronchial

asthma,

Sogo

Rehabilitation,

10:

591-597,

I982,

(Japanese>

IO)

Shimanuki,

K.:

Epidemiology

of

bronchial

ma,

BTonchial

asthma

in

children,

Paediatrics

Mook

No.2,

edited

by

Kan)o

Baba,

et al,,

haTa

Publishing,

Ce.

1978,

pp,6-IY).

aapanese)

Il)

Wale.

_J,O.:

Tidy's

massag'e

and

remedial

cises

in

medical and surgical

conditions,

11th

ed.,

要 　

’

　

旨

『

親

と 子 の

喘

息

教

室 』 の

効

果

一 一

ア

ン

ケ

ー

ト

調

査

よ

り

一

荻 原 新

八

郎

＊

　

荻 原

サ ン

ド

ラ＊ ’1：

平 谷 美 智 夫

＊ ＊＊

　

武 藤

　一

彦

聯 緜

大

友 　 順

一

＊ ＊ ＊ ＊＊

　 　

＊

金 沢

大

学 医 療 技 術 短 期 大学 部

理

学 療 法 学 科 助

教

授

　

：

：

t

＊ 元エ ド モン ト ン

総 合 病 院

ICU

主

任

理

学 療

法士

（

カナ ダ

）

　

＊ ＊ ＊ 金 沢

大 学 医 学 部 小 児科 講 師

＊＊ ＊ ＊

国

立

療

養 所 医

王

病 院 小 児 科 医 長

＊ ＊ ＊＊

’

：

t

　

as

_立

療 養

_所

_{医 王}

_{病 院 児童 指 導 員}

　

『

親

と

子

の

1

暢息 教 室

』 は

小 児

科

医

，

看 護

婦

，

理

学

療 法

土， その

他

の

職 員

が

協 力

し て

昭 和

57

年

以

来

春 秋

に

一

回つつ

国 立 療 養 所

医 王

病

院 で

開

か れ ている。 こ の

教 室

の

効 果 を確

か め る

た

め に

参 加 者

にア ン

ケ

ー

ト

調 査 を 行

っ た。 そ

れ

に よ

れ ば

参

加

し た

大

多数

の患

者

に

於

いて

喘息発作

の

頻 度

が

低 くな り

，

運 動

一

特

に

体 育

の

授 業 や 水 泳

一

に

も積 極 的

に

参

加

し

，

これに よ

り

精神 的

に

も 自信

がつ

き

，

親 も

気 管

支

喘 息

の

対 処

法

を

活 用

で き る よ

う

に なっ た。 理

学療

法

士の

役 割

，

即 ち呼 吸

コ ン トロ

ー

ル

，

発 作

時

に と る

姿 勢

，

体

位

排痰

法

，

鼻

を よ

く

か むこ と

等

の

指 導

がこ の

教 室

の

重 要 な

一

部

であ るこ と

も

この

調 査 結 果 が

示 し ている。 理

学

療

法

士 はこ の よ

うな

教

室

へ 『

教 育 者

』 とし て

も参 加

し

，

瑞 息 管

理の

一

部

を

担 う

ので

あ

る。

加

えて，

運

動誘

発 性

喘

息

の

恐 れ

，

過 保 護

，

そ

の

他

に

よ る低 体 力

の

患 児

に

対

し て は

病 院

の 理

学

療

法 部

で

運 動 耐 容

能

増 大 訓

練

を

計

画

し，

定 期 的 に 実 施 す る

こ

とが 望 ま

しい。 この

よ う

に し て

初

め て

気

管支

喘

息

の

治 療

。

管

理

が

『

_包

_括

_的

_{』 だ と}

_言

え よ

う

。