Spacer compliance after discharge following a mild to moderate asthma attack

Aim: To assess MDIS usage in patients discharged from a children''s hospital emergency department following a mild to moderate asthma attack. Methods: Prospective observational study of 73 consecutive patients presenting to a children''s hospital emergency department with a mild to moderate asthma attack. Demographic data, whether asthma literature/written MDIS instructions were provided, and who provided MDIS instructions (either a discharge coordinator or other emergency department staff) were noted. Parents of patients were telephoned after the first week following discharge and questioned about patient improvement, MDIS use/reasons for not using MDIS, and unscheduled presentations to their local doctor or hospital. Results: Following discharge, 50/73 (68.5%) patients used MDIS exclusively (compliers), while 23/73 used nebulisers some or all of the time (non-compliers). There was no difference in patient improvement or unscheduled presentations between compliers and non-compliers. Most non-compliers 14/23 (60.9%) changed because of parental preference; ease of nocturnal nebuliser use was a possible factor. Compliance was associated with the age of the patient, spacer usage at hospital, the size of device used at hospital, and whether an information fact sheet was given. Conclusions: Most children discharged from the emergency department following a mild to moderate asthma attack continue MDIS use exclusively in the first week. MDIS compliance may be associated with knowledge, experience, and ease of spacer usage. The study shows that education for parents is crucial for MDIS compliance.     

Analysis of body posture in children with mild to moderate asthma

The mechanical alterations related to the excessive use of accessory respiratory muscles and the mouth breathing observed in children with asthma may lead to the development of alterations in head posture, shoulders, thoracic region and, consequently, in alterations of body posture. The purpose of this study was to assess body posture changes of children with asthma compared to a non-asthmatic control group matched for gender, age, weight, and height. Thirty children with asthma and 30 non-asthmatic children aged 7 to 12 years were enrolled in this study. Digital photographic records were obtained for analysis of the body posture of the children by computed photogrammetry. The intraclass correlation coefficient and Student’s t test (p < 0.05) were used for statistical analysis. There were no significant differences between groups for the angles analyzed, except for the knee flexor angle. These results demonstrate that children with asthma did not present postural alterations compared to non-asthmatic controls since the only angle for which there was a significant difference between groups showed weak reproducibility. The findings of this study do not support the notion that children with asthma present alterations in body posture.     

Sensitization to food allergens in Iranian children with mild to moderate persistent asthma

Background

Asthma is the most common chronic respiratory disease in childhood. The clinical presentation of asthma may worsen after food allergen ingestion in sensitized patients. To avoid nonspecific dietary restrictions in children with asthma, laboratory-based advice about foods is potentially helpful. The purpose of this study was to determine food sensitization in children with asthma.

Methods

Seventy-nine children with mild to moderate persistent asthma were included in this study. Commercial food allergens including cow??s milk, egg white, almond, potato, and soybean were used in skin prick tests. Specific IgE to 20 common food allergens was also measured in serum.

Results

Twelve (15.2%) of the patients had a positive skin prick test to at least one of the five food extracts. Sensitization was detected by skin prick tests to cow??s milk and egg white (each 6.3%), almond (3.8%), potato (2.5%) and soybean (1.3%). Specific IgE levels ??0.35 kAU/L were detected in the serum of 47% of the children with asthma. The most common food allergens were cow??s milk (26.6%), hazelnuts (25.3%), wheat flour (15.2%) and egg white (12.6%). Patients with a history of at least one hospital admission due to asthma attack had a higher rate of sensitization to egg.

Conclusions

In our study, food sensitization was frequent in Iranian children with asthma. Although clinical food allergy could not be evaluated because food challenge tests were not used in our study, skin prick tests and serum-specific IgE to common food allergens might be helpful in identifying children with food sensitization.     

Effects of montelukast on symptoms and eNO in children with mild to moderate asthma

BACKGROUND: Asthma is a chronic inflammatory airway disease. Exhaled nitric oxide (eNO) is a marker reflecting airway inflammation. This study was conducted to investigate whether montelukast, a leukotriene receptor antagonist, could be used for the management of asthma and how fast the montelukast sodium decreased airway inflammation as demonstrated by eNO levels. METHODS: Twenty children aged 6-14 years (mean age: 9.2 +/- 2.4 years; mean weight 30 +/- 4.6 kg) with mild to moderate asthma were recruited for the study. They received montelukast plus an inhaled short-acting beta2 agonist as open and uncontrolled therapy. Asthma score (AS) and peak expiratory flow rate (PEFR) and eNO concentrations were measured at pretreatment (0 week) and post-treatment (1 and 2 weeks) as well as 2 weeks after withdrawal of therapy. RESULTS: In one week, the eNO levels (33.3 +/- 15.5 p.p.b. vs 14.8 +/- 8.6 p.p.b.; P < 0.05), and AS (4.2 +/- 1.3 vs 1.8 +/- 1.3; P < 0.05) decreased rapidly, and PEFR (206.9 +/- 69.7 L/min vs 236.2 +/- 69.8 L/min; P < 0.05) increased. Concurrent beta2 agonist use decreased from a mean +/- SD of 2.2 +/- 0.4-1.3 +/- 0.3 puffs per weeks (P < 0.05). After the withdrawal of treatment for 2 weeks, the eNO levels (29.2 +/- 16.1 p.p.b) rebounded again, although the improvements in AS (1.1 +/- 1.3) and PEFR (245.0 +/- 91.3 L/min) persisted. CONCLUSION: Oral montelukast sodium treatment of these children with mild to moderate asthma effectively improved asthmatic symptoms and suppressed airway inflammation in 1 week, suggesting that this leukotriene antagonist combined with short-acting beta2 agonists may provide effective treatment option in mild to moderate childhood asthma. Larger, controlled, and double-blinded studies are needed to confirm these preliminary open uncontrolled observations.     

妥洛特罗贴剂和口服硫酸沙丁胺醇治疗儿童支气管轻中度哮喘急性发作期的有效性和安全性比较

目的：比较妥洛特罗贴剂和口服硫酸沙丁胺醇治疗儿童轻中度支气管哮喘急性发作期的有效性和安全性。 方法：将92例轻中度哮喘急性发作期患儿随机分为沙丁胺醇组和妥洛特罗组,每组各46例。两组均给予抗组胺药、选择性白三烯受体拮抗剂、糖皮质激素治疗。沙丁胺醇组使用硫酸沙丁胺醇缓释胶囊,妥洛特罗组使用妥洛特罗贴剂。比较两组咳嗽、喘息、呼吸频率、哮鸣音、三凹征、呼气峰流速（PEF）评分变化及不良反应的发生情况。结果：两组症状评分随治疗的进行均下降。与治疗前评分比较,治疗第3天两组喘息、呼吸频率、哮鸣音、三凹征和PEF评分均显著下降（均P<0.05）,但妥洛特罗组评分较沙丁胺醇组低,差异有统计学意义（均P<0.05）。与治疗前评分比较,两组咳嗽评分到治疗第14天开始显著下降(均P<0.05) ,妥洛特罗组评分较沙丁胺醇组低,差异有统计学意义 (P<0.05)。沙丁胺醇组有1例出现手震颤,妥洛特罗组未出现不良反应。结论：与口服硫酸沙丁胺醇比较,妥洛特罗贴剂治疗儿童轻中度哮喘急性发作期疗效更显著,安全性高。     

The effect of nebulized budesonide treatment in children with mild to moderate exacerbations of asthma

Background: The role of inhaled corticosteroids in the treatment of acute asthma remains a controversial subject. Objective and methods: A randomized, double-blind, placebo-controlled parallel-group clinical trial on the effect of a 5-d course of nebulized budesonide treatment in children with mild to moderate exacerbation of asthma was performed. The need for systemic corticosteroid intervention was evaluated as the primary outcome measure. Results: Sixty-seven children aged 6 to 15 y were enrolled. During the emergency department phase, they received three nebulizations of either budesonide(1 mg/dose) or placebo, and then in the home phase of the study, they continued their study medications twice a day for another 4 d. Though the level of improvement in the emergency department phase was similar between the groups given either budesonide or placebo treatments (6.8±1.9% vs 4.0±1.5%, p=0.30, respectively), nebulized budesonide caused a trend towards a benefit in terms of the need for systemic corticosteroid intervention (2/33 vs 7/34, p=0.07), but not in secondary outcome measures.

Conclusion: Though we show a tendency towards a benefit with nebulized budesonide in children with mild to moderate exacerbations in terms of prevention of progression of the illness, the documented benefit is small and includes, at least, consideration for clinical significance, cost-effectiveness, impracticality and safety.     

轻-中度哮喘患儿气道炎症类型与病情、糖皮质激素疗效的关系

目的探讨轻-中度支气管哮喘患儿初始治疗前气道炎症类型与病情及吸入糖皮质激素治疗反应的关系。方法以87例轻-中度哮喘患儿作为研究对象,在糖皮质激素吸入治疗(ICS)前进行痰液诱导及诱导痰细胞学分析,酶联免疫荧光法测定痰液嗜酸粒细胞阳离子蛋白(ECP)、ELISA法检测痰液IL-8、TGF-β1,儿童肺功能仪检测基础肺功能和小气道通气指标、乙酰甲胆碱(Mch)支气管激发试验测定气道高反应性(AHR)。20例健康体检儿童作为对照组,应用SPSS13.0软件进行统计学分析。结果87例轻-中度哮喘患儿根据诱导痰液EOS%分为嗜酸性粒细胞哮喘组(EA)64例,非嗜酸性粒细胞哮喘组(NEA)23例,EA与NEA组ICS治疗前痰液细胞学构成比、诱导痰上清液ECP、IL-8差异有统计学意义(P<0.05);两组间FEV1%预测值(FEV1%pred)、PEF%pred、中-重度AHR%、小气道阻塞(%)、痰液TGF-β1水平等指标差异有统计学意义(P<0.05)。ICS治疗4周后EA组基础肺功能指标、气道高反应性、小气道通气功能明显改善,而NEA组改善不明显。多元逐步回归分析结果表明初治痰液EOS%、FEV1%预测值、痰液TG...     

Hypokalaemia following nebulized salbutamol in children with acute attack of bronchial asthma

Objective : To determine whether use of nebulized salbutamol therapy for treatment of an acute attack of asthma in children is associated with hypokalaemia and if so what is its frequency, severity and effect on recovery.
Methodology : Forty-six children, aged 10 months to 12 years (mean 7.9±1.5 years) with acute attack of bronchial asthma, treated initially with three doses of nebulized salbutamol 0.15-0.3mg/kg, every 30 min participated in the study. Blood for serum potassium was obtained at the beginning and after three doses of nebulized salbutamol therapy, before administering other drugs.
Results : The mean±SD serum potassium level decreased marginally from 3.9±0.5mEq/L to 3.7±0.5mEq/L ( P <0.05). A decrease in serum potassium concentration was noted in 26 (56.5%) and hypokalaemia (serum potassium <3.5 mg/L) in 17 (39%) patients. It was more frequent in patients who had received oral salbutamol for the preceding 7 days. The average time taken for recovery was longer in patients who had hypokalaemia than those who had normal serum potassium concentration (8.6±2.7 h vs 6.5±2.7 h; P <0.005).
Conclusions : Hypokalaemia may occur in about one-third of patients treated with three doses of nebulized salbutamol therapy, especially those on prior oral salbutamol therapy. The monitoring of serum potassium concentration may be warranted in such patients.     

孟鲁司特治疗儿童支气管哮喘的临床疗效观察

目的孟鲁司特联合布地奈德气雾剂吸入治疗合并过敏性鼻炎的轻、中度哮喘儿童临床疗效的前瞻性研究。方法将80例合并有过敏性鼻炎的轻、中度哮喘儿童随机分为治疗组和对照组。治疗组在吸入布地奈德气雾剂的同时加用孟鲁司特片，对照组则在吸入布地奈德气雾剂基础上加安慰剂，其余治疗相同。两组布地奈德气雾剂递减至最适有效剂量（无哮喘症状体征，β2激动剂吸入量无增加，呼气峰流速达预计值的8096以上，或变异率小于20％），并进行统计学分析。结果治疗组在加用孟鲁司特前后布地奈德吸入量减少差异有统计学意义（P〈0．05），对照组在加用安慰剂前后布地奈德吸入量减少差异有统计学意义（P〈0．05），而且两组比较差异亦有统计学意义（P〈0．05）。结论孟鲁司特片联合布地奈德气雾剂治疗儿童合并过敏性鼻炎的哮喘，不仅能明显缓解哮喘和鼻炎的症状，还可以减少糖皮质激素、β2激动剂吸入量，取得了满意的疗效且无明显的不良反应。     

孟鲁司特治疗儿童支气管哮喘的临床疗效观察

目的孟鲁司特联合布地奈德气雾剂吸入治疗合并过敏性鼻炎的轻、中度哮喘儿童临床疗效的前瞻性研究。方法将80例合并有过敏性鼻炎的轻、中度哮喘儿童随机分为治疗组和对照组。治疗组在吸入布地奈德气雾剂的同时加用孟鲁司特片,对照组则在吸入布地奈德气雾剂基础上加安慰剂,其余治疗相同。两组布地奈德气雾剂递减至最适有效剂量(无哮喘症状体征,β2激动剂吸入量无增加,呼气峰流速达预计值的80%以上,或变异率小于20%),并进行统计学分析。结果治疗组在加用孟鲁司特前后布地奈德吸入量减少差异有统计学意义(P<0.05),对照组在加用安慰剂前后布地奈德吸入量减少差异有统计学意义(P<0.05),而且两组比较差异亦有统计学意义(P<0.05)。结论孟鲁司特片联合布地奈德气雾剂治疗儿童合并过敏性鼻炎的哮喘,不仅能明显缓解哮喘和鼻炎的症状,还可以减少糖皮质激素、β2激动剂吸入量,取得了满意的疗效且无明显的不良反应。     

Measuring compliance with inhaled medication in asthma.

Using an electronic inhaler timer device (Nebulizer Chronolog), compliance with the prescribed frequency of inhaled prophylactic medication in 14 asthmatic children was measured. Underuse occurred in 55% of study days while overuse occurred in only 2%. Such devices provide an important new tool for investigating inhaled drug compliance.     

Safety of budesonide inhalation suspension in infants aged six to twelve months with mild to moderate persistent asthma or recurrent wheeze

OBJECTIVE: To compare the safety of budesonide inhalation suspension (BIS) with placebo in infants 6 to 12 months of age with mild to moderate persistent asthma or recurrent wheeze. STUDY DESIGN: In this multicenter, randomized, double-blinded, parallel-group, placebo-controlled study, 141 patients received 0.5 mg BIS (n = 48), 1.0 mg BIS (n = 44), or placebo (n = 49) once daily for 12 weeks. The primary variable was adrenal function, based on cosyntropin-stimulated plasma cortisol levels. Spontaneous adverse events and clinical laboratory findings also were monitored. RESULTS: Overall, the types and frequencies of adverse events reported during the study were comparable across treatment groups. The response to cosyntropin stimulation was similar across treatment groups, with no significant difference between BIS treatment and placebo. CONCLUSIONS: The safety profile of BIS was similar to that of placebo, with no suppressive effect on adrenal function in patients 6 to 12 months of age with mild to moderate persistent asthma or recurrent wheeze.     

Comparison of terbutaline and salbutamol inhalation in children with mild or moderate acute exacerbation of asthma

Objective: To compare the clinical efficacy and side effects of terbutaline and salbutamol administered by metered dose inhaler and holding chamber in the mild to moderate acute exacerbations of asthma in children.Methods: The study subjects were children in the age group of 5–15 years who presented with a mild or moderate acute exacerbation of asthma. Baseline assessment included clinical parameters and spirometry. The children were then randomized to receive salbutamol or terbutaline. Three puffs each of either 100 mcg salbutamol or 250 mcg of terbutaline were administered using 750 ml holding chamber with valve. Thirty minutes after drug administration, the children were reevaluated for clinical parameters and spirometry.Results: Of the total 60 subjects studied, 31 were administered terbutaline and 29 salbutamol. The baseline spirometric parameters were comparable. After drug administration, all the studied variables showed significant improvement within each group. However, there were no statistically significant differences when the two groups were compared with each other. There was no significant difference in the side effects between two groups.Conclusion: Terbutaline and salbutamol, when administered by MDI with holding chamber, are equally efficacious in children with mild or moderate acute exacerbation of asthma.     

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??Objective??To investigate the effects of long-term inhalation of corticosteroids at low dose on the height of Chinese children with mild to moderate asthma. Methods??From August 2015 to July 2016??a total of 966 prepubertal children aged 3.0 to 9.5 years from the Cooperative Group of Asthma??the Subspecialty Group of Respiration??the Society of Pediatrics??Chinese Medical Association were enrolled for the analysis of the cross-sectional questionnaire survey??in which 173 were asthmatic children who had received at least 12-month ICS treatment at low dose and stopped the ICS treatment at least 6 months before enrollment??415 were asthmatic children who had received any ICS treatment for no more than 2 months in a year or who didn’t receive ICS treatment??and 378 were healthy controls. The analysis of variance??ANOVA?? test was used to compare height standard deviation score??SDS??and height velocity among these three groups. The t test was used to analyze changes of height indicators across time in the long-term ICS treatment group. Results??No difference was found in the height SDS and weight SDS at enrollment??or in the height SDS and weight SDS one year before enrollment??or in growth velocity and weight velocity among these three groups. In the long-term ICS treatment group??the height SDS slightly decreased at withdrawal of ICS treatment??-0.62±2.75?? compared to that at the start of ICS treatment??-0.23±1.71?? and one year before enrollment??-0.20±2.91????but significantly increased after at least six monthsof withdrawalofICS??enrollment????0.15±1.39??. The height SDS after five years of treatment with ICS was -0.95±1.41??which was significantly reduced compared to the height SDS after one to three years of treatment??0.17±1.40??P??0.020?? or three to five years of treatment??0.32±1.27??P??0.013??. Conclusion??Long-term treatment????five years?? with ICS at low dose is not associated with height reduction in prepubertal children with mild to moderate asthma.