氧气驱动雾化治疗小儿中重度哮喘急性发作的疗效观察

目的     

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.     

Subcutaneous epinephrinevs nebulized salbutamol in asthma

Objective: This study was conducted to compare the efficacy of the subcutaneous epinephrine with nebulized salbutamol.Methods : Fifty asthmatic children in the age range of 6–14 years were divided into two equal groups. Group I children were given subcutaneous epinephrine and Group II were nebulized with salbutamol. Patients were observed at 15, 20, 30, 60, 120, 180 and 240 minute intervals. Both the groups had comparable mean increase in peak expiratory flow rate (PEFR %) (Group 127.7 ±0.7; Group II 28.8 ±0.06, p >0.05).Result : In Group I there was significant increase in systolic blood pressure, 30 minutes after the start of treatment, however it settled on its own by 60 minutes.Conclusion : Both the groups had satisfactory improvement in clinical parameters which continued upto 4 hours after start of treatment. Subcutaneous epinephrine can be safely used if nebulizers are not available.     

Effects of salbutamol inhalations on transcutaneous blood gases in children during the acute asthmatic attack: from acute deterioration to recovery

Holmgren D, Sixt R. Effects of salbutamol inhalations on transcutaneous blood gases in children during the acute asthmatic attack: from acute deterioration to recovery. Acta Pædiatr 1994;83:515–19. Stockholm. ISSN 0803–5253
Nine children, 7–16 years of age, were studicd repeatedly during an acute asthmatic attack, from acute deterioration to recovery. The transcutaneous blood gases, forced expiratory volume in l s (FEV₁) and maximum expiratory flow when 25% of vital capacity remained to be expelled (MEF₂₅) were monitored before and after salbutamol inhalation. The flow-volume variables were markedly impaired in the acute phase but improved gradually by the time of recovery. The transcutaneous PO₂ (tcPO₂) decreased in the acute and early recovery phase but improved by the late recovery phase. In the acute phase, the salbutamol inhalations increased the FEV₁, indicating an improvement in central airway function, but also reduced the MEF₂₅ and tcPO₂ in some of the children. The changes in tcPO₂ after the inhalations correlated with the changes in MEF₂₅ ( p< 0.001), thereby indicating a common denominator, probably the condition of the peripheral airways. In the recovery phase, the FEV₁, MEF₂₅ and tcPO₂ improved after the inhalations ( p < 0.05). In conclusion, transcutaneous PO₂ can be used to evaluate the effects of treatment in children with acute asthmatic symptoms and may add information about peripheral airway function which may prove particularly valuable in small children where few methods are available for such measurements.     

压缩式吸入器雾化吸入布地奈德治疗5岁以下儿童哮喘临床观察

目的 观察经压缩式吸入器吸入布地奈德雾化悬液治疗幼儿哮喘的临床疗效及适用性.方法 采用多中心、开放方法,选择≤5岁、临床确诊为支气管哮喘、症状未完全控制的61例患儿进行吸入治疗.入选者使用哮喘日记的形式每日对哮喘症状分别进行日间和夜间评分,每周随访1次,总疗程为6周.分别对治疗第1～6周哮喘症状评分进行控制评估,并对周-周之间的评分及控制评估行两两比较.结果 症状评分第2～6周各周与第1周比较,差异有统计学意义(P＜0.05);第2～6周之间周一周比较差异无统计学意义;连续应用2周以后患儿的完全控制比例呈明显上升达56.8%,并维持至疗程结束;整个疗程中患儿均无明显不良反应.结论 经压缩式雾化吸入器吸人布地奈德雾化悬液治疗5岁以下哮喘儿童,可显著提高患儿的哮喘控制率,具有良好的安全性,依从性好,值得在儿科临床中应用.     

At comparative study of the bronchodilating effect of oral fenoterol and salbutamol in children with asthma

Twelve children with asthma and persistent airflow obstruction were studied to determine the degree and duration of bronchodilation achieved following oral fenoterol compared to oral salbutamol. Each child received oral fenoterol, oral salbutamol or placebo in a randomized double-blind manner and pulmonary function was recorded up to 6 h after the dose. The baseline FEV₁, did not differ between the three groups. The responses to oral fenoterol and salbutamol, measured as the percentage change from the baseline FEV₁, were significantly greater from 1 to 6 h after treatment compared with responses to placebo but there were no significant differences in the responses to the two active medications. It is concluded that, using the manufacturers' recommended doses, there is no difference between oral fenoterol and oral salbutamol in term of their bronchodilator effectiveness and duration of action.     

Duration of action of formoterol and salbutamol dry-powder inhalation in prevention of exercise-induced asthma in children

The aim of this study was to evaluate the effect and tolerability of formoterol 12 μg on exercise-induced asthma in children for 12 h as compared to the effect of salbutamol 400 μg and placebo. The drugs were inhaled as dry powder from a flow-dependent metered-dose inhaler (DP-MDI). Sixteen asthmatic children took part in a double-blind placebo-controlled within-patient single-centre trial. On each study day the patients were given one of the drugs or placebo in random order, and standardized exercise tests were performed after 3 and 12 h. At a pretrial test the children had demonstrated a median maximum percentage fall of 38% (range 22–79%) in forced expiratory volume in 1 s after exercise challenge. Formoterol showed a median percentage protection of 77% and 70% at 3 and 12 h postexercise, respectively, as compared to 46% and 13% with salbutamol. No side-effects were observed. Formoterol 12μg administered as dry powder offers significantly better protection against exercise-induced asthma after 3 and 12 h as compared to salbutamol 400μg and placebo.     

Randomized controlled trial of ipratropium bromide and salbutamol versus salbutamol alone in children with acute exacerbation of asthma

Objective To evaluate effect of addition of ipratropium to salbutamol delivered by metered dose inhaler and spacer in the beginning of treatment of mild to moderate exacerbation of asthma. Methods Children between 5 to 15 years of age with mild to moderate exacerbation of asthma were randomized to receive either a combination of ipratropium bromide and salbutamol or salbutamol alone administered by metered dose inhaler and spacer. The effects on clinical asthma score and spirometric parameters were compared. Results A total of 60 children were randomized in the study. The baseline characteristics of two groups were comparable. Children getting combination of salbutamol and ipratropium showed significantly greater improvement in percent-predicted PEFR and FEF25–75% than children receiving salbutamol alone. Conclusion There was beneficial effect of addition of ipratropium to salbutamol administered by MDI with spacer at the beginning of therapy for mild to moderate acute exacerbation of asthma in children.     

The combination of nebulized sodium cromoglycate and salbutamol in the treatment of moderate‐to‐severe asthma in children

The aim of this multi‐centre prospective study was to evaluate the efficacy, tolerability, and safety of the combination of sodium cromoglycate (SCG) and salbutamol (administered as a nebulized solution), compared to SCG alone and salbutamol alone, in the management of severe, intractable asthma in childhood. The study was an open, randomized, cross‐over trial of 12 weeks' duration in children with moderate‐to‐severe intractable asthma. All treatments were administered twice daily by powered nebulizer. The primary outcome measure was the change in asthma severity, as measured by the mean asthma score during the last 2 weeks of a baseline period and the last 2 weeks of each treatment. Secondary outcome measure was the patient's opinion of the effectiveness of treatment. The change in asthma scores from baseline values were significantly greater with the combination treatment compared to each component administered separately. The mean difference in asthma score between the combination and salbutamol was: ?7.5; 95% CI, ?11.70 to ?3.29 (p < 0.0001). The mean difference between the combination and SCG was: ?8.53; 95% CI, ?14.03 to ?3.25 (p < 0.0001). Patients were also significantly in favor of combination treatment (p < 0.001 vs. salbutamol; p < 0.01 vs. SCG). Two patients reported adverse effects. We concluded that regular twice‐daily inhalation of a combination of SCG and salbutamol gave better control of symptoms than previous treatments in patients with severe, intractable asthma. Few adverse effects with this therapy suggest that it is extremely useful, safe, and effective.     

Nebulized salbutamol vs salbutamol and ipratropium combination in asthma

Objective : To see the additional benefit of combined frequent nebulization with salbutamol and ipratropium bromide in acute attack of asthma with moderate severity.Methods : Fifty asthmatic children in the age range of 6–14 years were divided into two equal groups. Group I children were nebulized with three doses of Salbutamol alone (0.03 ml/kg/dose) and Group II children were given combined nebulization of Salbutamol (dose as in group I) and Ipratropium bromide (250 Μgm/dose for three doses) at 20 minutes interval. Children were observed at 15, 30, 60,120,180 and 240 minutes interval.Results : A significant improvement in % of PEFR starting at 30 minutes and lasting the entire study period of 4 hours was noted in both the groups. However on analysis of varience the results were better in group II.Conclusion : Frequent combined nebulization with Salbutamol and Ipratropium bromide is beneficial in acute asthma of moderate severity.     

A comparative study of the inhaled dry powders of salbutamol and fenoterol and their delivery systems

Abstract A study was designed to establish whether there was a difference in response to inhaled salbutamol powder (400 μg) and fenoterol powder (200 μg) and whether the specific inhaler devices were a contributing factor. In the study of 40 children no significant difference could be attributed to the devices, but the salbutamol treated group had a marginally better response in two parameters of lung function.     

Treatment of hyperkalemia in children with intravenous salbutamol

The aim of this study is to investigate the efficacy and safety of intravenous salbutamol in hyperkalemia. Fourteen children with chronic renal failure, three with acute renal failure and hyperkalemia were treated by intravenous infusions of 4μg/kg salbutamol. Reductions in the mean plasma potassium (K⁺) concentrations obtained at 40 and 120 min after therapy were statistically significant when compared with the mean plasma K⁺ concentration at the beginning of therapy (P < 0.01).     

口服茶碱类药物治疗小儿哮喘的系统评价证据

目的 对口服茶碱类药物治疗d＇JL哮喘的疗效进行循证的系统评价。方法 使用相关的检索词检索Cochrane Library（1996～2006．6）、Medline（1985—2006．6）、EMBASE（1996—2006．6）,获得关于茶碱类药物治疗小儿哮喘的随机对照研究;用系统评价的专用统计分析软件ReVman4．2对纳入文献的资料作Meta分析。结果 共纳入34篇随机对照研究,将茶碱类药物与安慰剂、β受体激动剂、吸入皮质激索、色甘酸钠、酮替酚进行对比。结论 茶碱类药物在治疗小儿慢性轻至中度哮喘时,给予足够的剂量及疗程可以缓解哮喘的症状。未发现茶碱类药物且有影响小儿行为方面的不良反应．     

A comparison of inhaled powders of fenoterol and salbutamol in asthma

Abstract The present study compares fenoterol and salbutamol powders (0.2 mg). Twenty-five children with frequent episodic asthma, aged 4–9 years, entered a double-blind, randomized, crossover, placebo controlled study. On each of three days fenoterol, salbutamol or placebo were given in random order. Lung function testing and other observations were made before and at set intervals up to 4 h after the treatments. Both inhaled powders increased the forced expired volume in 1 s and the maximum mid-expiratory flow rate significantly above placebo effect. No side effects were observed and there were no significant differences in bronchodilator efficacy between fenoterol and salbutamol.     

复方异丙托溴铵雾化吸入在儿童急性喘息性疾病中的应用

小儿哮喘/婴幼儿喘息急性发作治疗时应该考虑下述方式:①最快捷的给药途径为吸入/雾化吸入疗法,可使药物直接吸至下气道和肺,以快速缓解支气管收缩及其伴随的急性临床症状,持续时间较长,疗效好,不良反应少.②最速效的救急药物为M3受体阻断剂/β2-受体激动剂.前者如异丙托溴胺能有效松弛支气管平滑肌以发挥解痉作用,后者如沙丁胺醇具有高选择性作用,作用维持时间长,给药途径多,为哮喘急性发作首选的对症治疗支气管弛张药.③最合理的组合雾化液如复方异丙托溴铵雾化液,是异丙托溴胺和沙丁胺醇混合制剂,异丙托溴胺能在整个肺部都起作用,沙丁胺醇为分布在周边小气道的β2肾上腺素能受体的激动剂,这两种药物合用可协同增强疗效,除具有该两种药物各自的药理作用外,更起着相辅相成的互补作用.复方异丙托溴铵常采用雾化吸入的雾化液,使用简便.     

The perception of asthma

Subjective scores of 'wheeze' or 'tightness in the chest' were compared with the forced expiratory volume in 1 s (FEV₁) in 40 asthmatic children before and after administration of nebulized salbutamol. Symptom scores were poor predictors of the degree of airways obstruction. Many children underestimated their improvement after salbutamol.
The results suggest that reliance on the child's perception of his symptoms and his response to a bronchodilator may result in incorrect assessment and inappropriate treatment.     

Aminophylline dosage in acute severe asthma

In 27 cases of acute severe asthma, a loading dose of 5 mg/kg of aminophylline (omitted if already receiving oral theophylline) followed by a continuous infusion of 1 mg/kg per hour gave satisfactory theophylline levels at 4 h and 24 h. Theophylline clearance rates varied widely, vomiting was common, but unrelated to blood theophylline levels.     

Decreasing admissions for childhood asthma to a Swedish county hospital

Hospital admission rates for childhood asthma have increased in many countries. To study if this is also true for Norrköping Hospital, paediatric admission rates for asthma every fifth year were examined for the period 1973 to 1993. Admission rates were found to have fallen over the last 10 years, especially in children of school age. Among the younger age groups (below 5 years of age) a fall in admission rates was also observed over the last 5 years. This fall occurred in spite of reported increases in the prevalence of childhood asthma. The relative risk for admission due to asthma thus decreased from 1 in 1973 to 0.09 in 1993. The readmission rate has been stable. The mean length of stay in hospital for asthma decreased significantly. The observed decreasing trend in hospital admissions for childhood asthma is contrary to that found in many other countries. Possible explanations are discussed.