Comparison of the Protective Effect of Ketotifen and Disodium Cromoglycate on Exercise-Induced Asthma in Asthmatic Boys

Fourteen boys with a mean age of 12.2 years were studied with respect to the protective effect of ketotifen on exercise-induced asthma (EIA) in comparison with disodium cromoglycate (DSCG). All had a positive history of EIA and a post-exercise fall in FEV1 of more than 20%. A double blind cross-over technique was used with a 1 week wash-out period between the two treatment alternatives. Both drugs gave some, but not significant protection for EIA and no differences between the two active substances tested were found. Great individual differences in the response to the two drugs were noted.     

Long-Term Modification on Histamine-Induced Bronchoconstriction by Disodium Cromoglycate and Ketotifen versus Placebo

In order to compare long-term changes induced on a wide spectrum of bronchial hyperreactivity (BH) by the antiallergic drugs disodium cromoglycate (DSCG) and ketotifen, 56 asthmatic patients (age range 15-55 years) were studied. Patients were allocated to three groups with similar age and BH level. During 2 months, 15 individuals inhaled 20 mg DSCG four times a day, 14 took ketotifen 1 mg twice a day orally and 14 one placebo (lactose) capsule twice a day. After preliminary results, an additional group of 13 patients took clemastine 1 mg orally twice a day for 1 week. Only the ketotifen and clemastine groups differed significantly from the placebo group on shifting log dose-response curves of inhaled histamine. In addition, no significant difference was seen between the ketotifen and clemastine groups. These results suggest that changes induced by ketotifen were mainly related to its powerful antihistamine action; similarly, nonspecific BH is not wholly dependent on mediator release.     

The Protective Effect of a New Agent, Ketotifen Syrup, in the Treatment of Childhood Asthma

Twenty-two children with perennial extrinsic allergic asthma participated in a double-blinded, controlled, cross-over study of Ketotifen syrup during a 2 x 6-week period. The placebo was identical with the active drug in taste, colour, and consistency. The dosage level was, on weight basis, a little higher than the standard dosage for adults. The double-blinded investigation was supplemented with a 1 2-week open study of the tolerance for Ketotifen. This study also involved 22 patients, 12 new ones, and 10 from the double-blind study. The study showed Ketotifen to have no effect on changes in lung function (peak flow), on reduction in frequency of asthmatic attacks, or on consumption of additional medicine. The tolerance for Ketotifen was good, but physicians are advised to watch for increases in weight and decreases in blood pressure during tests on children which involve higher dosage levels.     

Double-blind comparison of the protective effect of sodium cromoglycate and ketotifen on exercise-induced asthma in adults

In a double-blind double-placebo study 10 asthmatics exercised on a treadmill after treatment for 1 week with placebo, or ketotifen 1 mg twice daily, or SCG 10 mg four times daily. The post-exercise percentage fall in FEV1 after SCG but not after ketotifen was significantly smaller than after placebo. A 1-week treatment with SCG but not ketotifen protected against EIA.     

Terbutaline Depot Tablets in Childhood Asthma

Thirty children 8-13 years old, with perennial asthma and with a reversibility of greater than or equal to 20% in lung function (FEV1) were given a sustained-release preparation of terbutaline sulphate 5 mg twice a day and ordinary tablets 2.5 mg three times a day; each treatment lasted 1 week. The design of the study was double-blind, cross-over, with a randomized allocation of the drugs. Both drugs improved the lung function significantly. The children had significantly less coughing during the night when they took depot tablets than when they took ordinary tablets. The side effects were few with both treatments. Most of the patients preferred the depot tablets.     

A double-blind, placebo-controlled comparison of sodium cromoglycate and ketotifen in the treatment of childhood asthma

We compared three treatments: sodium cromoglycate 5 mg aerosol and placebo syrup (39 patients), placebo aerosol and ketotifen syrup (39 patients), and placebo aerosol and syrup (36 patients). The patients (mean age 11.7 years) had mostly allergic, moderately severe asthma. Treatments were added to current therapy (mostly bronchodilators only) for 3 months. Aerosols were taken four times daily and syrups twice daily. The following results were significant at a level of 5%. At the final clinic visit, the changes from baseline in lung function favored sodium cromoglycate over the other treatments. During month 3, sodium cromoglycate was superior to ketotifen for night symptoms, morning tightness, daytime symptoms, and cough. Bronchodilator use decreased more with sodium cromoglycate than ketotifen. Patients' and clinicians' overall opinions of treatment effectiveness favored sodium cromoglycate over ketotifen and placebo. In these patients, sodium cromoglycate was both effective and superior to ketotifen.     

Effect of Oral and Inhaled Sodium Cromoglycate in Exercise–Induced Asthma

Ten patients with bronchial asthma reacting with bronchoconstriction after exercise were studied to compare the effect of oral sodium cromoglycate against sodium cromoglycate inhalation and placebo. Only sodium cromoglycate inhalations protected against exercise-induced asthma. The effect of sodium cromoglycate seems to be a local action of mucosal surfaces.     

Childhood Asthma Control Test and airway inflammation evaluation in asthmatic children

Background:  The Childhood Asthma Control Test (C-ACT) has been proposed as a tool in assessing the level of disease control in asthmatic children. To evaluate the position of C-ACT in the clinical management of asthmatic children, in relationship to the level of airway inflammation as assessed by fractional exhaled nitric oxide (FeNO) and with lung function.
Methods:  A total of 200 asthmatic children were included in the study: 47 children with newly diagnosed asthma ('New') and without any regular controller therapy; and 153 children with previously diagnosed asthma, treated according to GINA guidelines, and evaluated during a scheduled follow-up visit ('Follow-up'). Childhood Asthma Control Test, FeNO and lung function [forced expiratory volume 1 (FEV1) and forced vital capacity (FVC)] were evaluated.
Results:  In New vs Follow-up participants, C-ACT score ( P  <   0.001), FVC ( P  <   0.005) and FEV1 ( P  <   0.05) were significantly lower, and FeNO ( P  =   0.011) were significantly higher. In New, but not in Follow-up participants, significant correlations were observed between C-ACT score and FeNO ( r  = −0.51; P  <   0.001), FEV1 ( r  =   0.34; P  =   0.022) and FEV1/FVC ( r  =   0.32; P  =   0.03). This lack of correlation in Follow-up visits seemed attributable to dissociation between inadequately controlled asthma by C-ACT ratings with normalization of other measures such as FeNO levels.
Conclusions:  This study confirms and expands the concept that C-ACT is complementary to, but not a substitute for, other markers of disease control in asthmatic children, especially in the context of follow-up visits.     

Childhood bronchial asthma in a desert country

A 3 year-study of emergency room visits (total 50,300) to the paediatric clinic of the main teaching hospital in Kuwait revealed that the rates of bronchial asthmatic attacks increased significantly from 8.8% of all visits during the 1st year to 14.9% during the 3rd year. The seasonal distribution of asthmatic attacks showed maximum rates during the winter and minimum values in the summer, giving a very close inverse correlation to temperature and direct correlation to relative humidity. A similar, excellent correlation was seen between asthmatic attacks and upper respiratory infections. Occurrence of atmospheric pollen, which characteristically shows a bi-annual pattern i Kuwait, was not found to correlate with asthma attack rates. Neither was there any demonstrable effect of dust storms on the frequency of asthmatic attacks in the children. Independent of season, the boy to girl ratio among the asthma cases was remarkably constant, around 2:1.     

High-Sensitivity C-Reactive Protein Can Reflect Small Airway Obstruction in Childhood Asthma

PurposeHigh-sensitivity assays enabled the identification of C-reactive protein (hs-CRP) at levels that were previously undetectable. We aimed to determine if hs-CRP could reflect airway inflammation in children, by comparing hs-CRP with spirometry and impulse oscillometry (IOS) parameters and symptomatic severities.ResultsOf the 276 asthmatic children [median age 7.5 (5.9/10.1) years, 171 boys (62%)], 39 were hs-CRP positive and 237 were negative. Regarding spirometry parameters, we observed significant differences in maximum mid-expiratory flow, % predicted (FEF_25–75) (p=0.010) between hs-CRP positive and negative groups, and a negative correlation between FEF_25–75 and hs-CRP. There were significant differences in the reactance area (AX) (p=0.046), difference between resistance at 5 Hz and 20 Hz (R5–R20) (p=0.027), resistance at 5 Hz, % predicted (R5) (p=0.027), and reactance at 5 Hz, % predicted (X5) (p=0.041) between hs-CRP positive and negative groups. There were significant positive correlations between hs-CRP and R5 (r=0.163, p=0.008), and X5 (r=0.164, p=0.007). Spirometry and IOS parameters had more relevance in patients with higher blood neutrophil levels in comparison to hs-CRP.ConclusionHs-CRP showed significant correlation with FEF_25–75, R5, and X5. It can reflect small airway obstruction in childhood asthma, and it is more prominent in neutrophil dominant inflammation.     

Effect of Respiratory Infections on Exacerbation of Asthma in Adult Patients

The peak expiratory flow values and asthma symptom scores of 92 adults with extrinsic and intrinsic asthma were recorded daily from September 1981 to April 1982 in order to study the effects of symptomatic respiratory infections (SRI) on the course of asthma. During the follow-up, 253 exacerbations of asthma were observed in 67 patients. 68 subjects had 141 episodes of SRI. 63 of 253 exacerbations (25%) were found in association with SRI. The mean duration of the exacerbations associated with SRI was 11.4 days, significantly different (P less than 0.01) from the mean duration of 8.1 days recorded for the other exacerbations. The results confirm the high incidence of asthmatic exacerbations during respiratory infections and suggest that the recovery from an exacerbation is slower in association with infection.     

Reproducibility of Exercise-Induced Asthma in Children

The reproducibility of exercise-induced asthma (EIA) was studied in children with perennial asthma, using treadmill exercise challenge tests repeated at mean intervals of 1 week (Group I, n = 20), 1 month (Group II, n = 20) and 1 year (group III, n = 18). The protocol was standardized with respect to intensity and duration of exercise, time of last medication prior to exercise, air humidity, use of corticosteroids, asthma attacks, and 6) pollen season. The mean percentage fall in peak expiratory flow (PEF) following exercise remained significantly unchanged in the three groups. The reproducibility of EIA was improved compared with previous studies. Although the random variation of EIA tended to be greater in Group III, the individual severity of EIA was remarkably stable whatever the interval between tests. Improvements in baseline airway function between tests were not followed by a simultaneous decrease in EIA. In conclusion, the severity of EIA is reproducible in children with perennial asthma, when the exercise protocol is standardized for factors known to influence bronchial reactivity.     

A New Aerosol Formulation of Sodium Cromoglycate Compared with Conventional Powder in the Treatment of Asthma

Sodium cromoglycate formulated as a pressurised aerosol was compared with the conventional powder for a period of 12 weeks in a double-blind group comparison trial involving 48 patients. A double dummy technique was used; the dose of sodium cromoglycate was 2 mg four times daily by aerosol, and 20 mg four times daily by Spinhaler. Patients were able to use the correct technique for both aerosol and dry powder inhalation. Patients recorded the severity of their asthma symptoms, their morning and evening peak flow rate, and the amount of other asthma therapy used, on a daily diary card. They also attended the clinic every 4 weeks for assessment. A statistical comparison of the efficacy of the powder and aerosol forms found no significant differences in clinical assessment of severity, diary card symptom scores, morning and evening peak flow readings, or aerosol bronchodilator usage. Thirty-four patients considered that the aerosol was more convenient and easier to use than the dry powder inhaler.     

孟鲁司特对支气管哮喘患者体内炎症水平的影响

目的：研究孟鲁司特对支气管哮喘患者外周血嗜酸性粒细胞（EOS）、NF-kB、TNF-α、IL-10的影响。方法：检测40例急性发作期哮喘患者（哮喘组）孟鲁司特治疗前后外周血EOS、NF-kB活性、TNF-α、IL-10的水平变化,并与40例健康体检人员（对照组）作比较。结果：哮喘患者（治疗前）外周血EOS、NF-kB、TNF-α水平都明显高于对照组（P〈0.05）,IL-10水平明显低于对照组（P〈0.05）。哮喘患者治疗后,外周血EOS、NF-kB、TNF-α水平明显下降（P〈0.05）,IL-10水平明显升高（P〈0.05）。结论：孟鲁司特对哮喘患者外周血EOS、NF-kB、TNF-α、IL-10的水平有一定程度的调节作用,从而降低支气管哮喘患者体内炎症水平,促进病情缓解与好转。     

肺功能检测在支气管哮喘降阶梯治疗中的临床应用

目的肺功能检测在支气管哮喘降阶梯治疗中的临床应用价值。方法选取本院支气管哮喘患者124例作为研究对象,通过降阶梯治疗,并对治疗前后进行常规肺通气功能检查,比较肺功能指数变化。结果治疗后FVC(3.64±3.02)L、FEV1(2.54±5.06)L、FEV1%(74.32±62.14)、PEF(5.36±3.51)L/min、PEF%(82.34±64.21)L/min以及FVC%(91.12±64.58)优于治疗前,比较均存在统计学差异(P0.05)。结论肺通气功能检测在支气管哮喘降阶梯治疗以及控制病情方面具有良好作用,值得临床医生推广应用。     

Neuropsychological Effects of Central Nervous System Prophylactic Treatment in Childhood Leukemia: Methodological Considerations

Reviewed 53 studies on the effects of centred nervous systemprophylactic treatment (CNSPT) on cognition and neuropsychologicalfunctioning. CNSPT involves irradiation and/or chemotherapydirected to the brain, and is frequently administered to childrenwho have leukemia. The effects of CNSPT on neuropsychologicalfunctioning in long-term cancer survivors remains controversial.A number of studies failed to identify any neuropsychologicalimpact secondary to CNSPT, whereas others reported deficitsthat appear to be a function of CNSPT. Several methodologicalissues that make it difficult to draw meaningful conclusionsfrom this research literature are identified and discussed.Specific recommendations are made for improvements in researchon CNSPT in children.     

Effects of ketotifen on symptoms and on bronchial mucosa in patients with atopic asthma

Ketotifen is marketed throughout the world as an antiallergy drug, but whether it affects infiltration of inflammatory cells into airway mucosa is not known. We studied the effects of ketotifen on symptoms, pulmonary function, and airway inflammation in 25 patients with atopic asthma. Patients took ketotifen (1 mg twice daily) or a matching placebo for 8 weeks in a double-blind, parallel-group study. Data recorded on diary cards were used for 2 weeks before treatment began, and they were used for the last 2 weeks of treatment to study asthma symptoms, use of β2–agonists, and peak expiratory flow (PEF). Pulmonary function tests, bronchial responsiveness to methacholine, and fiberoptic bronchoscopy were performed before and after treatment. Biopsy specimens were obtained by bronchoscopy. Specimens were stained immunohistochemically with monoclonal antibodies against stored eosinophil cationic protein (EG1), the secreted form of eosinophil cationic protein (EG2), mast-cell tryptase (AA1), neutrophil elastase (NP57), CD3, CD4, CD8, and CD25. The numbers of positively stained cells in the lamina propria were counted. Compared with the placebo, the ketotifen-treated group exhibited significant improvement of asthma symptoms ( P <0.05) and bronchial responsiveness (P<0.05). This was accompanied by a reduction of EG2+ eosinophils ( P <0.05), CD3+ T cells ( P <0.001), CD4+ T cells (P<0.01), and CD25+ activated T cells ( P <0.01) in the bronchial mucosa. These results suggested that the beneficial effects of ketotifen in bronchial asthma may result from consequent inhibition of activated eosinophils and T-cell recruitment into the airway. Moreover, ketotifen may relieve allergic inflammation in bronchial asthma.     

无创机械通气时氧动力雾化与超声雾化吸入治疗支气管哮喘的疗效观察

目的　观察无创机械通气时氧动力雾化吸入与超声雾化吸入治疗支气管哮喘的疗效区别。方法　 5 0例符合支气管哮喘急性发作患者随机分为 2组 ,即超声雾化吸入组 (A组 )和氧动力驱动雾化组 (B组 )各 2 5例。均吸入博力康尼令舒及爱喘乐 ,各 5 0 0 μg ,15min后观察各组临床症状改善情况。测定治疗前、治疗后 15min和 30min峰流速(PEF)的改变情况。结果　B组治疗后 15min、30min峰流速值与A组相比存在显著性差异 (P <0 .0 1)。B组治疗后症状及体征改善率显著优于A组 (P <0 .0 1)。结论　无创机械通气时氧气作动力雾化吸入在治疗支气管哮喘急性发作方面有更好的疗效 ,是一种快速、高效的方法     

孟鲁司特钠联合布地奈德治疗小儿哮喘的临床疗效分析

目的 探讨小儿哮喘应用孟鲁司特钠与布地奈德联合治疗的疗效。方法 选取本院儿科2014年7月~2015年7月接收治疗的110例哮喘患儿,随机分为甲组和乙组,各55例。甲组患儿单纯应用布地奈德进行治疗,乙组患儿在甲组治疗的同时联合应用孟鲁司特钠,对比两组哮喘患儿的肺功能、炎性情况以及临床疗效。结果 ①乙组治疗后的FEV1、FVC与PEF依次为（0.89±0.20）L、（0.83±0.19）L、（90.00±18.20）L/s,均分别高于甲组的（0.78±0.30）L、（0.65±0.20）L、（81.20±21.00）L/s,差异有统计学意义（P＜0.05）。②乙组治疗后的hs-CRP、IL-6依次为（8.00±1.29）mg/L、（44.00±12.40）pg/ml,分别低于甲组的（11.30±2.00）mg/L、（95.68±16.55）pg/ml,差异有统计学意义（P＜0.05）。③乙组治疗总有效率为90.91%,高于甲组的72.73%,差异有统计学意义（P＜0.05）。结论 对哮喘患儿应用孟鲁司特钠与布地奈德联合治疗,有助于缓解呼吸道炎性症状、改善肺功能,促进临床疗效的进一步提升。