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.     

Systemic absorption of salbutamol following nebulizer delivery in acute asthma

We measured plasma salbutamol concentrations in 35 children with acute asthma attacks before and after nebulizer therapy. The main finding was that older children had higher concentrations than younger children, despite similar dosage regimens. There was no influence of severity of the asthma attack on the following measures: pre- and post-nebulizer concentrations, absolute and percentage change in salbutamol levels with therapy. We conclude that the theoretical risks of high concentrations in young children were not found and we suggest that the very young may indeed require higher doses due to possible problems in nebulizer technique or differences in kinetics.     

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.     

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.     

Nonspecific bronchial hyperresponsiveness and development of asthma in children with hay fever

It has been suggested that patients with allergic rhinitis who present nonspecific bronchial hyperresponsiveness (BHR) are those most likely to develop asthma. Therefore, a study was conducted in children with rhinoconjunctivitis to ascertain whether BHR to methacholine might predict the development of asthma in these patients. Fifteen patients with hay fever and no previous symptoms of asthma were selected. All underwent clinical symptom tests and methacholine tests, during the pollen season in the 4 consecutive years following the start of the study. At the end of this period, 5 patients had developed asthma. It may thus be affirmed that, in this group, neither the presence nor the degree of previous BHR was useful for predicting which patients would later develop asthma.     

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.     

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.     

Tissue Doppler echocardiographic assessment of cardiac function in children with bronchial asthma

BACKGROUND: The aim of the present study was to evaluate the role of tissue Doppler echocardiography in assessment of ventricular function in pediatric patients with bronchial asthma (BA). PATIENTS AND METHODS: Fifty-one pediatric patients with BA and 30 age- and sex-matched healthy subjects were studied. BA patients were divided into two groups: mild BA (n = 33) and moderate to severe BA (n = 18). All subjects were examined on conventional and tissue Doppler echocardiography, and 44 patients had pulmonary function tests on spirometry within 1 week of echocardiographic examination. RESULTS: Conventional echocardiographic parameters were all similar in mild asthmatic patients and control subjects. Tricuspid E velocity, E/A ratio and isovolumetric relaxation time (IVRT) in moderate and severe cases differed significantly from mild cases and control subjects. E', A', E'/A' ratio and IVRT of the lateral tricuspid annulus, and IVRT of the medial and lateral mitral annuli were different between mild cases and control subjects. E' velocity and IVRT of the lateral tricuspid annulus and IVRT of the medial and lateral mitral annuli were also different between mild cases and moderate to severe cases. Pulmonary function tests correlated well with E', E'/A' and IVRT of lateral tricuspid annulus. CONCLUSION: Patients with BA have subclinical right ventricular diastolic dysfunction even in the early stages. The severity of the functional impairment is parallel with the severity of the disease. Tissue Doppler echocardiography has a greater predictive value than conventional imaging, and is useful for evaluating ventricular function in patients with BA.     

Treatment of asthma crises in children with nebulized salbutamol

Thirty-two children were treated with nebulized salbutamol for acute asthma. Seventy-five per cent of the treatments were efficient, either after a first nebulization at 0.15 mg/kg (47% = group I), or after a second nebulization 45 min later, at 0.05 mg/kg (27% = group II). Twenty-five per cent of the treatments (group III) were inefficient or only partly efficient. The clinical tolerance was good except in two children. Group I and II presented differences only for the auscultation score. Children from group I and II were older and had less severe asthma than those from group III. On the basis of this study, nebulized salbutamol appears to be an affective and safe treatment for acute asthma. The repeated administration of low doses, shortly after the first nebulization increases the quality of the response.     

哮喘儿童白细胞介素13基因型与表型的关联研究

目的探讨哮喘儿童白细胞介素13(IL-13)Arg130Gln基因型与血清总IgE、IL-13水平及过敏原表型之间的关系。方法采用聚合酶链式反应-限制性片段长度多态性(PCR-RFLP)法,对130例哮喘患儿和100例健康对照儿童进行IL-13Arg130Gln基因多态性的检测,并用酶免法检测血清总IgE、IL-13水平和空气过敏原。结果基因型分布及等位基因频率哮喘组与对照组比较差异均无显著性,哮喘组突变型个体的Log10IL-13水平高于未突变型个体的水平(P<0.05),哮喘组突变纯合型个体的Log10IgE水平高于突变杂合型及未突变型个体的水平(P<0.05),哮喘组及对照组突变型与未突变型的过敏原阳性率比较差异均无显著性。结论IL-13Arg130Gln突变不是中国长春地区儿童哮喘的易感基因,但此突变可能与血清IL-13蛋白质水平升高有关,突变纯合型可能与血清总IgE水平相关联。     

Additive effects of dexamethasone in nebulized salbutamol or l-epinephrine treated infants with acute bronchiolitis

BACKGROUND: Although it is the most common lower respiratory infection of infancy, the optimal treatment for acute bronchiolitis is still controversial. The aim of this study was to compare the early and late effects of nebulized L-epinephrine (EPI) and intramuscular dexamethasone (DEX) combination therapy with nebulized salbutamol (SAL) and dexamethasone combination and bronchodilators alone in outpatients with acute bronchiolitis. METHODS: A total of 69 infants aged 2-21 months who were admitted to the Pediatrics Department of the Faculty of Medicine, Mersin University, with acute bronchiolitis were included in a randomized, placebo-controlled, prospective trial study. Patients were assigned to receive either nebulized L-epinephrine (3 mg) or salbutamol (0.15 mg/kg) and 15 min later, either dexamethasone 0.6 mg/kg or placebo (PLA), intramuscularly, in a double-blind randomized fashion. The study groups were: epinephrine + dexamethasone group (group 1, n=23), salbutamol + dexamethasone group (group 2, n=23), epinephrine + placebo group (group 3, n=11), and salbutamol + placebo group (group 4, n=12). The outcome measures were heart rate, respiratory rate and Respiratory Distress Assessment Instrument (RDAI) score determined at 30, 60, 90 and 120 min, 24 h, and 5 days after the first therapy. Patients were then followed-up during the subsequent 2 months for the prevalance of respiratory complaints regarding bronchial hyperreactivity. RESULTS: There were no significant differences between the outcome variables of the four groups within the first 120 min and at 24 hours, or between the rates of requirement of a second dose of the same bronchodilator. However, fifth day RDAI score values of both DEX groups were significantly lower than that of SAL + PLA group (P=0.000 and P=0.01, respectively). The fifth day score value of group 1 was also significantly better than that value of EPI + PLA group but not different from group 2. CONCLUSIONS: A single dose of intramuscular dexamethasone added to nebulized L-epinephrine, or salbutamol therapies resulted in better outcome measures than bronchodilators alone in the late phase (fifth day) of mild to moderate degree bronchiolitis attack. However, effects of EPI + DEX combination was not different from SAL + DEX combination.     

Non-atopic asthma in children is related to maternal bronchial hyperreactivity

Data on the pathogenic mechanisms underlying the development of non-atopic asthma in children are scarce. Our aim was to evaluate the association and compare the atopic status, pulmonary functions, bronchial hyperresponsiveness and serum total immunoglobulin E (IgE) levels of parents of atopic and non-atopic asthmatic children by using objective methods. Fifty-one asthmatic children aged 4–16 yr and their parents were included into the study. Initially the American Thoracic Society's Respiratory Disease questionnaire inquiring data on symptoms of asthma, rhinitis and past medical history was filled in. Afterwards, skin prick test with aeroallergens, pulmonary function and methacholine bronchial provocation tests and serum sampling for total IgE level determinations were carried out. Bronchial hyperresponsiveness to methacholine was significantly more common in the mothers of non-atopic children compared to those of atopic ones, although no significant difference was observed in the skin prick test reactivity, pulmonary function test parameters and serum IgE levels. Questionnaire data revealed that the presence of asthmatic symptoms such as wheezing and phlegm and doctor-diagnosed asthma were more common in the mothers of non-atopic children. Meanwhile, asthmatic symptoms were also found to be significantly more common in fathers of non-atopic children. Logistic regression analyses revealed that maternal PC₂₀ was the only predictive factor for the risk of displaying non-allergic asthma in children. The results demonstrate that among the risk factors studied, maternal bronchial hyperreactivity was associated with the development of asthma in non-atopic children.     

Adrenaline and nebulized salbutamol in acute asthma.

The effects of injected adrenaline and nebulized salbutamol on acute asthma were compared in 46 children. The results showed that salbutamol had a significantly better bronchodilatory effect than adrenaline. Nebulized salbutamol is recommended as a primary method of treatment of asthmatic attacks in childhood.     

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。     

哮喘患儿外周血单个核细胞趋化因子的分泌及意义

为探讨外周血单个核细胞 (PBMC)分泌的正常T细胞活化后所表达和分泌的调节蛋白 (RANTES)与哮喘临床表型的关系 ,选择不同发病状况的哮喘患儿45例 ,取外周血分离单个核细胞 ,进行细胞培养 ,用酶联免疫吸附 (ELISA)方法测定细胞培养上清的RANTES含量。结果缓解期与发作期哮喘患儿外周血单个核细胞均能分泌一定水平的RANTES ,经植物血凝素 (PHA)刺激后RANTES分泌水平显著增加 (P<0.05) ;特应性哮喘患儿PBMC经PHA刺激后分泌RANTES水平显著高于非特应性哮喘患儿(P<0.05) ,以血清总IgE增高患儿更为明显 ;哮喘患儿PBMC经刺激后分泌RANTES与血清总IgE水平及吸入性过敏原皮肤点刺检查阳性数呈显著相关(P<0.05)。表明除趋化作用外 ,RANTES可能促进IgE合成 ,从而在特应性哮喘发病中发挥重要作用     

肺炎支原体肺炎及支气管哮喘HLA-DRB1基因位点频率研究

为探讨肺炎支原体（MP）肺炎的免疫致病机理及其与支气管哮喘9简称哮喘）之间的关系。应用颗粒凝集法检测29例MP肺炎患儿，40例哮喘患儿及92例正常对照组的血清MP特异性IgM抗体，PCR-SSOP法标记HLA-DRB1等痊基因位点。结果显示MP肺炎组，哮喘组的DRB1*08基因频率明显低于正常对照组（P=0.035)。但MP肺炎组与哮喘组之间差异无显著性，哮喘组中除DRB*08外，DRB1*02基因出现频率亦较正常人显著降低（P=0.041)；各组间HLA-DRB1*04，07，09，10，11，12基因频率虽有所变化，但均无统计学差异。提示MP肺炎与哮喘有着极为相似的遗传易感性。     

High prevalence and young onset of allergic rhinitis in children with bronchial asthma

Bronchial asthma and allergic rhinitis often co-exist, and rhinitis is a major risk factor for the development of asthma. However, the reported incidence of allergic rhinitis in asthmatic children varies widely. The aim of this study was to elucidate the incidence of allergic rhinitis, the onset age of chronic upper and lower airway symptoms, and the correlation of these two symptoms in asthmatic children. A cohort of 130 consecutive children (ages 2–10) with asthma was evaluated. A questionnaire regarding upper and lower airway symptoms was filled out by the parents. Objective diagnosis of allergic rhinitis was also made on the basis of rhinoscopy, nasal cytology, nasal challenge, and specific serum IgE (CAP-RAST). Persistent nasal symptoms were present in 83.8% of the asthmatic children. The incidence of allergic rhinitis was 77.7% based on the objective findings. The mean onset age of asthma was 2.8 yr, and that of rhinitis was 2.9 yr. Nasal symptoms started as early as the first year of life in 8.9% of the children. In children with comorbid asthma and allergic rhinitis, rhinitis preceded in 33.7%, asthma preceded in 31.7%, and both started in the same year in 26.7%. In 7.9%, rhinitis was asymptomatic. Concomitant exacerbation of the upper and lower airways occurred in 34.6% of the total 130 children. These results demonstrate that allergic rhinitis manifested early in life in the majority of the asthmatic children. Persistent nasal symptoms in infancy may point to subsequent development of asthma and possible early intervention.     

(n-6)-Fatty acids in plasma lipids of children with atopic bronchial asthma

It has been suggested that atopy is associated with an impairment in the δ6-desaturation of (n-6)-polyunsaturated fatty acids and subsequently low levels of eicosanoid precursors. To evaluate this hypothesis we analyzed the fatty acid composition of plasma phospholipids and plasma cholesterolest-ers in a well-defined group of children with atopic bronchial asthma (n = 17) and age-matched healthy controls (n = 10). Atopic children showed significantly higher levels of linoleic acid and lower proportions of arachidonic acid in plasma lipids. No differences were observed with respect to γ-lino-lenic acid (GLA) and dihomo-γ-linolenic acid (DHLA). It is concluded that there is no biochemical evidence for a δ6-desaturation defect in atopic children and therefore no justification for the supplementation of GLA and DHLA; e.g. by the use of evening primrose oil preparations.     

低剂量丙酸倍氯松吸入对轻度哮喘儿童气道高反应性的影响

为探讨低剂量丙酸倍氯松（ＢＤＰ）吸入对轻度哮喘儿童肺功能及气道高反应性（ＢＨＲ）的影响,将３０例轻度哮喘患儿随机分为３组,分别吸入安慰剂、ＢＤＰ２００μｇ／ｄ或４００μｇ／ｄ。结果：患儿吸入２００μｄ／ｇ或４００μｇ／ｄＢＤＰ后,哮喘症状及肺功能明显改善,ＢＨＲ显著下降,各项指标变化在２００μｇ组及４００μｇ组间无显著差异。结论：每天吸入２００μｇＢＤＰ即能有效控制轻度哮喘的临床症状,改善其肺功能     

低剂量丙酸倍氯松吸人对轻度哮喘儿童气道高反应性的影响

为探讨低剂量丙酸倍托松(BDP)吸入对轻度哮喘儿童肺功能及气道高反应性(BHR)的影响,将30例轻度哮喘患儿随机分为3组,分别吸入安慰剂、BDP200μg/d或400μg/d。结果;患儿吸入200μg/d或400μg/dBDP后,哮喘症状及肺功能明显改善,BHR显著下降,各项指标变化在200μg组及400μg组间无显著差异。结论,每天吸入200μgBDP即能有效控制轻度儿童哮喘的临床症状,改善其肺功能井降低BHR,将剂量增加至400μg/d并不能明显增加疗效。建议使用BDP吸入疗法治疗轻度儿童哮喘时,常规剂量宜采用200μg/d。