Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma.

OBJECTIVE: In children with mild acute asthma, to compare treatment with a single dose of albuterol delivered by a metered dose inhaler (MDI) with a spacer in either a weight-adjusted high dose or a standard low-dose regimen with delivery by a nebulizer. STUDY DESIGN: In this randomized double-blind trial set in an emergency department, 90 children between 5 and 17 years of age with a baseline forced expiratory volume in 1 second (FEV1 ) between 50% and 79% of predicted value were treated with a single dose of albuterol, either 6 to 10 puffs (n = 30) or 2 puffs (n = 30) with an MDI with spacer or 0.15 mg/kg with a nebulizer (n = 30). RESULTS: No significant differences were seen between treatment groups in the degree of improvement in percent predicted FEV1 (P =.12), clinical score, respiratory rate, or O2 saturation. However, the nebulizer group had a significantly greater change in heart rate (P =.0001). Our study had 93% power to detect a mean difference in percent predicted FEV1 of 8 between the treatment groups. CONCLUSION: In children with mild acute asthma, treatment with 2 puffs of albuterol by an MDI with spacer is just as clinically beneficial as treatment with higher doses delivered by an MDI or by a nebulizer.     

Higher-dose intravenous magnesium therapy for children with moderate to severe acute asthma

OBJECTIVE: To evaluate the efficacy of a 40-mg/kg dose of intravenous magnesium sulfate for moderate to severe asthma exacerbations in pediatric patients. STUDY DESIGN: Double-blind placebo-controlled trial. SETTING: Two urban tertiary care pediatric emergency departments. SUBJECTS: Thirty patients, aged 6 to 17.9 years, being treated for an acute asthma exacerbation. INTERVENTION: Eligible patients received either a magnesium sulfate infusion of 40 mg/kg or saline solution. RESULTS: At 20 minutes, the time at which the infusion was completed, the magnesium group had a significantly greater percentage of absolute improvement from baseline in each of the following: predicted peak expiratory flow rate (8.6% vs 0.3%, P<. 001), forced expiratory volume in 1 second (7.0% vs 0.2%,P<.001), and forced vital capacity (7.3% vs -0.7%, P<.001). The improvement was greater at 110 minutes: peak expiratory flow rate (25.8% vs 1.9%, P<.001), forced expiratory volume in 1 second (24.1% vs 2.3%; P<. 001), and forced vital capacity (27.3% vs 2.6%, P<.001). Patients who received intravenous magnesium were more likely to be discharged to their homes than those who received the placebo (8/16 vs 0/14; P=. 002). CONCLUSION: Children treated with 40 mg/kg of intravenous magnesium sulfate for moderate to severe asthma showed remarkable improvement in short-term pulmonary function.     

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     

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。     

Comparison of handling and acceptability of two spacer devices in young children with asthma

This study compared parents' preference for two spacer devices, NebuChamber® and Babyhaler® for the treatment of young children with asthma. In this open, cross-over study 141 patients (aged 5-57 mo) who used inhaled steroids via a spacer device were randomized to budesonide via NebuChamber or beclomethasone dipropionate via Babyhaler. Both treatments were given by the parents twice daily for 2 wk. At the final visit parents completed a questionnaire on preference in general and for a given set of features. Acceptability and handling were scored in a diary. Diary scores on acceptability by the child and handling of both spacer devices were comparable. In the preference questionnaire, 68% of parents preferred NebuChamber [95% confidence interval (CI) 60-76] and 25% Babyhaler (95% CI 18-33). The preference was independent of the type of spacer used before the study and was also apparent in the different features: acceptability by child, carrying around, cleaning, close fitting of face mask, assembling and disassembling, damage resistance and size. These differences were statistically significant for all features, except for acceptability by the child. Conclusion: Two-thirds of parents prefer NebuChamber over Babyhaler for the treatment of their young asthmatic children.     

Influence of spacer device on drug delivery to young children with asthma

The budesonide dose delivered to the patient from three different spacer devices (Nebuhaler = 750 ml, Aerochamber = 140 ml, and Babyspacer = 260 ml) was assessed by measuring the budesonide dose deposited on a filter inserted between the spacer outlet and the mouth of the patient. Twenty children aged 10-25 months were given a single dose of 200 micrograms budesonide from each spacer device in a randomised crossover study. All spacers had a facemask attached and a one way valve system. The children breathed through the inhalation system for 30 seconds. Furthermore, the minute ventilation of the children through a tightly fitting facemask was measured. The filter dose of budesonide was significantly lower after Aerochamber treatment (39.4 micrograms, range 19-67 micrograms) than after Nebuhaler (53.5 micrograms, range 34-88 micrograms) and Babyspacer (55.5 micrograms, range 39-76 micrograms) treatment. The minute ventilation of the children varied from 1.4 l/min to 7.0 l/min (mean 5.0 l/min). This was sufficient to empty all spacers within the 30 seconds of inhalation. It is concluded that spacer volume does not seem to be so important for children aged 10-25 months as long as spacers with a volume lower than 750 ml are used.     

小儿重症哮喘的治疗

重症哮喘(severe asthma)患儿在临床上较为常见。由于严重的支气管痉挛、黏液过度分泌和气道炎症、水肿等影响,如不及时治疗可发展至呼吸衰竭甚至死亡,是临床急症之一。重症哮喘在全球仍是收入PICU患儿的常见疾病,并仍然有很高的病死率。有资料报道,美国15岁以下哮喘患儿病死率从1979年的1·2/10万上升至1995年的2·1/10万。我国目前尚无全国性流行病学调查数据。高度重视、早期确诊、恰当治疗、减少并发症是降低病死率的关键[1]。1避开哮喘发作诱因哮喘的发作起始于各类诱发因素的刺激,而发作后诱发因素的持续接触,能增高气道对其他变应…     

The tube spacer in children with asthma

ABSTRACT. We compared the use of a standard metered aerosol actuator with the tube spacer in delivering 500 micrograms of terbutaline sulphate to the airways of seven children with clinical asthma. Each child used the standard metered aerosol in his usual way and the tube spacer with a 5 second delay between actuation and inhalation on separate occasions. Response was measured by change in forced expiratory volume in one second (FEV₁). We found no significant difference in bronchodilatation between the two methods of aerosol delivery. We conclude that the tube spacer is an effective way of delivering a metered aerosol and that it has the advantage of allowing up to 5 seconds between actuation and inhalation. The tube spacer has particular application in young children who have difficulty in co-ordinating their inspiration with metered aerosol actuation.     

Influence of spacer device on drug delivery to young children with asthma.

The budesonide dose delivered to the patient from three different spacer devices (Nebuhaler = 750 ml, Aerochamber = 140 ml, and Babyspacer = 260 ml) was assessed by measuring the budesonide dose deposited on a filter inserted between the spacer outlet and the mouth of the patient. Twenty children aged 10-25 months were given a single dose of 200 micrograms budesonide from each spacer device in a randomised crossover study. All spacers had a facemask attached and a one way valve system. The children breathed through the inhalation system for 30 seconds. Furthermore, the minute ventilation of the children through a tightly fitting facemask was measured. The filter dose of budesonide was significantly lower after Aerochamber treatment (39.4 micrograms, range 19-67 micrograms) than after Nebuhaler (53.5 micrograms, range 34-88 micrograms) and Babyspacer (55.5 micrograms, range 39-76 micrograms) treatment. The minute ventilation of the children varied from 1.4 l/min to 7.0 l/min (mean 5.0 l/min). This was sufficient to empty all spacers within the 30 seconds of inhalation. It is concluded that spacer volume does not seem to be so important for children aged 10-25 months as long as spacers with a volume lower than 750 ml are used.     

联合吸入治疗儿童中重度哮喘疗效观察

目的探讨沙美特罗替卡松复方干粉制剂治疗我国4-14岁哮喘患儿的临床疗效和安全性方法 对中重度支气管哮喘30例患儿进行3个月治疗,使用沙美特罗替卡松干粉吸入剂(沙美特罗50μg/泡,替卡松100μg/泡),经准纳器吸入,2次/d 观察治疗前及治疗后1周、3个月最大呼气流速(PEF)及PEF占预计值的百分数、日间和夜间症状评分、患儿及家长对疗效的自我评价及药物相关的不良事件。结果 治疗第1周后平均PEF值及PEF占预计值百分数均有显著改善,治疗3个月均恢复正常 治疗前平均日间症状评分为3.4分,夜间症状评分3.2分,治疗后日间症状及夜间症状评分均为0分 治疗第1周至治疗结束,患儿及家长对疗效的自我评价为均显效 无1例发生与药物相关的不良事件结论 吸入沙美特罗替卡松干粉治疗哮喘起效快,疗效显著,可显著改善患儿生活质量,且安全性良好 实用儿科临床杂志,2004,19(12):1035-1037     

小儿重症哮喘的机械通气治疗

病情极危重的哮喘常被称为“致死型哮喘”或“危及生命的哮喘”,表现为严重的低氧血症、呼吸性酸中毒、呼吸肌疲劳、肺性脑病等。这些症状可危及生命且药物治疗通常不能缓解。1961年Leonhardt首先用机械通气治疗危重型哮喘,现已成为治疗这类疾病的重要手段。哮喘的机械通气治疗     

Comparison of six-minute walk test in children with moderate/severe asthma with reference values for healthy children

Objectiveto compare physical performance and cardiorespiratory responses in the six-minute walk test (6MWT) in asthmatic children with reference values for healthy children in the same age group, and to correlate them with intervening variables.Methodsthis was a cross-sectional, prospective study that evaluated children with moderate/severe asthma, aged between 6 and 16 years, in outpatient follow-up. Demographic and spirometric test data were collected. All patients answered the pediatric asthma quality of life (QoL) questionnaire (PAQLQ) and level of basal physical activity. The 6MWT was performed, following the American Thoracic Society recommendations. Comparison of means was performed using Student's t-test and Pearson's correlation to analyze the 6MWT with study variables. The significance level was set at 5%.Results40 children with moderate or severe asthma were included, 52.5% males, 70% with normal weight and sedentary. Mean age was 11.3 ± 2.1 years, mean height was 1.5 ± 0.1 m, and mean weight was 40.8 ± 12.6 Kg. The mean distance walked in the 6MWT was significantly lower, corresponding to 71.9% ± 19.7% of predicted values; sedentary children had the worst values. The difference between the distance walked on the test and the predicted values showed positive correlation with age (r = 0.373, p = 0.018) and negative correlation with cardiac rate at the end of the test (r = -0.518, p < 0.001). Regarding QoL assessment, the values in the question about physical activity limitations showed the worst scores, with a negative correlation with walked distance difference (r = -0.311, p = 0.051).Conclusionsasthmatic children's performance in the 6MWT evaluated through distance walked is significantly lower than the predicted values for healthy children of the same age, and is directly influenced by sedentary life style.     

Metered-dose inhaler with spacer vs nebulization for severe and potentially severe acute asthma treatment in the pediatric emergency department]

OBJECTIVE: To compare treatment with beta 2 agonist delivered either by a spacer device or a nebulizer in children with severe or potentially severe acute asthma. METHODS: In this randomized trial, children 4 to 15 years, cared for in the emergency department for severe or potentially severe acute asthma, received 6 times either nebulizations of salbutamol (0.15mg/kg) or puffs of a beta 2 agonist (salbutamol 50 microg/kg or terbutaline 125 microg/kg). The primary outcome was the hospitalization rate. Secondary outcomes included percentage improvement in Bishop score, in PEF, SaO(2), respiratory and heart rates, side effects, length of stay and relapses 10 and 30 days later. RESULTS: Groups did not differ for baseline data. There were no significant differences between the 2 groups (nebulizer N=40, spacer N=39) for baseline characteristics before emergency department consultation except for length of acute asthma in the spacer group. Clinical evolution after treatment, hospitalization rate, relapse were similar including the more severe subgroup. In the spacer group, tachycardia was less frequent (P<0.02). The overall length of stay in the emergency department was significantly shorter (148+/-20 vs 108+/-13 min, P<10(-9)). CONCLUSIONS: The administration of beta 2 agonist using a metered-dose inhaler with spacer is an effective alternative to nebulizers for the treatment of children with severe or potentially severe acute asthma in the emergency department. Time gained can be used for asthma education.     

The effects of ipratropium bromide and fenoterol nebulizer solutions in children with asthma

The effects of nebulized solutions of ipratropium bromide and fenoterol combined were compared with the response to either preparation alone in single dose and longer-term administration in children who had asthma. The combination produced a slightly greater response than either alone, especially in peak expiratory flow. Over a 1-month period, there were no significant differences in symptom scores or lung function parameters between the combination of ipratropium bromide and fenoterol and fenoterol alone in a group of children who had asthma. It is possible that the addition of ipratropium bromide to a sympathomimetic drug may be useful in a subgroup of asthmatics, particularly if there is a considerable large airway contribution to bronchial narrowing.