Effect of ipratropium bromide on respiratory mechanics in infants with acute bronchiolitis

The effect of nebulized ipratropium bromide in 14 infants (mean age: 20 weeks, range: 4-41) with acute respiratory syncytial virus bronchiolitis was examined. A modified rapid chest compression technique was used to obtain partial expiratory flow-volume curves and maximum flow at functional residual capacity. Passive respiratory mechanics were assessed by brief occlusion at end inspiration. Thoracic gas volume was measured in a body plethysmograph. No significant difference was found in forced and passive respiratory mechanics pre- and post-ipratropium bromide. No subgroups could be identified. These results do not support the use of ipratropium bromide in acute viral bronchiolitis.     

Effect of ipratropium bromide on respiratory mechanics in infants with acute bronchiolitis

The effect of nebulized ipratropium bromide in 14 infants (mean age:20 weeks, range:4–41) with acute respiratory syncytial virus bronchiolitis was examined. A modified rapid chest compression technique was used to obtain partial expiratory flow-volume curves and maximum flow at functional residual capacity. Passive respiratory mechanics were assessed by brief occlusion at end inspiration. Thoracic gas volume was measured in a body plethysmograph. No significant difference was found in forced and passive respiratory mechanics pre- and post-ipratropium bromide. No subgroups could be identified. These results do not support the use of ipratropium bromide in acute viral bronchiolitis.     

Effect of oral and inhaled salbutamol in infants with bronchiolitis

The response of bronchiolitis to bronchodilator drugs is controversial. The present study was designed to evaluate the efficacy of oral or metered dose inhaler (MDI) salbutamol using a coffee cup as a spacer device in bronchiolitis. In the trial, 31 hospitalized patients between 6 and 24 months of age, who exhibited the first episode of acute bronchiolitis without any other predisposing illness such as cystic fibrosis, congenital heart disease etc., were randomly assigned to receive oral salbutamol (n=11, 0.1 mg/kg per dose, four times a day), or MDI salbutamol (n = 12, 200 μg per dose, every 3 h) or formed the control group without any bronchodilator therapy (n = 8). All of the patients were given supplemental oxygen as needed and adequate hydration was maintained. The patients were evaluated with clinical symptom scores. There were no differences in the beneficial or side effects of salbutamol, or the number of days in hospital between the treatment groups and the control group. It was concluded that there is no beneficial effect in using bronchodilators in infants with bronchiolitis. Supplemental oxygen and maintenance of normal hydration may be adequate.     

Randomized trial of salbutamol in acute bronchiolitis

To test whether nebulized salbutamol (albuterol) is safe and efficacious for the treatment of young children with acute bronchiolitis, we enrolled 83 children (median age 6 months, range 1 to 21 months) in a randomized, double-blind clinical trial. Participants received two treatments at 30-minute intervals of either nebulized salbutamol (0.10 mg/kg in 2 ml 0.9% saline solution) or a similar volume of 0.9% saline solution placebo. Outcome measures were the respiratory rate, pulse oximetry, and a clinical score based on the degree of wheezing and retractions. Patients in the salbutamol arm had significantly greater improvement in clinical scores after the initial treatment (p = 0.04). There was no difference between the groups in oxygen saturation (p = 0.74); patients treated with salbutamol had a small increase in heart rate after two treatments (159 +/- 16 vs 151 +/- 16; p = 0.03). We conclude that salbutamol is safe and effective for the initial treatment of young children with acute bronchiolitis.     

沙丁胺醇、丙酸氟替卡松吸入佐治毛细支气管炎疗效观察

毛细支气管炎 (毛支 )为 2岁以下婴幼儿特有呼吸道感染性疾病。既往治疗方法多为抗病毒、氧疗、短期静脉应用糖皮质激素。本文应用沙丁胺醇溶液 (万托林 ) (葛兰素史克公司生产 ,生产批号 :C0 7195 0 )和丙酸氟替卡松 (辅舒酮 ) (葛兰素史克公司生产 ,生产批号 :D0 36 32 7)吸入佐治小儿毛支 ,疗效显著。现将报道如下。对象与方法一、对象　 2 0 0 2年 3～ 12月我科收治的毛支患儿 96例 ,均符合毛支诊断标准[1] 。随机分为治疗组、对照组各 4 8例。年龄 3～ 18个月 ;男 5 2例 ,女 4 4例。两组例数、性别、年龄、病程均无显著性差异 (P均 >…     

Effect of surgical repair on respiratory mechanics in congenital diaphragmatic hernia

To determine whether surgical repair of congenital diaphragmatic hernia (CHD) results in improvement in respiratory mechanics, we measured respiratory system compliance in nine patients (five survivors and four nonsurvivors) before and after operation. In all nine infants, CHD was diagnosed within 6 hours of life, and surgical repair was through an abdominal approach after a period of stabilization. Measurements were made noninvasively, using the passive expiratory flow-volume technique. In only one of the nine infants did compliance immediately improve after surgical repair, and in another it showed no change. Both of these infants survived, with an uneventful postoperative course. In the remaining seven infants, however, postoperative compliance immediately decreased to 10% to 77% from the preoperative value. The four infants with more than 50% decrease in compliance died with increasing hypoxemia and acidosis. These results suggest that respiratory mechanics in CHD, far from improving, frequently deteriorate as a result of repair of the hernia. The role of urgent surgery in this malformation should be reevaluated.     

The efficacy of nebulized salbutamol,magnesium sulfate,and salbutamol/magnesium sulfate combination in moderate bronchiolitis

The aim of this paper is to compare the effect of nebulized magnesium sulfate to nebulized salbutamol and salbutamol/magnesium sulfate on successful discharge from the emergency department. A total of 56 infants were included in this double-blinded, prospective study. Infants were grouped according to the nebulized treatment they received: group 1—salbutamol/normal saline, group 2—magnesium sulfate and normal saline, and group 3—salbutamol plus magnesium sulfate. Heart beat, bronchiolitis, clinical severity scores (CSS), and oxygen saturation of the patients were determined before and after nebulization (0, 1, 4 h). The patients were monitored for adverse reactions. Post-treatment mean CSS results were significantly lower than pre-treatment scores in all groups at 4 h with no significant difference within groups. CSS scores were lower in the salbutamol/magnesium sulfate group when compared with the magnesium sulfate and salbutamol groups (3.4 (2.4–4.3), 4.7 (3.8–5.7), 4.0 (3.2–4.3)). CSS were significantly lower than those from the magnesium sulfate group. Conclusion: Nebulized magnesium sulfate plus salbutamol may have additive effects for improving the short-term CSS.     

Effect of feeding on ventilation and respiratory mechanics in newborn infants.

Measurements of ventilation and respiratory mechanics were made before and after tube feeding in 24 infants. In 12 infants with the respiratory distresssyndrome tidal volume tended to fall after feeding; as the respiratory rate increased after feeding; as the respiratory rate increased after feeding, minute ventilation remained unchanged. Hypoventilation is therefore unlikely to be the cause of hypoxaemia after feeding. Compliance, resistance, and the work of breathing showed no changes after feeding. In 12 healthy infants feeding had no effects on pulmonary function. There was a slight rise in compliance and a tendency for work of breathing to fall after feeding. Respiratory rate, tidal volume, and minute ventilation remained unchanged. There was therefore no evidence of adverse effects of feeding on any of the factors measured. It is suggested that hypoxaemia without hypoventilation after feeding in infants with pre-existing respiratory distress syndrome might be attributable to a reduction in functional residual capacity associated with a greater extent of airways closure than before feeding.     

布地奈德、沙丁胺醇、异丙托溴铵三联吸入治疗毛细支气管炎的疗效观察

毛细支气管炎常见于2岁以内小儿，多由呼吸道合胞病毒引起，以喘憋为主要表现，有明显的毛细支气管阻塞症状，可引起呼吸困难，呼吸衰竭，甚至威胁生命。目前尚无特效抗病毒药物。平喘止咳仍为主要的治疗手段。近年来，随着毛细支气管炎发病机制的研究，抗炎治疗日益为临床医生重视。本研究采用以抗炎为主的不同药物联合治疗322例毛细支气管炎患儿，现就其临床疗效报道如下。     

Leucocyte populations in respiratory syncytial virus-induced bronchiolitis

OBJECTIVES: To enumerate the cellular composition of the airways in infants with acute bronchiolitis. METHODOLOGY: Cells were obtained by airway lavage from the upper and lower airway and the peripheral blood of infants with respiratory syncytial virus (RSV)+ bronchiolitis, RSV- bronchiolitis and age-matched controls. RESULTS: Neutrophils are the predominant cells present in the upper and lower airway. Neutrophils are present at a higher number/unit volume in the airway than in the peripheral blood. CONCLUSIONS: Neutrophils, being the dominant cellular infiltrate into the airway, are likely to contribute to the pathophysiology of bronchiolitis. Therapies targeted at limiting neutrophil influx or neutrophil-mediated damage in the airway may have a therapeutic role.     

Neutrophil-mediated inflammation in respiratory syncytial viral bronchiolitis

BACKGROUND: The involvement of neutrophil-mediated inflammation may play an important role in the pathogenesis of acute respiratory syncytial virus bronchiolitis. However, no measurable marker is sensitive enough to assess neutrophil-mediated inflammation in the airways. Released neutrophil elastase (NE) in intraluminal airways has been reported to induce pulmonary inflammation. The aim of this study was to determine whether the amount of urinary trypsin inhibitor (UTI) in serum, a degenerate induced by NE, reflects the degree of airway inflammation in children with respiratory syncytial viral (RSV) bronchiolitis and whether the severity of inflammation is evaluated. The pre-alpha-/inter-alpha-trypsin inhibitor is assumed to be precursors of the UTI. When NE degrades these inhibitors, UTI is liberated. METHODS: Serum UTI concentrations in infants admitted with RSV bronchiolitis, other viral infections, bacterial pneumonia and control subjects were measured by means of one-step sandwich-type enzyme immunoassay. RESULTS: Serum UTI concentrations in 25 patients on admission were significantly higher than the 15 infantile control values (mean +/- SEM, 22.126 +/- 2.317 and 6.701 +/- 0.719 U/mL, respectively; P < 0.0001). The elevated levels returned to baseline values with improvement in the respiratory symptoms. Higher levels of serum UTI with RSV infection were consistently associated with clinical symptoms and artificial ventilation. Serum NE concentrations of patients were elevated in some patients but not significantly different from controls in the patients who showed only upper respiratory symptoms with RSV infections. CONCLUSION: The findings strongly suggested that neutrophil-mediated events are involved in the pathogenesis of RSV bronchiolitis, and the monitoring of UTI concentrations might be useful for evaluating the neutrophil-mediated airway inflammation.     

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.     

Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis.

Rutter, N., Milner, A. D., and Hiller, E. J. (1975). Archives of Disease in Childhood, 50, 719. Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis. Respiratory resistance was measured using a forced oscillation technique in 16 infants and young children with bronchiolitis and wheezy bronchitis. Measurements were made before and after administration of nebulized salbutamol or isoprenaline. No significant change in resistance was found.     

Multiple viral respiratory pathogens in children with bronchiolitis

Aim: The aim of the study was to describe the frequency of viral pathogens and relative frequency of co-infections in nasal specimens obtained from young children with bronchiolitis receiving care at a children's hospital.
Methods: We conducted a study of nasal wash specimens using real-time PCR and fluorescent-antibody assay results from children less than two with an ICD-9-CM code for bronchiolitis. All specimens were collected for clinical care at Children's Hospital in Seattle, WA, USA, during the respiratory season from October 2003 to April 2004.
Results: Viruses were detected in 168 (93%) of the 180 children with bronchiolitis. A single virus was identified in 127 (71%) children and multiple viruses in 41 (23%). Respiratory syncytial virus (RSV) was the most common virus detected (77%), followed by adenovirus (15%), human metapneumovirus (11%), coronavirus (8%), parainfluenza (6%) and influenza (1%). Of the 139 samples with RSV detected, 34 (24%) were co-infected with another viral pathogen.
Conclusion: Molecular diagnostic techniques identified a high frequency of viruses and viral co-infections among children evaluated for bronchiolitis. Further study of the role of viral pathogens other than RSV and co-infections with RSV in children with bronchiolitis appears warranted.     

Production of interferon in respiratory syncytial virus bronchiolitis.

Production of interferon alfa in vitro was significantly reduced during acute respiratory syncytial virus bronchiolitis but subsequently returned to normal. Nasopharyngeal and endotracheal interferon alfa were detected intermittently and in low concentrations. The degree of impairment of in vitro production and poor in vivo production of interferon alfa suggest the need for a therapeutic trial of nebulised or systemic interferon in acute bronchiolitis.