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.     

Salbutamol and/or beclomethasone diproprionate in asthma

Objective: Acute severe exacerbation of asthma is potentially life threatening and requires critical assessment and appropriate therapy. Now a days, steroids are often combined with bronchodilators for the treatment of bronchial asthma. Therefore, the present study was undertaken to compare effectiveness of beclomethasone diproprionate-salbutamol combination versus salbutamol alone by MDI (with or without spacer) in acute asthma.Methods : A total of 57 paediatric patients (5–12 years) with acute attack of bronchial asthma attending emergency department of Indira Gandhi Medical College and Hospital was randomised to receive salbutamol (100 μg/puff) alone or with BDP (50 μg/puff) by metered dose inhaler with or without spacer. All baseline investigations were repeated one hour after the therapy.Results : Clinical parameters indicative of severity of asthma improved statistically in all treatment groups. The increase in PEFR was better with MDI-S+B with spacer as compared to other groups, though it failed to reach statistical significance. The fall in serum potassium level is significantly more with MDI-S+B group when spacer was not used. No serious adverse effects were observed in any of the treatment groups.Conclusions. Metered dose inhalation of BDP-salbutamol combination with spacer provides better recovery whereas fall in serum potassium with MDI-S+B suggests use of spacer and monitoring of serum potassium during treatment.     

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。     

婴幼儿哮喘急性发作雾化吸入硫酸沙丁胺醇对肺功能影响的研究

目的 通过观察哮喘急性发作的婴幼儿雾化吸入硫酸沙丁胺醇前后肺功能的变化,客观评价该药对低龄儿童气道阻力的影响.方法 将轻中度哮喘急性发作的49名婴幼儿按年龄分为1～3岁幼儿(32例)和<1岁婴儿(17例)两组,予0.5%硫酸沙丁胺醇0.25ml/次,驱动式压缩泵雾化吸入,在治疗前及后30min分别检查其肺功能,做潮气呼吸流速容量环检查,采用到达潮气呼气峰流速时的呼气量/潮气量(%V-PF)、呼出75%潮气量时的呼气流速/潮气呼气蜂流速(25/PF)和潮气呼气中期流速/潮气吸气中期流速(ME/MI)参数反映大小气道阻力情况.结果 在幼儿组和婴儿组治疗前肺功能指标%V-PF、25/PF和ME/NI降低,显示大小气道阻力增高,治疗后幼儿组肺功能各指标均有所提高,比较差异有统计学意义(P<0.01);婴儿组治疗前后比较差异无统计学意义(P>0.05).结论 对幼儿哮喘急性发作予雾化吸人硫酸沙丁胺醇后能有效地改善肺功能,降低气道阻力,对婴儿治疗的关键是结合有效的抗炎和积极的祛痰.     

Co-administration of salbutamol and fluticasone for emergency treatment of children with moderate acute asthma.

This study aimed to compare the efficacy of nebulized therapy with salbutamol alone or in combination with fluticasone. In a randomized, double-blind clinical trial, 150 children with moderate acute asthma were randomly assigned to receive by nebulizations either (i) three doses of salbutamol 30 microl/kg per dose, each dose administered every 15 min, (ii) three doses of salbutamol plus two doses of fluticasone 500 microg/dose at 15 and 30 min after first dose of salbutamol, or (iii) three doses of salbutamol/fluticasone 500 microg/dose, each combined dose administered every 15 min. Pulse oxymetry (SaO2), peak expiratory flow (PEF) and Wood et al. (Am J Dis Child, 123, 1972, 123) clinical scale were evaluated at baseline, 15, 30, 45, 60, 90 and 120 min after the first nebulization. Patients in the three groups significantly improved since 15 min after the first nebulization. We did not observe differences in the recovery of SaO2 and PEF among the three groups of treatment (p > 0.10). In group 3, children showed better clinical response at 120 min than the other two groups (p < 0.05). No significant adverse effects were observed with any treatment. To summarize, in children with acute moderate asthma, nebulized salbutamol at an accumulated dose of 90 mul/kg plus fluticasone at an accumulated dose of 1500 microg produced better clinical relief after 2 h. However, similar PEF and SaO2 responses were observed with salbutamol alone or in combination with different doses of fluticasone.     

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目的了解布地奈德联合沙丁胺醇雾化吸入治疗儿童哮喘急性发作前后其气道炎性细胞、白细胞介素-6(IL-6)、IL-8、肿瘤坏死因子-α(TNF-α)的变化,探讨其影响机制。方法对上海市第五人民医院2002-09—2003-12收治的急性哮喘发作患儿采用上述联合治疗1周,共对34例急性发作期、24例缓解期患儿和15名正常儿童的诱导痰液进行炎性细胞计数和分类,测定其中IL-6、IL-8、TNF-α水平。结果急性期哮喘患儿的总细胞数、嗜酸性细胞、中性粒细胞和单核细胞比例及IL-8、IL-6、TNF-α水平均高于正常对照组。缓解期哮喘患儿除嗜酸细胞及淋巴细胞比例明显高于正常对照组外,其余上述炎性细胞比例及细胞因子水平均降至正常。结论布地奈德联合沙丁胺醇雾化吸入可显著降低急性哮喘发作患儿气道分泌物内嗜酸性细胞、中性粒细胞和单核细胞数量及IL-8、IL-6、TNF-α水平。     

Analysis of body posture in children with mild to moderate asthma

The mechanical alterations related to the excessive use of accessory respiratory muscles and the mouth breathing observed in children with asthma may lead to the development of alterations in head posture, shoulders, thoracic region and, consequently, in alterations of body posture. The purpose of this study was to assess body posture changes of children with asthma compared to a non-asthmatic control group matched for gender, age, weight, and height. Thirty children with asthma and 30 non-asthmatic children aged 7 to 12 years were enrolled in this study. Digital photographic records were obtained for analysis of the body posture of the children by computed photogrammetry. The intraclass correlation coefficient and Student’s t test (p < 0.05) were used for statistical analysis. There were no significant differences between groups for the angles analyzed, except for the knee flexor angle. These results demonstrate that children with asthma did not present postural alterations compared to non-asthmatic controls since the only angle for which there was a significant difference between groups showed weak reproducibility. The findings of this study do not support the notion that children with asthma present alterations in body posture.     

鼻病毒感染与儿童哮喘急性加重机制

人鼻病毒(HRV)感染是哮喘急性发作和(或)加重的重要诱发因素,但其致病机制极其复杂,除鼻病毒的直接作用及因炎性介质释放和炎性细胞浸润而导致机体的炎症反应外,HRV感染诱导机体的异常免疫反应特别是Th1/Th2免疫失衡及调节性T细胞功能异常已受到研究者们的广泛重视.深入研究HRV感染所诱导的儿童哮喘急性发作,对阐明哮喘的发病机制及探索疾病免疫治疗有重要意义.     

Comparison of salbutamol powder with terbutaline aerosol administered with a tube spacer in asthmatic children

ABSTRACT. The bronchodilator effect of 400 μ of salbutamol powder (2 capsules) administered by a rota-haler was compared with that of 500 μg of terbutaline (2 mete red doses) administered as an aerosol via a tube-spacer in a group of ten stable asthmatic children (mean age 12 years). The salbutamol powder produced significantly greater bronchodilatation compared with the terbutaline. Forty-five minutes after the administration of each preparation, nebulised salbutamol was given to determine if further bronchodilatation was possible. Additional bronchodilatation was seen in both groups, the greater additional change being after terbutaline. It is concluded that 400 μg of salbutamol powder was more effective than 500 μg of terbutaline via tube-spacer but following both preparations, nebulised salbutamol produced significant additional bronchodilatation.     

A survey of consultant practice: intravenous salbutamol or aminophylline for acute severe childhood asthma and awareness of potential hypokalaemia

British Thoracic Society guidelines recommend intravenous salbutamol or aminophylline for acute severe asthma in children. In the survey reported here, 133 consultant paediatricians completed a questionnaire aimed at evaluating their choice of intravenous bronchodilator for acute severe asthma and their awareness of subsequent hypokalaemia. Of the non-Paediatric Intensive Care Unit (PICU) consultants who responded, 82%, including respiratory paediatricians, reported using aminophylline; in contrast, PICU consultants were significantly more likely to use salbutamol (p=<0.001). There was a lack of awareness that hypokalaemia occurs with aminophylline: 50% of the consultants suggested that hypokalaemia was rare or did not occur. Consultants using intravenous aminophylline were significantly less likely to recheck serum potassium levels than those using intravenous salbutamol (p=0.03). Based on the completed questionnaires, salbutamol infusions are rarely used outside the PICU, and the awareness of potential hypokalaemia following intravenous bronchodilator treatment is variable. It would appear, therefore, that standardised clinical practice is required in order to recognise and treat potential hypokalaemia.     

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。     

儿童支气管哮喘急性发作的病原分布特点

目的 了解重庆地区儿童支气管哮喘急性发作的病原分布特点.方法 回顾性分析重庆医科大学附属儿童医院2007年11月至2009年10月收治的203例5岁及以上支气管哮喘急性发作住院患儿临床资料.结果 哮喘急性发作患儿肺炎衣原体(CP)检出率为29.6%、肺炎支原体(MP)检出率为22.9%;7种呼吸道病毒检出阳性率为10.2%,其中RSV占4.5%,居病毒检出率首位.哮喘患儿呼吸道感染诱导哮喘的发作窗为(4.2±3.1)d.结论 重庆地区5岁及以上儿童哮喘急性发作与呼吸道病毒、MP、CP感染密切相关,且常见的7种呼吸遭病毒检出率低.     

Efficacy of a home-made spacer with acute exacerbation of bronchial asthma : A randomized controlled trial

Metered dose inhaler (MDI) with spacer is the preferred method for administration of aerosolized medications in pediatric asthma. The expense of commercial spacers limits their use and indigenous alternatives have therefore been developed. Information on the clinical efficacy of home-made spacers is limited. This study was conducted to compare the efficacy of a valve-less home-made spacer with a commercial spacer in delivering salbutamolvia MDI in acute asthma. Asthmatic children aged 5–15 years who presented with an acute exacerbation to the pediatric chest clinic of a tertiary care hospital were enrolled in a single blinded randomized parallel group study. The study patients received 10 puffs of salbutamol (100(igJ puff)via MDI-home-made spacer or MDI-commercial spacer. Pre and post inhalation measurements of peak expiratory flow rate (PEFR), oxygen saturation (SaO2), respiratory rate (RR), pulse rate (PR) were made and compared. Sixty children were enrolled in the study, 31 were administered salbutamolvia the home-made spacer and 29via the commercial spacer. The median increase in PEFR was similar in both the groups (20.8% vs22.2%, p=0.4), clinical improvement being satisfactory in all patients. The valve-less home-made spacer is equally efficacious and cheaper than the commercial spacer in administering bronchodilators in acute exacerbations of asthma. Further studies on the efficacy of home-made spacer in delivery of inhaled steroids are needed.