Jayachandran R Panickar | PubMed Health

PubMed2006

Controversies in the management of preschool viral wheeze.

The clinical diagnosis of asthma represents several putative wheeze phenotypes, each associated with a unique cluster of risk factors, underlying inflammation, and response to therapy. In school-age children, the 'classical' atopic asthma phenotype predominates. By contrast, asthma in children aged between 1 and 5 years is frequently characterised by transient episodes of wheeze trigged by viral colds, with few or no interval symptoms (preschool viral wheeze). This phenotype has a different cluster of risk factors from atopic asthma and thus might not respond to asthma therapies of proven efficacy in older children. The objective of this review is to look at the current evidence in the management of 'preschool viral wheeze'.

Anti-Inflammatory Agents↗

PubMed2005

Intramuscular triamcinolone for difficult asthma.

We treated a selected group of children attending a difficult asthma clinic with intramuscular triamcinolone acetonide. This study retrospectively reviews markers of asthma severity in those who received one or more monthly doses for three periods: 1) 3 months preceding the first injection (pretreatment), 2) from the first injection to 1 month after the last injection (treatment period), and 3) 3 months after the treatment period (follow-up period). Severity markers during the treatment and follow-up periods were compared with the pretreatment period by paired t-test. Five children (5-13 years old) received a single dose, and 8 children (12-15 years old) received multiple doses. Multiple doses of triamcinolone (n = 3-5) were associated with a fall in the number of asthma exacerbations (P < 0.01) and hospital admissions (P < 0.01) in both the treatment and follow-up periods. A single dose reduced exacerbations (P < 0.05, treatment vs. pretreatment) but not hospital admissions. We conclude that intramuscular triamcinolone is a useful short-term therapy in difficult asthma. Whether its efficacy is due to improved compliance, or an improved anti-inflammatory profile compared with oral steroids, remains unclear.

Adolescent↗