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Biomedical subjects

W Lenney

Publications and source records attributed to W Lenney.

At least 19 recordsLinked to original sources
PubMed1998

Prednisolone in acute childhood asthma: clinical responses to three dosages.

Ninety-eight children aged 1-15 years entered a randomized double-blind study investigating an appropriate dose of oral prednisolone in children admitted to hospital with an acute exacerbation of asthma. None of the children had recently been treated with oral prednisolone. Following admission, the children were randomized to receive prednisolone 0.5 mg kg-1, 1.0 mg kg-1 or 2.0 mg kg-1 in a single daily dose in addition to nebulized bronchodilators. Clinical asthma scores, oxygen saturations, pulse rate, duration of admission and number of nebulizers given were compared in the three treatment groups. Thirty-five children received 0.5 mg kg-1, 33 received 1.0 mg kg-1 and 30 received 2.0 mg kg-1. There were no significant differences in the pattern of recovery between the three treatment groups. There were no advantages in using higher doses of prednisolone. We recommend 0.5 mg kg-1 day-1 of prednisolone as an appropriate dose for treating an acute exacerbation of asthma.

Adolescent↗
PubMed1997

The burden of pediatric asthma.

Childhood asthma is common and its prevalence is increasing in most countries of the world. Large-scale studies indicate that approximately one-third of children with asthma have had five or more episodes of wheezing in the previous 12 months. Such frequency of symptoms leads to a significant number of days lost from school, interference with physical exercise, and underfunctioning at school because of interrupted sleep. In cases of more severe asthma, the more frequent school absences may affect the individual's education and, possibly, choice of career. In addition to the extensive individual burden of asthma, the burden on the family is substantial. Additional housework may be required to reduce the child's exposure to potential environmental triggers. Time "off work" may be required to take care of a sick child. In cases of severe asthma, children regularly wake at night, and 50% of parents indicate limitation of their social life. Sibling studies show that sometimes siblings who do not have asthma are neglected and that parents may have insufficient time to devote to them. Mortality in pediatric asthma is low, but there has been little reduction in recent years. When viewed as potential life-years lost, the burden is considerable in social and economic terms. In the United States, the mean annual cost per patient has been estimated at in excess of US$1,000. In Australia, the cost ranges from A$85 to A$884 per patient, depending on asthma severity. In the United Kingdom the estimated annual costs of childhood asthma to the Health Service are between Pounds 100 million and Pounds 150 million. To reduce the burden to patients, their families, and health care services, improved understanding of the basic pathophysiology of asthma is necessary. Environmental issues need to be addressed as does delivery of care using appropriate devices and effective therapeutic medications.

Absenteeism↗
PubMed1995

Efficacy and safety of salmeterol in childhood asthma.

UNLABELLED: In children with asthma, twice daily administration of salmeterol 25 micrograms, salmeterol 50 micrograms and salbutamol 200 micrograms were compared in two, 3-month, double-blind, parallel group studies, one using metered dose inhalers (MDIs), the other using dry powder inhalers (Diskhaler, DPIs). Both studies were continued for a further 9 months during which time exacerbation rates, lung function at the clinic and adverse events were monitored. Similarities in design and methodology of the two studies justified a combined analysis. Eight hundred and forty-seven asthmatic children aged between 4 and 16 (mean 10.1) years, requiring inhaled beta 2-agonist treatment were randomised to treatment. After a 2 week run-in when all bronchodilator therapy was withdrawn, 279 patients received salmeterol 25 micrograms bd, 290 patients salmeterol 50 micrograms bd and 278 patients salbutamol 200 micrograms bd. After 3 months' treatment the change from baseline in daily morning and evening peak expiratory flow (PEF) was significantly greater with salmeterol 50 micrograms bd than with salbutamol 200 micrograms bd (P < 0.001). Salmeterol 50 micrograms bd was also significantly better than salmeterol 25 micrograms bd at improving mean morning PEF (P = 0.017) but both treatments had a similar effect on evening PEF. Analysis of variance showed an interaction between baseline PEF less than 100% predicted normal value and treatment outcome. Analysis of this sub-set of patients with lower lung function revealed similar results to the total population although the improvements in PEF from baseline were greater. Data from both studies, showed that the improvement in lung function was maintained throughout 12 months' treatment. Patients receiving salmeterol 50 micrograms bd had significantly more symptom-free nights (P < 0.01) and a higher percentage of rescue bronchodilator-free days (P = 0.01). The incidence of asthma exacerbations was evenly distributed between the three treatment groups and there was no evidence of any change in the rate of occurrence of exacerbations over the 12 month period. Adverse events were no different across treatment groups or across age groups and were primarily related to the patients' disease state. CONCLUSION: Salmeterol 50 micrograms bd is the appropriate dose for the treatment of children with mild to moderate asthma.

Administration, Inhalation↗
PubMed1995

Pilgrim's progress: the effect of salmeterol in older children with chronic severe asthma.

Twenty-four children aged 12-17 years entered a randomized, double-blind placebo-controlled study investigating the use of salmeterol in chronic severe asthma. In addition to their usual medication, the children were given either placebo or 100 micrograms salmeterol b.d. by dry powder inhalation. Treatment was continued throughout one term at a residential school for asthma. Symptom scores, peak expiratory flow rates, spirometry and quality-of-life scores were compared between the two treatment groups. One child withdrew during the run-in period. Twelve pupils received placebo and 11 pupils received salmeterol. There were consistent improvements in favour of salmeterol, reaching statistical significance for morning and evening peak flow rates and spirometry when measured on four occasions during the study period. There were no medication-related adverse events recorded and no pulse rate changes. Salmeterol (100 micrograms b.d.) is well tolerated and efficacious in older children with chronic severe asthma.

Adolescent↗
PubMed1994

Prednisolone and salbutamol in the hospital treatment of acute asthma.

The use of oral prednisolone (2 mg/kg) to treat children admitted to hospital with acute asthma was assessed in a placebo controlled study. Children were further randomised to receive either 0.15 mg/kg salbutamol every 30 minutes for the first three hours of admission, or 5 mg salbutamol every one to four hours as needed. Treatment was double blind and the assessor was unaware of the nebuliser regimen given. Children were examined before and after treatment with salbutamol on arrival and reassessed four hours after admission. Seventy children completed the study. Seventeen (46%) of 37 children receiving prednisolone and six (9%) of 33 receiving placebo were fit for discharge after four hours of treatment. There was no significant difference between the two nebuliser regimens. Clinical parameters indicative of asthma severity were improved in all groups. Between group comparisons at reassessment showed higher peak flows in those receiving prednisolone and nebulisers every 30 minutes but differences were not significant for other parameters. Objective parameters indicating steroid efficacy over placebo were minimal. Despite this, those receiving prednisolone were more readily identifiable as being fit for discharge within four hours of treatment.

Acute Disease↗
PubMed1993

Use of pulse oximetry in the hospital management of acute asthma in childhood.

Oxyhemoglobin saturation values were recorded before and 10 minutes after 5 mg of nebulized salbutamol in 75 children (age, 1.5-14.6 years) admitted to hospital with acute asthma. Other assessments included heart rate, respiratory rate, peak expiratory flow rate, pulsus paradoxus, and an asthma severity score. All assessments were performed by the same observer (GC) and subsequent hospital care was transferred to the on-call pediatricians, who were not told the initial saturation values. Six children required intravenous therapy after hospital admission when their symptoms were not improved after nebulized salbutamol. Cutoff points for each continuous variable were selected so that they identified at least 5 of these 6 children (i.e., with a sensitivity of at least 83 percent). The resulting specificities and positive predictive values were calculated for each variable before and after nebulized therapy. A postnebulizer saturation of less than 91% had a sensitivity of 100% [95% confidence interval (CI), (54-100] with a specificity of 98% (95% CI, 92-100) and a positive predictive value of 86%. This was the best predictor of the need for intravenous (IV) therapy. Correlation coefficients were calculated for the 75 admissions and 2 others who required immediate IV treatment to determine how closely saturation values were related to the other recorded clinical variables. Saturation values were significantly, though weakly, correlated with asthma severity scores and prenebulizer heart rate, but they were not associated with any of the other variables. These results highlight the difficulties encountered when assessing acute asthma in a hospital population with a large number of preschool children.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1993

Prevention of viral induced asthma attacks using inhaled budesonide.

Thirty two preschool children were entered into a double blind, placebo controlled study using intermittent budesonide to treat viral induced wheeze. Active treatment was either 800 micrograms twice a day via a spacer or 1600 micrograms twice a day via a spacer and facemask in those children too young to use a mouthpiece. Treatment was started at the onset of an upper respiratory tract infection and continued for seven days or until symptoms had resolved for 24 hours. Each child remained in the study until they had completed using one pair of budesonide and placebo inhalers in random order without the need for additional oral prednisolone. Twenty five children completed 28 treatment pairs. All 25 families were asked to express a preference after completing their first treatment pair: 12 preferred budesonide and six preferred placebo; seven had no preference. Symptom scores were compared in 17 treatment pairs that were completed without the need for oral prednisolone. Mean day and night time wheeze in the first week after infection were significantly lower in those receiving budesonide. Intermittent inhalation of budesonide can modify the severity of wheezing in preschool children developing asthma after viral respiratory infections but improvements were modest with the doses used in this study.

Administration, Inhalation↗
PubMed1993

Audit strategies to reduce hospital admissions for acute asthma.

An eightfold rise in hospital admissions for acute asthma from 1971-85 prompted two studies to audit the admissions policy at the Royal Alexandra Hospital. In the first study the on call senior house officer (SHO) was replaced by an experienced registrar and over a four month period 53 children out of 158 were sent home from the receiving room compared with six out of 39 seen by the SHOs. In the second study an SHO training programme was established together with a home treatment package. Over a 12 month period the on call SHOs assessed 687 children with acute asthma; 229 (43.5%) were deemed fit to be sent home. Only seven of these were readmitted within one week. Diary symptom score cards filled in by parents indicated that children sent home without admission fared no worse at home than those admitted and then discharged for the two weeks after leaving hospital. The development of strategies to improve assessment and immediate management in the hospital receiving room can reduce hospital admissions for acute asthma, allowing more children to be safely managed in the community.

Acute Disease↗
PubMed1993

Use of budesonide in severe asthmatics aged 1-3 years.

The treatment of severe asthmatics aged 1-3 years with budesonide administered via Nebuhaler and Laerdal facemask was assessed in a six month, double blind, placebo controlled study. Patients were randomised to budesonide (n = 20) or placebo (n = 20) treatment. Daily symptom scores were recorded by parents and clinic visits occurred every six weeks. Cough scores improved significantly with budesonide: nocturnal and daytime cough scores (0-2) fell by a mean (SEM) of 0.4 (0.2) and 0.5 (0.2); while with placebo the nocturnal score increased by 0.1 (0.2) and daytime score was unchanged at 0.0 (0.2). All other data showed improvements for active over placebo treatment. Thirteen children in each group completed six months' treatment. Parents of 25 of these found the delivery system convenient and easy to use. While blinded to treatment it was assessed to be beneficial in nine of 13 receiving budesonide and four of 13 receiving placebo. The Nebuhaler and facemask is an acceptable delivery system for long term asthma treatment. Symptoms are significantly reduced when it is used to give 400-800 micrograms budesonide/day to children aged 1-3 years who cannot use other delivery systems.

Administration, Topical↗
PubMed1993

Prolonged hypoxaemia after nebulised salbutamol.

Pulse oximetry is increasingly used to assess hypoxaemia in respiratory illnesses. Six children presenting with acute asthma and prolonged falls in oxygen saturation values after treatment with salbutamol are described who were subsequently shown to have pneumonic consolidation on chest radiography.

Acute Disease↗
PubMed1993

Role of plasma phosphate measurements in detecting rickets of prematurity and in monitoring treatment.

Twice weekly plasma and urine measurements were made in 24 very low birth weight infants. Intravenous feeding was given whilst infants required respiratory support. Subsequently they received breast milk or formula milk with a vitamin D supplement of 400 U/day. Fourteen babies required intravenous feeding for more than 10 days. Six developed radiological rickets or severe osteoporosis, and these infants had plasma phosphate levels < 1.2 mmol/L on breast milk or < 1.8 mmol/L on formula milk. Babies without radiological rickets had plasma phosphate levels > 1.2 mmol/L on breast milk and > 1.8 mmol/L in all but one on formula milk. Successful treatment of rickets was associated with a rise in plasma phosphate to the above levels. Untimed urine calcium and phosphate concentrations expressed as creatinine ratios were not helpful in detecting babies with rickets, but may be useful in monitoring therapy.

Alkaline Phosphatase↗
PubMed1993

Late pulmonary scintigraphic defects after uneventful recovery from simple focal pneumonia of childhood.

We present a pilot study designed to determine whether pneumonia in children accompanied by focal consolidation on the chest radiograph (CXR) is associated with late abnormality as detected by radionuclide lung scintigraphy. 14 children with focal pneumonia were assessed 1 year after initial presentation. In 12 both krypton-81m ventilation and technetium-99m MAA perfusion studies were performed, while in two only perfusion studies were obtained. All cases had a further CXR. Abnormal or equivocal cases were reviewed clinically. Scans and CXRs were independently assessed by two observers and subsequently consensus reached by discussion. There were five abnormal and nine normal lung scans. Two defects matched the site of the initial pneumonia while three did not. A CXR at the time of lung scanning was normal except for one case with a small focus of consolidation on the opposite side to the initial pneumonia but with a normal lung scan. Similarly, clinical assessment at the time of scanning was unremarkable, with no history of further respiratory episodes except in one child excluded from the study because of an interval diagnosis of asthma. This pilot study indicates that lung scan defects are common in the medium term after supposedly uncomplicated pneumonia in childhood. The cause of these defects remains uncertain. The correlation with the site of the initial radiological abnormality is variable, pointing to the need for further research in this area. The importance of independent blind interpretation is also highlighted.

Child↗
PubMed1992

Management of asthma in pre-school children.

The management of asthma in pre-school children often presents physicians with challenging problems. This article addresses the diagnostic criteria by which the diagnosis may be made, discusses the prognosis of untreated asthma and states the principles underlying the treatment of asthma in this age group. The management according to a stepwise protocol is discussed with reference both to maintenance therapy, and the treatment of acute severe asthma. The methods by which appropriate medication may be delivered are also described.

Age Factors↗