Inhalation therapy and postural drainage for the treatment of cystic fibrosis.
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A number of different inhalation appliances are available for the inhalation treatment of chronic obstructive bronchial diseases. Electrical aerosol appliances, aerosols providing measured dosage and dry powder inhalers all show good physical properties for creating aerosol particles with an average aerodynamic mass diameter of 2-9 microns, which is a prerequisite for optimum bronchial deposition. Advantages and disadvantages of the principal appliances available on the market are compared. In an overview the action, indications and side effects of beta-2 sympathomimetics, ipratropium bromide, anti-allergens and inhaled steroids are discussed. Both in chronically obstructive pulmonary diseases (COPD) and in chronic asthma, precise patient instructions and the correct use and combination of bronchial dilating medicines and inhaled steroids in asthma, and of beta-2 sympathomimetics and ipratropium bromide in COPD, are important for optimum effect of inhalation treatment. The literature shows that the widespread fear of side effects of steroids applied in inhalant form is unfounded.
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Beclomethasone dipropionate, a new corticosteroid for inhalation in the form of a pressurised aerosol with a daily dosage of 300-400/mug, has been given to 130 adult asthmatics. In 56% of the steroid-dependent asthmatics, oral or parenteral corticosteroids were reduced and in a further 28% discontinued entirely. In 16% of patients a reduction of systemic corticosteroids could not be achieved. 12 patients suffering from an obstructive airway disease who had not previously been on systemic corticosteroids were treated successfully with inhalation of beclomethasone dipropionate alone. The reduced dosage of systemic corticosteroids as a result of the use of beclomethasone dipropionate was 4.24 mg of prednisone daily. Side effects, in the form of mouth candidiasis, were noted in only 2 patients.
Topically applied corticosteroid is a known provoking factor in perioral dermatitis. In recent years inhaled corticosteroids have become first line therapy for asthma in children. We present two characteristic cases of perioral dermatitis that developed during asthma treatment with budesonide using either a nebulizer or a spacer connected with a mask. In severe cases treatment with oral erythromycin or topical metronidazole gel may be considered. The eruption should not be confused with atopic eczema.
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