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PubMed1993

The "wheezy infant" diagnosis, epidemiology and management.

Already in the earliest childhood, the onset of an allergic/immunologic inflammatory process may be caused on the basis of an inherited predisposition by an exaggerated mediator-release in the mucosa. Repeated action of trigger factors maintain this inflammation and provoke exacerbations of asthmatic symptoms. The protective task of the bronchial mucosa can not be fulfilled anymore. However, the most important goal of the approach to identify and treat wheezy infants is to avoid structural damage of bronchi and the lung by the underlying process for later life. General measures of treatment such as prophylaxis against house-dust-mite exposure, improved breathing technique and improvement of lung clearance are indispensable measures of an individually adapted, effective symptomatic (bronchodilators) and protective (cromoglycate, topical steroids) drug therapy in infants and young children with the so called "wheezy baby syndrome". A successful therapy should ensure a physiological development of the child.

Administration, Inhalation↗
PubMed1994

Efficacy of albuterol in the management of bronchiolitis.

OBJECTIVE: To examine the efficacy of albuterol (0.15 mg/kg per dose) in the management of bronchiolitis. DESIGN: Randomized, double-blind, placebo-controlled outpatient clinical trial utilizing four study groups: neubulized albuterol, nebulized saline, oral albuterol, and oral placebo. SETTING: Pediatric emergency department and outpatient clinic at University of Maryland in Baltimore. PATIENTS: Eighty-eight infants (median age 5.5 months) being treated for their first episode of wheezing were randomly assigned to nebulized albuterol (n = 22), nebulized saline (n = 23), oral albuterol (n = 19), oral placebo (n = 24). INTERVENTIONS: The nebulized groups received two nebulizations 30 minutes apart, whereas the oral groups received one oral dose. MAIN OUTCOME MEASURES: Respiratory and heart rates, clinical score, oxygen saturation (Spo2), and the infant's state, ie, asleep, awake, or feeding, were recorded at baseline and at 30 and 60 minutes after treatment. RESULTS: Randomization produced equivalent groups in terms of demographics and baseline measures. There were no statistically significant differences in any outcomes among the four treatments, except for oral albuterol, which produced an increase in heart rate (15 beats per minute, P = .005). No differences in the need for additional treatment or hospitalization were observed. Change in the state of the infant during the trial had significant effects on respiratory rate and clinical score. CONCLUSIONS: Albuterol is as effective as oral placebo in the management of bronchiolitis. Past studies supporting the use of albuterol did not control for effects of change in state of the infant and did not use a truly inactive placebo group. This study underscores the importance of these design components in measuring the efficacy of albuterol in infants.

Administration, Inhalation↗
PubMed1993

[DNCG (acecromol) and ketotifen (Zatofug) in treatment of children with bronchial asthma].

In an open clinical study, 80 children and adolescents of 12 months to 20 years of age suffering from asthma bronchiale were treated for a minimum of 8 weeks with DNCG (acecromol) or ketotifen (Zatofug) or with both drugs. Both under the treatment with DNCG and with ketotifen the overall disease pattern was improved with a large proportion of the patients and the concurrent adjuvant medication with prednisolone and/or aminophyllin could be markedly reduced or in some cases discontinued altogether. Both substances appear to be comparable as far as the therapy result is concerned; however, the range of application of ketotifen is wider due to its additional antihistaminic action and oral administration, e.g. in case of concomitant urticaria or food allergy.

Administration, Inhalation↗
PubMed1993

[Amiloride inhalation therapy in mucoviscidosis].

The defective regulation of the secretory chloride channel and the accelerated rate of sodium absorption in the airway epithelia of patients with cystic fibrosis (CF) contribute to the dehydration of airway secretions which is responsible for secondary damage in the respiratory tract. The sodium-blocker amiloride inhibits sodium absorption depending on the dosage of the drug. This effect is documented by means of measuring transepithelial potential difference which is decreased following to inhalative amiloride administration in CF patients. Clinical long term efficiency has been shown to be probable, but has to be confirmed. Investigation in this field is difficult, because there are some other important factors which influence viscosity of mucus. The use of amiloride can best be evaluated, if it is given immediately after birth. However, the answer to some important questions has to be found before.

Administration, Inhalation↗
PubMed1993

[Treatment of ureteral colic with glycerol trinitrate].

METHOD: In an open randomized clinical trial, the efficacy of 2.4 mg glycerol trinitrate (GTN) administered in a variety of forms (2 x 1.2 mg capsules; 6 x 0.4 mg puffs of an atomizer; 2.4 ml of an 0.1% infusion solution) in comparison with 20 mg of butylscopolamine bromide i.v. (BSB) in 80 patients suffering from acute ureteral colic. RESULTS: Some 30 minutes following medication, the effect was adjudged by the physician to be good (no pain) moderate (some pain still present) or non-existent (alternative treatment within 30 minutes). CONCLUSION: GTN was effective in 40% of the cases, BSB in 26.3%. A moderate effect was seen in 46.7% and 62.3%, respectively, while no response was elicited in 13.3 and 10.5%, respectively. In addition, recurrence within 24 hours, blood pressure, pulse rate and laboratory tests were recorded. Side effects occurred in 13 patients (12 in the GTN and 1 in the BSB group), but, with one exception (GTN i.v.), were all mild in nature.

Administration, Inhalation↗
PubMed1993

Respiratory preparations.

Australian Family Physician is pleased to present a home course in extemporaneous prescribing, an interesting area that is poorly understood by many practitioners, especially recent graduates. Dr Bernard Kelly has been teaching this discipline to Family Medicine trainees in New South Wales for many years. A question is included at the end of each module.

Administration, Inhalation↗
PubMed1995

Crude oil spill in sea water: an assessment of the risk for bathers correlated to benzo(a)pyrene exposure.

In the spring of 1991, there was a shipwreck of the oil tanker "Haven" off the Ligurian coast of Italy. This resulted in the spillage of a very large amount of crude oil, some of which was burned off by fire. The accident caused several serious problems (sea and air pollution, damage to the marine fauna, risk of human exposure, etc.). In this context, an assessment was carried out at the Istituto Superior di Sanità with the aim of determining any possible risks to humans which might derive from bathing activities during the following summer season. The whole evaluation carried out after the accident demonstrated that the impacts induced were not serious enough to require bathing restrictions in the coastal areas involved. Assuming a benzo(a)pyrene (BaP) concentration in sea water of 1 microgram/m3 cancer risk is in the order of 10(-8) and in the case of 10-kg child, a 10(-6) risk level correspond to about 0.18 microgram/l of BaP in sea water.

Administration, Inhalation↗
PubMed1995

Salmeterol xinafoate in asthmatic patients under consideration for maintenance oral corticosteroid therapy. UK Study Group.

In severe chronic asthma, long-term oral steroids may be necessary to control symptoms. In patients in whom such treatment was under consideration, the efficacy and safety of salmeterol xinafoate 100 micrograms b.i.d. was investigated in a randomized, double-blind, placebo-controlled parallel-group, multicentre study. One hundred and nineteen chronic symptomatic asthmatics were randomized to receive either salmeterol, 100 micrograms b.i.d. (n = 55; baseline % predicted morning peak expiratory flow (PEF) 59%; forced expiratory volume in one second (FEV1) 66%) or placebo (n = 64; baseline % predicted morning PEF 63%; FEV1 66%) both via the Diskhaler. Morning and evening PEF and asthma symptoms were recorded in daily record booklets by the patient over a 12 week period. A significant improvement in morning PEF was achieved after 1 month in the salmeterol treated group; this persisted throughout the treatment period (estimated treatment difference 22 L.min-1). There was a significant increase in the proportion of symptom-free nights experienced by the salmeterol treated group (33 (SD 32) %) compared with placebo (13 (26) %), and a significant decrease in daily use of relief medication (mean decrease 5.1 (4.7) doses per day with salmeterol, 2.5 (4.0) doses with placebo). Both treatments were well-tolerated, with no evidence of any difference in the side-effects associated with beta 2-agonists. In conclusion, the addition of salmeterol (100 micrograms daily) to the existing treatment of chronic asthmatics under consideration for maintenance oral corticosteroid therapy is well-tolerated, improves lung function and provides additional symptom control.

Administration, Inhalation↗
PubMed1997

First-line treatment of seasonal (ragweed) rhinoconjunctivitis. A randomized management trial comparing a nasal steroid spray and a nonsedating antihistamine.

OBJECTIVE: To determine whether better health-related quality of life (HRQL) is achieved by initiating treatment of seasonal (ragweed) rhinoconjunctivitis (hay fever) with a nasal steroid (fluticasone) backed up by a nonsedating antihistamine (terfenadine) or whether it is better to start with the antihistamine and add the nasal steroid when necessary. DESIGN: Randomized, nonblind, parallel-group management study during the 6 weeks of the ragweed pollen season in 1995. PATIENTS: Sixty-one adults with ragweed pollen hay fever recruited from patients who had participated in previous clinical studies and from those who responded to notices in the local media. SETTING: Southern Ontario. INTERVENTIONS: Nasal steroid group: 200 micrograms of fluticasone nasal spray when needed (up to 400 micrograms/d) starting about 1 week before the ragweed pollen season and continued throughout, with 1 to 2 tablets of terfenadine daily (maximum 120 mg/d) if needed. Antihistamine group: 1 60-mg tablet of terfenadine when needed (maximum 120 mg/d) starting about 1 week before the ragweed pollen season and continued throughout, with 200-400 micrograms/d of fluticasone nasal spray (maximum 400 micrograms/d) if needed. OUTCOME MEASURES: HRQL before, at the height of and toward the end of the ragweed pollen season; HRQL was measured using the Rhinoconjunctivitis Quality of Life Questionnáire. RESULTS: Overall, HRQL tended to be better in the group of patients whose first-line treatment was with fluticasone (p = 0.052), but the difference between the 2 groups was small and not clinically important. Just over half (52% [16/31]) of the patients in the fluticasone group did not need additional help with terfenadine, whereas only 13% (4/30) of those in the terfenadine group did not need additional help with fluticasone (p = 0.002). CONCLUSIONS: There is little difference in the therapeutic benefit between the 2 approaches for the treatment of ragweed pollen hay fever. Therefore, the approach to treatment should be based on patient preference, convenience and cost. Regardless of the treatment, at least 50% of patients will need to take both types of medication in combination to control symptoms adequately.

Administration, Inhalation↗