The Journal of asthma : official journal of the Association for the Care of Asthma
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New emphasis on pediatric drug development makes the availability of safe, easy-to-use dosage formulations imperative for clinical practice. Chewable tablets are a widely used pediatric dosage form; however, a literature review on the safety of this formulation has not been published. We have, therefore, determined the safety of chewable tablets in the pediatric age group based on the published literature. ⋯ Medical issues, including foreign-body injuries, related to the chewable-tablet formulation were extremely rare. The advantages of chewable tablets include palatability, stability, precise dosing, portability, and ease of delivery. It is concluded that the available literature suggests that chewable tablets provide a safe, well-tolerated alternative to traditional pediatric drug formulations and offer significant advantages in children 2 years of age and older.
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Randomized Controlled Trial Clinical Trial
Mouthpiece versus facemask for delivery of nebulized salbutamol in exacerbated childhood asthma.
We compared the bronchodilator response to salbutamol (albuterol) delivered by a compressed air nebulizer through a mouthpiece and via a facemask in 18 asthmatic children, to determine the most appropriate delivery method. Patients using a mouthpiece had significantly better mean percent increases in forced expiratory volume in 1 sec (FEV1) and in forced vital capacity (FVC) than those using a facemask 30 min after inhalation (FEV1, 56.4 +/- 32.6% vs. 28.9 +/- 19.1%, FVC: 34.4 +/- 26.4% vs. 7.5 +/- 14.9%, respectively). Nebulized therapy plays an important role in the management of bronchial asthma in children and should be delivered by a mouthpiece whenever possible in cases of exacerbated asthma.
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The aim of this study was to examine the relationship of wheezing to airflow obstruction during acute episodes of asthma in patients who had CVA (Cough variant asthma). Two groups of asthmatic children, one group with a past history of CVA (n = 13) and the other group without such a history (n = 14), were followed longitudinally for 12 months. ⋯ Significant airflow obstruction occurred free of wheezing more frequently and the presence of clinical wheezing was associated with more severe airflow limitation, in asthmatic patients with a past history of CVA than in those without such a history. We conclude that asthmatic patients who have experienced CVA develop the wheezing symptom at a higher level of airflow obstruction.
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Meta Analysis
The use of ipratropium bromide for the management of acute asthma exacerbation in adults and children: a systematic review.
Ipratropium bromide is a quaternary anticholinergic bronchodilator that is commonly used to treat obstructive lung disease. Although ipratropium is not usually employed as a first-line bronchodilator to treat chronic asthma, it has been used extensively in hospital emergency departments as adjunctive therapy for the emergency treatment of acute asthma exacerbation. This review will summarize the physiological actions of ipratropium and the rationale for its use as an anticholinergic bronchodilator. ⋯ In conclusion, there is a modest statistical improvement in airflow obstruction when ipratropium is used as an adjunctive to beta2-agonists for the treatment of acute asthma exacerbation. In pediatric asthma exacerbation, use of ipratropium also appears to improve clinical outcomes; however, this has not been definitively established in adults. It would seem reasonable to recommend the use of combination ipratropium/beta2-agonist therapy in acute asthmatic exacerbation, since the addition of ipratropium seems to provide physiological evidence of benefit without risk of adverse effects.
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Exhaled nitric oxide levels are elevated in asthmatic children and decrease after inhaled steroid treatment. We evaluated the time-dependent changes in fractional exhaled nitric oxide concentration (FENO) and pulmonary function parameters following inhaled steroid therapy. Thirty-nine steroid-naive atopic patients (age 11.92+/-0.48 years) with mild intermittent asthma and 22 age-matched healthy controls were enrolled in the study; pulmonary functions and FE(NO) levels were measured. ⋯ Sixteen of the 39 asthmatic patients were evaluated on two occasions after the beginning of treatment, at days 10 and 40. The significant reduction in FE(NO) levels (p < 0.01) and the significant increase in FEV1 and FEF(25-75%) values observed (p < 0.05) after 10 days did not further improve at day 40. These data show that it is possible to demonstrate early effects of low-dose inhaled steroids in asthmatic children using objective measurements of airway caliber and inflammation.