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Bronchodilator Therapy (bronchodilator + therapy)
Selected AbstractsGUIDELINES FOR WEANING OF BRONCHODILATOR THERAPYJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 12 2005LG Roddick No abstract is available for this article. [source] Laryngeal Findings in Users of Combination Corticosteroid and Bronchodilator Therapy,THE LARYNGOSCOPE, Issue 9 2004Natasha Mirza MD Educational Objective: At the conclusion of this article, the readers should be able to 1) describe the laryngeal findings in patients who use combination therapy for asthma, 2) discuss the mechanism of laryngeal irritation from the use of inhalers, and 3) describe possible mechanisms for reducing laryngeal irritation and secondary dysphonia from the use of inhalers. Objectives: To describe voice changes and laryngeal findings in patients who are started on combination corticosteroid and bronchodilator therapy in the form of a dry powder inhaler (DPI). Study Design: Retrospective, single-subject design. Methods: Retrospective review of 10 consecutive patients meeting inclusion criteria, who presented at the voice center with more than 4 weeks of dysphonia after being started on a combination form of asthma medication for control and maintenance therapy. All patients were nonsmokers and without history of previous identification or excision of vocal pathology. All patients were treated previously with a proton pump inhibitor for gastroesophageal reflux. Laryngeal videostroboscopic evaluations were performed on all patients. Patients were asked to complete a questionnaire regarding their perceived voice change and history of medical maintenance therapy for asthma. Results: Dysphonia was present in the patients selected for greater than 4 weeks. Patients had been switched to combination therapy after previously using traditional two-drug asthma regimens. In eight of nine patients, the vocal folds demonstrated areas of hyperemia, with plaque-like changes on the surface mucosa. Reduced amplitude of vibration and a reduction in mucosal wave propagation were present on videostroboscopy. Questionnaires revealed that all patients were initiated on combination DPI treatment within the last 6 months. Conclusions: Dysphonia caused by a change in the surface mucosa is a side effect from the use of DPI therapy for asthma. The high-impact force during inhalation of the medication and carrier leads to deposition of particles in the upper airway. We believe the extent of mucosal irritation can be minimized by patient education in the proper delivery of DPI. In some cases, however, return of the two medications delivered separately was necessary. The irritation of the laryngeal mucosa and return of normal vibratory parameters occurred in all patients. [source] Qualitative and quantitative evaluation of equine respiratory mechanics by impulse oscillometryEQUINE VETERINARY JOURNAL, Issue 1 2006E. VAN ERCK Summary Reasons for performing study: The long- established conventional reference technique (CRT) for measuring respiratory mechanics in horses lacks sensitivity and there is a need for further refinement in new technology, such as the impulse oscillometry system (IOS). Objectives: To evaluate the potential use of the IOS as a clinical respiratory function test and compare it to the current CRT in horses suffering from common upper and lower airway dysfunctions. Methods: Six healthy horses were tested before and after induction of a unilateral nasal obstruction (UNO) or transient left laryngeal hemiplegia (LLH). Six heaves-affected horses were tested in clinical remission and during a heaves crisis, before and after nebulisation of cumulative doses of a bronchodilator therapy (ipratropium bromide; IPB). Results: As opposed to the CRT, the IOS was able to detect partial upper airway obstruction (UAO) caused by UNO or LLH in resting horses, without differentiating both conditions. Upper airway obstruction caused an upward shift of resistance (Rrs) from 5 to 35 Hz without altering reactance (Xrs). As for the CRT, IOS respiratory parameters measured in heaves-affected horses in crisis differed significantly from values measured during remission. The difference in frequency-dependent behaviour of Rrs and Xrs allowed discrimination between upper and lower airway obstructions. Bronchodilator treatment induced significant dose-dependent changes in Xrs at 5 and 10 Hz, from the first dose. Total pulmonary resistance (RL) and Rrs at 5 Hz were affected from the second dose and displayed similar sensitivity. Although post treatment RL values were comparable to remission, Rrs and Xrs remained significantly different, characterising persistent peripheral obstruction. Conclusions: The IOS was more sensitive than the CRT in detecting partial UAO in resting horses and persistent post treatment peripheral dysfunction in heaves-affected horses. The IOS is a sensitive test that provides graded quantitative and qualitative information on disease-induced respiratory dysfunctions as well as on treatment efficiency in horses. Potential relevance: The IOS could represent a practical and sensitive alternative respiratory function test for routine clinical investigations of common airway obstructive diseases and therapy in horses. [source] Chronic lung disease of prematurity and respiratory outcome at eight years of ageJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2007Karthikeyan Kulasekaran Aim: The study aimed to determine the respiratory outcome of children who had chronic lung disease of prematurity (CLD) compared with a preterm control group of children at school age. Methods: Fifty-two preterm infants with CLD born between 26 and 33 weeks gestation were assessed regarding respiratory illness with 47 having lung function testing. Information regarding respiratory illness was obtained from 52 children in the birthweight-matched control group of whom 45 had lung function testing. The results were compared between the CLD and control groups. Results: There was no difference in respiratory symptomatology between CLD groups and control preterm infants. On lung function testing, a significantly lower mean forced expiratory flow at 25,75% of vital capacity was identified compared with the preterm controls (P = 0.024). This significant difference did not persist after bronchodilator therapy. There was no evidence of increased air trapping or bronchial hyper-reactivity in the CLD children compared with the controls. Conclusion: Lung function in CLD children is largely normal in comparison with preterm controls, apart from some evidence of reversible small airway obstruction. Respiratory symptomatology is not increased in chronic disease children in comparison with control preterm children. [source] The effect of ,2-adrenoceptor haplotypes on bronchial hyper-responsiveness in patients with asthmaALLERGY, Issue 2 2006A. M. Wilson Background:, The ,2-adrenoceptor exhibits genetic polymorphism which may be clinically relevant in terms of treatment response or bronchial hyper-responsiveness (BHR). The combined effect of these genotypes, or the haplotype, has not been fully characterized in terms of BHR. Methods:, We performed a retrospective analysis of the effects of haplotypes of amino acid substitution at position 16 (Gly/Arg) and position 27 (Gln/Glu) on spirometry and BHR to methacholine and adenosine monophosphate (AMP) in 594 asthmatic patients. Results:, There was a significant (P < 0.05) overall effect for forced expiratory volume (FEV1) but not after correction for steroid dose and atopic status. There were no significant differences for BHR to methacholine or AMP between the different haplotypes and no difference between the numbers of patients with or without clinically relevant BHR. Methacholine PD20 geometric mean-fold difference was 1.63 (95% CI: 0.95,2.80) between Arg,Arg/Gln,Gln and Gly,Gly/Gln,Gln and 1.26 (95% CI: 0.75,2.11) between Gly,Gly/Gln,Gln and Gly,Gly/Glu,Glu. Conclusions:, The degree of BHR to indirect and direct stimuli does not differ between ,2-adrenoceptor haplotypes, and haplotypes cannot be used to predict BHR in patients presenting with asthma. Although ,2-adrenoceptor haplotypes do not predict BHR they may be important in predicting response to bronchodilator therapy. [source] Intrathoracic nontuberculous mycobacterial infections in otherwise healthy childrenPEDIATRIC PULMONOLOGY, Issue 11 2009Alexandra F. Freeman MD Abstract Background Nontuberculous mycobacterial (NTM) infection is typically associated with lymphadenitis in immune competent children, and disseminated disease in children with immune deficiencies. Isolated pulmonary NTM disease is seen in cystic fibrosis, and is increasingly recognized in immunocompetent elderly women, where it is associated with an increased incidence of cystic fibrosis transmembrane regulator (CFTR) mutations. Thoracic NTM infection has been reported rarely in otherwise healthy children. We aimed to determine whether otherwise healthy children with pulmonary NTM disease had immunologic abnormalities or CFTR mutations. Clinical presentations of five otherwise healthy children with pulmonary NTM were reviewed. Immunologic studies were performed including a complete blood cell count (CBC), flow cytometric lymphocyte phenotyping and IFN-gamma receptor expression, in vitro cytokine stimulation, and serum immunoglobulin levels. Mutational analysis was performed for CFTR. The children ranged in age from 12 months to 2.5 years at diagnosis. Four presented with new onset wheezing or stridor failing bronchodilator therapy. One child was asymptomatic. Endobronchial lesions and/or hilar lymph nodes causing bronchial obstruction were identified in all patients. Mycobacterium avium complex was cultured from four patients, and Mycobacterium abscessus from one patient. All patients were successfully treated with anti-mycobacterial therapy with or without surgery. No definitive immunologic abnormalities were identified. No clinically significant mutations were found in CFTR. Pulmonary NTM infection should be considered in otherwise healthy young children presenting with refractory stridor or wheezing with endobronchial lesions or hilar lymphadenopathy. It does not appear to be associated with recognized underlying immune deficiency or CFTR mutations. Pediatr Pulmonol. 2009; 44:1051,1056. ©2009 Wiley-Liss, Inc. [source] What is the role of tests of lung function in the management of infants with lung disease?PEDIATRIC PULMONOLOGY, Issue 1 2003S. Godfrey MD This review considers whether there is a role for lung function tests in the clinical management of infants with lung disease. The purpose of testing lung function in older subjects, the tests available for infants, and the practical problems of testing lung function in infants are considered. After reviewing all the facts, we suggest that there are four situations in which lung function testing should be recommended for infants, as follows: 1) the infant who presents with unexplained tachypnea, hypoxia, cough, or respiratory distress in whom a definitive diagnosis is not apparent from physical examination and other, less difficult investigations; 2) the infant with severe, continuous, chronic obstructive lung disease who does not respond to an adequate clinical trial of combined corticosteroid and bronchodilator therapy; 3) the infant with known respiratory disease of uncertain severity in whom there is need to justify management decisions; and 4) research and development. A review of 62 recent publications to determine how lung function tests are being used at the present time showed that they are being used overwhelmingly for research. The role of lung function testing in the clinical management of infants has not been established, and research is needed to clarify this situation. We suggest that such studies should explore the role of lung function tests in infants with specific symptoms, signs, or diagnoses, taking into account information from other types of investigation and the cost/benefit/risk ratios. Pediatr Pulmonol. 2003; 36:1,9. © 2003 Wiley-Liss, Inc. [source] Laryngeal Findings in Users of Combination Corticosteroid and Bronchodilator Therapy,THE LARYNGOSCOPE, Issue 9 2004Natasha Mirza MD Educational Objective: At the conclusion of this article, the readers should be able to 1) describe the laryngeal findings in patients who use combination therapy for asthma, 2) discuss the mechanism of laryngeal irritation from the use of inhalers, and 3) describe possible mechanisms for reducing laryngeal irritation and secondary dysphonia from the use of inhalers. Objectives: To describe voice changes and laryngeal findings in patients who are started on combination corticosteroid and bronchodilator therapy in the form of a dry powder inhaler (DPI). Study Design: Retrospective, single-subject design. Methods: Retrospective review of 10 consecutive patients meeting inclusion criteria, who presented at the voice center with more than 4 weeks of dysphonia after being started on a combination form of asthma medication for control and maintenance therapy. All patients were nonsmokers and without history of previous identification or excision of vocal pathology. All patients were treated previously with a proton pump inhibitor for gastroesophageal reflux. Laryngeal videostroboscopic evaluations were performed on all patients. Patients were asked to complete a questionnaire regarding their perceived voice change and history of medical maintenance therapy for asthma. Results: Dysphonia was present in the patients selected for greater than 4 weeks. Patients had been switched to combination therapy after previously using traditional two-drug asthma regimens. In eight of nine patients, the vocal folds demonstrated areas of hyperemia, with plaque-like changes on the surface mucosa. Reduced amplitude of vibration and a reduction in mucosal wave propagation were present on videostroboscopy. Questionnaires revealed that all patients were initiated on combination DPI treatment within the last 6 months. Conclusions: Dysphonia caused by a change in the surface mucosa is a side effect from the use of DPI therapy for asthma. The high-impact force during inhalation of the medication and carrier leads to deposition of particles in the upper airway. We believe the extent of mucosal irritation can be minimized by patient education in the proper delivery of DPI. In some cases, however, return of the two medications delivered separately was necessary. The irritation of the laryngeal mucosa and return of normal vibratory parameters occurred in all patients. [source] Follow-up of 5- to 11-year-old children treated for persistent pulmonary hypertension of the newbornACTA PAEDIATRICA, Issue 2 2009Vibeke Eriksen Abstract Aim: Determine the prevalence of sensorineural hearing loss (SNHL) and relate this to cumulative exposure to hypoxia, hypocapnia and hypotension. Describe chronic health problems among 5- to 11-year-old children treated for persistent pulmonary hypertension of the newborn (PPHN). Methods: The index group consisted of 85 children and a reference group was matched for age, sex and municipality of current residence. Questionnaires were sent to the families. The families in the index group were asked to participate in an examination of their child's hearing. Results: Seven children (11%) had SNHL. SNHL was not associated with hypoxia, hypocapnia or hypotension during treatment for PPHN. In the index group chronic health problems were reported in 42% compared with 17% in the reference group (chi-square test, p = 0.001). Twenty-one percent in the index group were treated with bronchodilator therapy compared with 8% in the reference group (chi-square test, p = 0.028). In the index group five children had cerebral palsy and two had developmental delay. Nineteen percent in the index group and 5% in the reference group had remedial education (chi-square test, p = 0.008). Conclusion: Children treated for PPHN are at high risk for SNHL. Exposure to hypoxia, hypocapnia or hypotension did not predict SNHL. The incidence of chronic health problems and use of remedial education was high. [source] Cysteinyl leukotrienes as common mediators of asthma and allergic diseaseCLINICAL & EXPERIMENTAL ALLERGY REVIEWS, Issue 2 2003S-E. Dahlén Summary The cysteinyl leukotrienes (CysLTs) induce a number of pro-inflammatory effects including smooth muscle contraction, an increase in blood flow, plasma exudation, mucous secretion, and activation of inflammatory cells. They play a key role in asthma and allergy, and can be recovered from different body fluids (e.g. bronchoaleveolar or nasal lavage and urine) during allergen-induced hypersensitivity reactions. The advent of antileukotriene agents (i.e. leukotriene receptor antagonists or leukotriene synthesis inhibitors) has helped clarify how the different mechanisms contribute to inflammation, as well as offer new treatment options for both asthma and allergy. It is now clear that the release of leukotrienes is the final common path for the many different factors causing airway obstruction and inflammation. In asthma, clinical studies have shown that treatment with antileukotrienes can improve pulmonary function, alleviate symptoms, reduce asthma exacerbations, and decrease the need for bronchodilator therapy. Similarly, in patients with allergic rhinitis, improvements have been seen in nasal symptoms, eye symptoms and quality of life. Antileukotrienes provide a new opportunity for simultaneous management of allergic diseases of the upper and lower respiratory tract, and are a rational treatment approach to the concept of ,one airway' disease. In future, their utility may also extend to inflammatory disorders of other organ systems (e.g. skin). [source] | ||||||||||||||||||||||