Implementation of Asthma Management Guidelines and Possible Barriers in Korea

BACKGROUND: There could be a gap between asthma management guidelines and current practice. We evaluated the awareness of and compliance with asthma management guidelines, and the internal and external barriers to compliance, for the first time in Korea.METHODS: From March to September of 2012, 364 physicians treating asthma patients at primary, secondary, and tertiary teaching hospitals were enrolled. They completed a questionnaire on the awareness of and compliance with asthma management guidelines, and the barriers and alternatives to their implementation.RESULTS: Of the 364 physicians, 79.1% were men and 56.9% were primary care physicians. The mean age was 40.5 ± 11.2 years. Most of them were aware of asthma management guidelines (89.3%). However, only a portion (11.0%) of them complied with the guidelines for asthma. Pulmonary function tests for diagnosis of asthma were performed by 20.1% of all physicians and 9.2% of primary care physicians, and by 9.9% of all physicians and 5.8% of primary care physicians for monitoring. Physicians stated that ‘asthma monitoring’ was the most difficult part of the guidelines, followed by ‘environmental control and risk factors.’ Only 39.6% (31.9% of the primary care physicians) prescribed an inhaled corticosteroid (ICS) as the first-line treatment for persistent asthma. The internal barriers were physician's preference for oral medications, difficulty in use even with inhaler training, and concern over ICS side effects. The external barriers were possible rejection of medical reimbursement by health insurance, refusal by the patient, cost, and a poor environment for teaching the patient how to use the inhaler. Alternatives proposed by physicians to implement asthma management guidelines were to improve medical reimbursement policies and the level of awareness of such guidelines.CONCLUSION: Compliance with the asthma management guidelines, including ICS prescription, is low despite the awareness of the guidelines. It is necessary to develop a strategy to overcome the internal and external barriers.

Guia para o manejo da asma grave 2019 ­ Associação Brasileira de Alergia e Imunologia / Guide to the management of severe asthma 2019 ­ Brazilian Association of Allergy and Immunology

Antes de rotular um paciente como tendo asma grave, é crucial confirmar o diagnóstico da doença e de sua gravidade, além de excluir diagnósticos diferenciais de condições que podem se assemelhar ou se confundir com a asma, tais como: tuberculose, doença pulmonar obstrutiva crônica, disfunção de corda vocal, apneia do sono, bronquiectasia, entre outras. Neste guia são abordados, além dos diagnósticos diferenciais, dados de história clínica e exames laboratoriais que permitem classificar o paciente com relação à evolução da doença (controlado ou não controlado) e, assim, possibilitar a instituição do esquema terapêutico mais apropriado. São apresentadas alternativas terapêuticas disponíveis para a abordagem clínica desses pacientes, incluindo os imunobiológicos.

Prior to labeling a patient as having severe asthma, a crucial step is to confirm the diagnosis and severity as well as to exclude conditions that may resemble or be mistaken for asthma such as tuberculosis, chronic obstructive pulmonary disease, vocal cord dysfunction, sleep apnea, bronchiectasis, among others. In addition to differential diagnoses, this guide addresses clinical history data and laboratory tests that classify the patient regarding disease progression (controlled or uncontrolled asthma), allowing the establishment of an adequate therapeutic plan. Therapeutic options available for the treatment of these patients are detailed, including biologics.

Comparison of the efficacy of budesonide by nebulizer, metered dose inhaler and dry powder inhaler in chronic stable bronchial asthma

Background: The study has been performed to evaluate the efficacy of budesonide delivery by different form of devices like nebulizer, metered dose inhaler and dry powder inhaler to adult patients of chronic stable bronchial asthma. The changes in pulmonary function test parameters have been consider for evaluation.Methods: This prospective study was undertaken to assess the relative efficiency of budesonide administered from devices like nebulizer, metered dose inhaler and dry powder inhaler in adult patients of chronic stable bronchial asthma. Fifty subjects where administered budesonide (1mg) via nebulizer, budesonide (400 microgram) by metered dose inhaler and dry powder inhaler consecutively each week for four weeks under direct supervision. To analyze the effect of budesonide delivered through different devices pulmonary function test was carried out on the subject before and one hour after administration of the drug on each visit.Results: No significant difference in Peak expiratory flow rate (P=0.77), forced expiratory volume in one second (P=0.851), forced vital capacity (P=0.178) and forced expiratory volume in one second and forced vital capacity ratio (P=0.298) was seen after giving budesonide by different devices.Conclusions: Budesonide delivered by different devices (nebulizer, metered dose inhaler, and dry powder inhaler) have similar effect on lung function in patients of chronic stable bronchial asthma. In the daily clinical practice, the correct choice of an inhaler device should be related with the patient's characteristics. They may be used interchangeably depending on availability, cost and compliance of the patients.

Pharmacotherapy for chronic obstructive pulmonary disease

The goals of management of stable chronic obstructive pulmonary disease (COPD) are to reduce both current symptoms and future risks with minimal side effects from treatment. Identification and reduction of exposure to risk factors are important in the treatment and prevention of COPD. Appropriate pharmacologic therapy can reduce symptoms and exacerbations, and improve health status and exercise tolerance. To date, none of the existing medications for COPD has been shown to modify disease progression or reduce mortality. The classes of medication are bronchodilators including beta2-agonist, anticholinergics and anti-inflammatory drug including inhaled corticosteroid and phosphodiesterase-4 inhibitor such as roflumilast. Each treatment regimen needs to be individualized as the relationship between severity of symptoms, airflow limitation and severity of exacerbation can differ between patients.

Investigation of Pharmacists’ Intervention to Inhalational Skills and Effective Inhalation of Patients Taking Corticosteroids / 社会薬学

Inhaled corticosteroids should be taken continuously. As the methods of inhalation vary depending on the pharmaceutical preparations of inhaled corticosteroids, satisfactory effects cannot be expected without proper inhalation. This paper deals with the assessment of inhalational skills with the use of a manual of corticosteroid inhalation and a check sheet of patients’ performance. The effective inhalation as judge by the combination of the speed and the time needed for inhalation was assessed with the help of the training device for inhalation of each inhaled corticosteroid. The average scores of inhalational skills were increased significantly as follow ; aerosol : from 3.8 to 4.9 (p=0.035), Turbuhaler: from 2.6 to 3.0 (p=0.003), discus: from 4.9 to 6.0 (p<0.001). Among 7 in patients (38.9%) who were insufficient in inhalational ability, except for 1 patient who interrupted medication, 4 and 2 patients were improved in the speed and the time needed for inhalation, respectively. It was suggested to advise physicians to dispense alternative preparations of inhaled corticosteroids depending on the repeated evaluation of the inhalational ability.

Investigation of Pharmacists’ Intervention to Inhalational Skills and Effective Inhalation of Patients Taking Corticosteroids / 社会薬学

Inhaled corticosteroids should be taken continuously. As the methods of inhalation vary depending on the pharmaceutical preparations of inhaled corticosteroids, satisfactory effects cannot be expected without proper inhalation. This paper deals with the assessment of inhalational skills with the use of a manual of corticosteroid inhalation and a check sheet of patients’ performance. The effective inhalation as judge by the combination of the speed and the time needed for inhalation was assessed with the help of the training device for inhalation of each inhaled corticosteroid. The average scores of inhalational skills were increased significantly as follow ; aerosol : from 3.8 to 4.9 (p=0.035), Turbuhaler: from 2.6 to 3.0 (p=0.003), discus: from 4.9 to 6.0 (p<0.001). Among 7 in patients (38.9%) who were insufficient in inhalational ability, except for 1 patient who interrupted medication, 4 and 2 patients were improved in the speed and the time needed for inhalation, respectively. It was suggested to advise physicians to dispense alternative preparations of inhaled corticosteroids depending on the repeated evaluation of the inhalational ability.

Estudio aleatorizado abierto de niños con exacerbación aguda del asma tratados con esteroides inhalados / Open randomized study of children with acute exacerbation of asthma and treated with inhaled steroids

Introducción: la terapia primaria en la crisis de asma aguda, incluye administración de oxígeno, uso de ß2-agonistas por vía inhalada y la administración de esteroides sistémicos. Las ventajas que se citan sobre el uso de los esteroides inhalados serían, su rápido inicio de acción y su buen perfil de seguridad, en contraposición a los esteroides sistémicos. Objetivo: evaluar la utilidad de los corticoides inhalados en el tratamiento de la crisis de asma aguda en niños mayores de 2 años. Métodos: se realizó un estudio prospectivo, transversal, experimental, aleatorizado, de eficacia clínica; la selección se realizó por medio de una tabla de números aleatorios, y se incluyeron tres grupos: el I recibió terapia estándar, el II la sustitución del esteroide sistémico por el inhalado y el III combinó a la terapia estándar el esteroide inhalado. El análisis estadístico se realizó por medio de ANOVA y chi cuadrado con una p< 0,05 como significativa. Resultados: se estudiaron 165 pacientes, los tres grupos de tratamiento mejoraron la escala de severidad inicial. Los pacientes que recibieron esteroides inhalados adicionados a la terapia estándar, tuvieron 73 por ciento de posibilidades de no ser hospitalizados, 27 por ciento de posibilidades de reducir el riesgo de hospitalizaciones y de cada 100 pacientes tratados con la combinación, se pudieran prevenir 8 hospitalizaciones(AU)

Changes of exhaled nitric oxide level in patients with chronic obstructive pulmonary disease and its clinical significance / 上海交通大学学报（医学版）

Objective·To observe changes of exhaled nitric oxide (FeNO) level in patients with chronic obstructive pulmonary disease (COPD) before and after inhaled corticosteroid (ICS) therapy and to explore the correlation of FeNO level with inflammation and pulmonary function indexes. Methods·Seventy COPD patients at stable stage who underwent ICS therapy (the COPD group) were enrolled. Levels of peripheral blood eosinophil (Eos) and neutrophil (N), FeNO, PEF, FEV1 and FEV1/pred before and after treatment were measured. Fifty healthy volunteers who received physical examination at the same time served as controls (the control group). The relationship between these indexes and clinical efficacy and the correlation between FeNO level and inflammation or pulmonary function indexes were analyzed. Results·The COPD group had significantly higher FeNO, Eos, and N levels before treatment, significantly lower PEF, FEV1 and FEV1/pred after treatment (P0.05). Conclusion·The FeNO level increased significantly in patients with COPD at stable stage and is a sensitive index of airway inflammation. Combined with lung function test, it's useful for evaluating the efficacy of ICS and guiding treatment.

Safety and efficacy of oral versus inhaled corticosteroid for moderate persistent asthma in children 6 to 15 years old: A randomized controlled trial

@#<p style="text-align: justify;"><strong>BACKGROUND: </strong>One out of 10 Filipino children suffer from bronchial asthma. Its increasing prevalence over the past decades causes significant morbidity to the patients and their families, especially when it is uncontrolled. In developing countries, the form of medicine, cost and access to medications are significant factors in achieving good control of symptoms. No study has been done to determine if the use of low dose oral corticosteroid is a safe and effective alternative treatment for children with asthma.</p><p style="text-align: justify;"><strong>OBJECTIVE</strong>: To compare the safety and efficacy of oral versus inhaled corticosteroid in moderate persistent asthma.</p><p style="text-align: justify;"><strong>METHODS: </strong>An open label randomized controlled trial was carried out in 40 patients 6 to 15 years old with newly diagnosed moderate persistent asthma. They were assigned to either inhaled or oral corticosteroid group. Efficacy of treatment based on daytime and nighttime coughing, limitation of activity, use of bronchodilators, FEV1, PEFR and level of asthma control were assessed. Safety of both treatment options were evaluated by the occurrence of corticosteroid induced hypertension, adrenal insufficiency and diabetes.</p><p style="text-align: justify;"><strong>RESULTS: </strong>The use of inhaled and oral corticosteroid showed improvement in daytime and nighttime cough, need for bronchodilators, limitation of activity, FEV1, PEFR and level of control. Furthermore, both treatment options had comparable safety profile.</p><p style="text-align: justify;"><strong>CONCLUSION: </strong>There was no significant difference on the safety and efficacy of oral versus inhaled corticosteroid in the longterm treatment of moderate persistent bronchial asthma.</p>

Soluble CD93 in Serum as a Marker of Allergic Inflammation

PURPOSE: CD93 is receiving renewed attention as a biomarker of inflammation. We aimed to evaluate the potential for serum sCD93 to serve as a novel biomarker for allergic inflammation. MATERIALS AND METHODS: We enrolled 348 subjects with an allergic disease [allergic rhinitis (AR), chronic spontaneous urticaria (CSU), or bronchial asthma (BA)], including 14 steroid-naïve BA patients who were serially followed-up. RESULTS: The serum sCD93 levels (ng/mL) in patients with exacerbated AR (mean±standard deviation, 153.1±58.4) were significantly higher than in patients without AR (132.2±49.0) or with stable AR (122.3±42.1). Serum sCD93 levels in exacerbated CSU (169.5±42.8) were also significantly higher than those in non-CSU (132.4±51.6) and stable CSU (122.8±36.2). This trend was also seen in BA. Serum levels in patients with ICS-naïve BA (161.4±53.1) were significantly higher than those in healthy controls without BA (112.2±30.8), low- and medium-dose ICS users. Serum sCD93 levels in high-dose ICS users (72.2±20.6) were significantly lower than those in low- and medium-dose users. The serum sCD93 levels in steroid-naïve patients with BA (195.1±72.7) decreased after ICS use for 4 weeks (134.4±42.8) and 8 weeks (100.7±13.4), serially. CONCLUSION: Elevated serum sCD93 levels reflected exacerbated status of allergic diseases, including CSU, AR, and asthma. ICS use significantly diminished serum sCD93 levels in steroid-naïve patients with BA. This result may suggest sCD93 in serum as a therapeutic marker for allergic inflammation.

Relationship between Fractional Exhaled Nitric Oxide Level and Efficacy of Inhaled Corticosteroid in Asthma-COPD Overlap Syndrome Patients with Different Disease Severity

This study explored the relationship between the fractional exhaled nitric oxide (FeNO) level and the efficacy of inhaled corticosteroid (ICS) in asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) patients with different disease severity. A total of 127 ACOS patients with ACOS (case group) and 131 healthy people (control group) were enrolled in this study. Based on the severity of COPD, the ACOS patients were divided into: mild ACOS; moderate ACOS; severe ACOS; and extremely severe ACOS groups. We compared FeNO levels, pulmonary function parameters including percentage of forced expiratory volume in 1 second (FEV1) to predicted value (FEV1%pred), ratio of FEV1 to forced vital capacity (FEV1/FVC), inspiratory capacity to total lung capacity (IC/TLC) and residual volume to total lung capacity (RV/TLC), arterial blood gas parameters, including PH, arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂), total serum immunoglobulin E (IgE), induced sputum eosinophil (EOS), plasma surfactant protein A (SP-A), plasma soluble receptor for advanced glycation end products (sRAGE), sputum myeloperoxidase (MPO), sputum neutrophil gelatinase-associated lipocalin (NGAL) and Asthma Control Test (ACT) scores, and COPD Assessment Test (CAT) scores. Compared with pre-treatment parameters, the FeNO levels, RV/TLC, PaCO₂, total serum IgE, induced sputum EOS, plasma SP-A, sputum MPO, sputum NGAL, and CAT scores were significantly decreased after 6 months of ICS treatment, while FEV1%pred, FEV1/FVC, IC/TLC, PH, PaO₂, plasma sRAGE, and ACT scores were significantly increased in ACOS patients with different disease severity after 6 months of ICS treatment. This finding suggests that the FeNO level may accurately predict the efficacy of ICS in the treatment of ACOS patients.

Evaluación del uso de corticoides inhalados en altas dosis para el tratamiento de crisis asmática / Evaluation of the Use of High-dose Inhaled Corticosteroids for the Treatment of Acute Asthma

Introducción: El asma es una enfermedad heterogénea caracterizada por la inflamación crónica de la vía aérea. Se caracteriza por síntomas respiratorios como sibilancias, disnea, opresión en el pecho, tos que varía en el tiempo y en la intensidad, además de presentar limitación variable al flujo aéreo. Afecta del 1 al 18% de la población mundial. Existe evidencia que sugiere que los corticoides inhalados pueden mostrar efectos terapéuticos tempranos (< 3 h). Esta rápida respuesta se encontraría vinculada a un efecto tópico (vasoconstricción de la mucosa de la vía aérea), debido a la potenciación del efecto adrenérgico por modificación de los receptores post-sinápticos. Materiales y métodos: Se realizó un estudio prospectivo, aleatorizado, analítico, longitudinal de cohorte y experimental, en pacientes con crisis de asma atendidos en la guardia externa del Hospital de Rehabilitación Respiratoria María Ferrer. Resultados: Se evaluó a un total de 71 pacientes en un período de 10 meses, todos ingresaron por el servicio de guardia del Hospital de Rehabilitación Respiratoria María Ferrer y accedieron a participar del protocolo firmando un consentimiento informado. Ambos grupos presentaron un 63% de respuesta significativa (FEV1 > 60%) a los 30 minutos de iniciado el tratamiento (p: 0.72). Al fnal del protocolo (180 minutos), el grupo control (salbutamol + bromuro de ipratropio) presentó 3 pacientes que no lograron el objetivo del FEV1 > 60% a comparación de 2 pacientes en el grupo tratado con corticoides inhalados a altas dosis (P: 0.97). Conclusión: Actualmente el uso de corticoides inhalados a altas dosis en crisis de asma es una opción terapéutica para pacientes con crisis moderadas a severas. Nuestro estudio no obtuvo valores significativos que apoyen el uso de esta medicación para reducir la incidencia de internaciones o mejorar significativamente la función pulmonar.

Introduction: Asthma is a heterogeneous disease characterized by chronic inflammation of the airways. Its more common respiratory symptoms such as wheezing, breathlessness, chest tightness and cough vary in time and intensity, in addition to displaying variable airflow limitation. Asthma affects 1 to 18% of the world population. Evidence suggests that inhaled corticosteroids may show early therapeutic effects (<3 hours). This quick response would be linked to a local effect (vessel constriction of the airway mucosa) due to the potentiation of the adrenergic effect that modifies the postsynaptic receptors. Materials and methods: A prospective, randomized, analytical and experimental longitudinal cohort study in patients with acute asthma treated at the emergency services of the Respiratory Rehabilitation Hospital Maria Ferrer, Buenos Aires. Results: A total of 71 patients were evaluated over a period of 10 months who had agreed to participate in the study by signing an informed consent. Both the study and the control groups had a 63% significant response (FEV1> 60%) within 30 minutes of starting treatment (p = 0.72). At the end of the observation (180 minutes), three patients of the control group (Salbutamol + ipratropium bromide) did not achieve the objective of FEV1> 60% compared to 2 patients in the study group treated with high-dose inhaled corticosteroids (P group: 0.97). Conclusion: Currently the use of high-dose inhaled corticosteroids in asthma attack is a therapeutic option for patients with moderate to severe crisis. The results of our study do not provide significant evidence in support of the use of this medication to reduce the incidence of hospitalizations or improve the lung function.

Effect of long-term inhaled glucocorticoids on height in children with asthma / 国际儿科学杂志

Asthma is the most common chronic respiratory disease in children. Currently,inhaled corti-costeroids is the most effective drug for asthma,however,there are some adverse effect by long-time using. Ac-cording to recent literature,long-time treatment with inhaled corticosteroids may inhibit height growth. But this suppression only occurs within early stage of asthma treatment, and have no effect or slight effect on adult height. The adverse effects of inhaled corticosteroids for height are also related to its iypes,dose and usage.

Factors Affecting Recovery Time of Pulmonary Function in Hospitalized Patients With Acute Asthma Exacerbations

PURPOSE: Prolonged recovery time of pulmonary function after an asthma exacerbation is a significant burden on asthmatics, and management of these patients needs to be improved. The aim of this study was to evaluate factors associated with a longer recovery time of pulmonary function among asthmatic patients hospitalized due to a severe asthma exacerbation. METHODS: We retrospectively reviewed the medical records of 89 patients who were admitted for the management of acute asthma exacerbations. The recovery time of pulmonary function was defined as the time from the date each patient initially received treatment for asthma exacerbations to the date the patient reached his or her previous best FEV1% value. We investigated the influence of various clinical and laboratory factors on the recovery time. RESULTS: The median recovery time of the patients was 1.7 weeks. Multiple linear regression analysis revealed that using regular inhaled corticosteroids (ICS) before an acute exacerbation of asthma and concurrent with viral infection at admission were associated with the prolonged recovery time of pulmonary function. CONCLUSIONS: The prolonged recovery time of pulmonary function after a severe asthma exacerbation was not shown to be directly associated with poor adherence to ICS. Therefore the results indicate that an unknown subtype of asthma may be associated with the prolonged recovery of pulmonary function time after an acute exacerbation of asthma despite regular ICS use. Further prospective studies to investigate factors affecting the recovery time of pulmonary function after an asthma exacerbation are warranted.

Addition of Montelukast to Low-Dose Inhaled Corticosteroid Leads to Fewer Exacerbations in Older Patients Than Medium-Dose Inhaled Corticosteroid Monotherapy

PURPOSE: There have been few reports regarding the efficacy of antiasthmatics in older patients. To compare the efficacy of the addition of montelukast to low-dose inhaled budesonide (MON-400BUD) versus increasing the dose of inhaled steroid (800BUD) on asthma control in older asthmatics. METHODS: A randomized, open-label, parallel-designed trial was conducted for 12 weeks. The primary endpoint was the rate of patients who reached "well-controlled asthma status" after the 12-week treatment period. Additionally, asthma exacerbations, sputum inflammatory cells, asthma control test (ACT) and physical functioning scale (PFS), and adverse reactions were monitored. RESULTS: Twenty-four (36.9%) and 22 (34.9%) subjects in the MON-400BUD (n=65) and 800BUD (n=63) groups had well-controlled asthma at the end of the study, respectively. The numbers of asthma exacerbations requiring oral corticosteroid treatment (20 vs 9, respectively, P=0.036) and the development of sore throat (22 vs 11, respectively, P=0.045) were significantly higher in the 800BUD group than in the MON-400BUD group. Body mass index and changes in ACT, FEV1%, 6-min walk distance and PFS from baseline were all significant determinants for distinguishing subjects with well-controlled and partly controlled asthma from those with uncontrolled asthma (P<0.05) at the end of the study. CONCLUSIONS: The efficacy of 12-week treatment with MON-400BUD in older asthmatics was comparable to that of 800BUD on asthma control but associated with reduced frequency of asthma exacerbations requiring oral steroids and sore throat events. Changes in ACT and PFS can be useful predictors of asthma control status in older patients.

Treatment of mild asthma: Is it necessary to keep regular inhaled corticosteroids?

The main goal of asthma treatment is an adequate control of symptoms and a reduction in future exacerbations. To achieve the goal, international guidelines recommend daily use of controllers, such as inhaled corticosteroids (ICSs), even in patients with mild asthma. However, poor adherence is an unavoidable issue in the management of mild asthma. In addition, there is concern about possible adverse reactions and economic burden by unnecessary treatment. Recently, several studies have shown that as-needed use of ICSs has similar effects as regular use of ICSs on the prevention of acute asthmatic exacerbations. However, daily regular use of ICSs seems to be superior in terms of symptom-free days or airway inflammation suppression. Further studies are needed to determine whether symptom-driven use of ICSs can be an effective strategy for the management of mild asthma. Also, it is necessary to develop proper methods that can predict mild asthmatics who experience frequent exacerbations if they stop regular ICSs.

A C OMPARISON OF SYSTEMIC AND INHALED CORTICOSTEROID THERAPY IN PATIENTS WITH EXACERBATION OF COPD / Шинэ санаа Шинэ нээлт

Objective: To compare the efficacy of systemic and inhaled corticostcroid in patients with acute exacerbation of COPD.Methods: In this randomized, parallel-group study 80 patients (average age 59,7±7.7) were randomized to receive inhaled corticosteroid (fluticasone propionate 1000-1200 meg/daily, n -40) or systemic corticosteroid (intravenous dcxamethasone 4-8 mg every 24 hours, n-40). Outcome variables included the lung function tests (FEV1, FVC, FEV1/FVC), 6MWT, and 1 Symptoms. 2. Activity and 3. Impact components of St George's Respiratory Questionnaire for t OPD patients (SGRQ-C).Results: In group with systemic corticosteroid increased the FF.V1 from 63.5±9 to 68.118.1, FVC from 78.7±11.8 to 86.6±11, FEV1/FVC from 64.918.7 to 69.917.3; score of SGRQ-C improved I.from 58.5114.3 to 31 5ÈË 2. from 60.6116.7 to 37.7117.2, 3.1'rom 44.9+14.5 to 21.5113. In group wi«fi fluticasone propionate increased the FEV1 improved from 64.719 to 68.718.5, FVC from 79.7111.3 to 88.1110.7, and FEV1/FVC from 64.9+8.6 to 69.517.5; score of SGRQ-C I .from 58.5111.1 to 36.4113,0. 2.from 59.9117.2 to 39.1 + 16.8. 3.from 45.7114.7 to 23.5+13.8. The difference in efficacy of treatment in two groups was not significant.Conclusion:I fioth inhaled and systemic GSs improve airflow and lung function test in C'OPI) patients with

Ratio of Leukotriene E4 to Exhaled Nitric Oxide and the Therapeutic Response in Children With Exercise-Induced Bronchoconstriction

PURPOSE: This study assessed the association between the ratio of leukotriene E4 (LTE4) to fractional exhaled nitric oxide (FENO) in the response of children with exercise-induced bronchoconstriction (EIB) enrolled in a therapeutic trial with montelukast or inhaled corticosteroid (fluticasone propionate [FP]). METHODS: Children aged 6 to 18 years with EIB were randomized in a 4-week, placebo-controlled, double-blinded trial with montelukast or FP. Before and after treatment, treadmill exercise challenges were performed. The LTE4 levels in the induced sputum and urine and the FENO levels were measured in subjects before and 30 minutes after the exercise challenges. The same tests were conducted after treatment. RESULTS: A total of 24 patients completed the study: 12 in the montelukast group and 12 in FP group. Both study groups displayed a similar postexercise maximum decrease in forced expiratory volume in one second (FEV1) before treatment as well as after treatment. However, there were significant differences in the magnitude of change between the two (Delta; -18.38+/-14.53% vs. -4.67+/-8.12% for the montelukast and FP groups, respectively; P=0.021). The Delta logarithmic sputum baseline and postexercise LTE4/FENO ratio were significantly lower in the montelukast group than in the FP group (baseline; -0.09+/-0.21 vs. -0.024+/-0.03, P=0.045; postexercise, -0.61+/-0.33 vs. -0.11+/-0.28, P=0.023). CONCLUSIONS: These data indicate that the efficacy of montelukast for preventing a maximum decrease in FEV1 after exercise is significantly higher than that of FP, and the high LTE4/FENO ratio is associated with a greater response to montelukast than to FP for EIB therapy. These results suggest that LTE4 may play an important role in EIB.

Quality of life of chronic obstructive pulmonary disease patients / Монголын Анагаах Ухаан

Chronic obstructive pulmonary disease (COPD) is a disease state characterized by airflow limitation that is not fully reversible. The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. Pathological changes characteristic COPD are found in the proximal airways, peripheral airways, lung parenchyma, and pulmonary vasculature.GoalTo evaluate corticosteroid therapy effects in patients with acute exacerbation of COPDMaterial and MethodsWe examined the efficacy of corticosteroid (CS) therapy in 45 patients who admitted to Department of Pulmonology at Shastin`s Central Hospital during 2011-2012 and met GOLD criteria of COPD exacerbation. All patients randomly divided into two groups. Patients received from randomization inhaled corticosteroids (flixotide 1000 mcg/daily or frenolyn 800-1200 mcg/daily), systemic corticosteroid (intravenous prednisone 30- 60 mg every 24 hours). In evaluation of efficacy of treatment we use lung function tests and St George`s Respiratory Questionnaire for COPD patients (SGRQ-C).Results45 patients (average age 59, 6±7.9) were enrolled in our study. 23 patients were randomly assigned to high dose of inhaled corticosteroids (ICS), 22 to intravenous prednisone. Outcomes of treatment were evaluated by 1. Symptoms, 2. Activity and 3. Impact components of SGRQ-C and FEV1, FVC, FEV1/FVC. The difference in quality of life and lung functional tests between ICS and prednisone was not significant. Score of SGRQC in two groups improved with CS therapy from 1. 50,8±1,7 2. 63,9 ±10,7 3. 45.2±15,0 to 1. 27,3±4,2 2. 40,8±9.5 3. 22,7±9,7 The changes of lung functional tests were 1.FEV1 65,7±10,7 2.FVC 80,5±12,0 3.FEV1/ FVC 65,1±8,7 before and 1.FEV1 69,4±9,2 2.FVC 88,3±11,1 3.FEV1/FVC 69,5±7,8 after treatment. Incidence of hyperglycemia and hypertension observed with prednisone. In some patients who used ICSs we detect throat hoarse.Conclusions:1. Both inhaled and systemic GSs improve airflow and lung function test in COPD patients with acute exacerbation.2. After treatment improve quality of life in COPD patients with acute exacerbation.3. High dose of ICSs may be an alternative to systemic prednisone in the treatment of no severe acute exacerbation of COPD.

New regimen of inhaled corticosteroid in preschool children with asthma

Daily low-dose inhaled corticosteroid in preschool children with asthma is recommended to prevent the development of asthma symptom and sign based on many asthma management guidelines. But the retarded growth after long-term steroid inhalation has been concerned. Recently the method of intermittent high-dose (suspension, 1,000 microg, 2 times a day for 7 days) budesonide inhalation when the initial phase to develop the asthma exacerbation was studied to compare the efficacy and safety with daily low-dose budesonide (500 microg) inhalation regimen in preschool children positive with modified asthma predictive index in recurrent wheezer during the study period with 52 weeks. There were no significant difference between two regimen with respect to the frequency of exacerbations, the time to the first exacerbation and to the second exacerbation, and the frequency of treatment failure. The total exposure to budesonide over the period was less in the intermittent high-dose regimen than in the daily low-dose regimen. There were no significant difference in change in height. But the change in height from baseline in intermittent high-dose regimen group was 8.01 cm and in daily low-dose was 7.76 cm. We need the more clinical studies in preschool children with persistent moderate and severe asthma and in various country and nations. It is suggested the intermittent high-dose budesonide inhalation regimen in preschool children with freqeunt wheezing may be a very good alternative to control the allergic inflammation and symptoms of asthma without concerning the adverse effect of steroid.