Conduta terapêutica em pacientes com doença pulmonar obstrutiva crônica: monoterapia ou terapia cominada? / Therapy for chronic obstructive pulmonary disease patients: monotherapy or combination therapy?

Objetivo: Comparar a dupla terapia broncodilatadora com glicopirrônio mais indacaterol à monoterapia com glicopirrônio em pacientes portadores de doença pulmonar obstrutiva crônica. Métodos: Estudo clínico prospectivo, unicêntrico, controlado, cruzado, randomizado e duplo-cego realizado com 14 pacientes com diagnóstico de doença pulmonar obstrutiva crônica grau II. Os participantes receberam cada um dos tratamentos durante 30 dias. Antes de cada terapia, realizou-se período de wash-out por 7 dias, com broncodilador de curta ação. Antes e após cada intervenção, os pacientes passaram por exame de espirometria e responderam ao questionário COPD Assessment Test. Resultados: Observou-se melhora na função pulmonar medida por meio do volume expiratório forçado no primeiro segundo de 19mL (±36) para a monoterapia e 87mL (±33) para a terapia dupla. O ganho foi de 67mL (p=0,042) da associação dos medicamentos em relação ao glicopirrônio isolado. A melhora na qualidade de vida, medida a partir das pontuações do questionário, foi de 4,7 (±8,9) pontos para a monoterapia e 5,2 (±11) pontos para a dupla terapia (p=0,08). Conclusão: Ambos os tratamentos demonstram melhora na função pulmonar dos pacientes.

Objective: To compare dual bronchodilator therapy (Glycopyrronium with Indacaterol) versus Glycopyrronium monotherapy in patients with chronic obstructive pulmonary disease. Methods: This was a prospective, unicentric, controlled, crossover, randomized, and double-blind clinical trial with 14 patients diagnosed with grade II chronic obstructive pulmonary disease. The participants received each treatment during the period of 30 days. Before each therapy, a 7-day wash-out period with a short-acting bronchodilator was instituted. Before and after each intervention, the patients underwent spirometry and answered the COPD Assessment Test questionnaire. Results: An improvement in pulmonary function measured by forced expiratory volume during the first second of 19mL (±36) for monotherapy, and 87mL (±33) for dual therapy was observed. The gain was of 67mL (p=0.042) in the association of the drugs in relation to Glycopyrronium alone. The mean improvement in quality of life measured from the questionnaire scores was 4.7 (±8.9) points for monotherapy and 5.2 (± 11) points for dual therapy (p=0.08). Conclusion: Both treatments show improvement in the patients' pulmonary function.

Broncodilatadores en pacientes con bronquiolitis / Bronchodilators for bronchiolitis

La bronquiolitis es una infección respiratoria aguda baja de causa viral, de aparición invernal, que es común en bebés de 0a 12 meses de edad. Conduce a que las vías respiratorias pequeñas se inflamen y se llenen de desechos, obstruyéndose.El bebé tiene una tos fuerte, secreción nasal, generalmente fiebre y puede presentar sibilancias dificultad respiratoria ydesaturación de oxígeno. Tras la presentación de un caso en la guardia se generó una controversia científica sobre lautilidad de los broncodilatadores en pacientes con bronquiolitis. Luego de realizar una búsqueda bibliográfica y seleccionarla evidencia más reciente y de mejor calidad, se concluye que la evidencia no apoya el uso de broncodilatadores enpacientes con bronquiolitis.(AU)

Bronchiolitis is a low acute respiratory lower respiratory tract infection of viral origin, winter appearance, which is commonin babies from 0 to 12 months of age. It causes the small airways in the lungs to become inflamed and fill with debris. Theinfant has a harsh cough, runny nose, usually fever and may have wheezing, respiratory distress and oxygen desaturation.After the presentation of a case in the emergency department, a scientific controversy was generated about the usefulnessof bronchodilators in patients with bronchiolitis. After conducting a literature search and selecting the most recent and bestquality evidence, it is concluded that evidence does not support the use of bronchodilators in patients with bronchioliTIS.(AU)

The comparisons of the efficacy of two fixed dose combinations, i.e. Salmeterol and Fluticasone vs. Formoterol and Tiotropium bromide in moderate to severe COPD patients

Background: Bronchodilators are essential for symptomatic management of all stages of chronic obstructive pulmonary disease (COPD). For patients whose COPD is not sufficiently controlled by monotherapy, combining a ß2-agonist with either inhaled steroid or anticholinergic drug is a convenient way of delivering treatment. Currently, there is no documentation to say that one drug is superior to other or the contrary, but a combination of two drugs is more effective than giving single drug alone in patients suffering from COPD.Methods: The study was prospective, open labelled, randomized, comparative interventional clinical study conducted by the Departments of Pharmacology and Medicine, Basaveshwara Medical College and Hospital, Chitradurga in 60 moderates to severe COPD patients.Results: Both the treatments i.e. Salmeterol/Fluticasone and Tiotropium/Formoterol were equally effective as far as the improvement of the lung functions and Borg dyspnoea score are concerned. The difference in improvement with the combination of Salmeterol/Fluticasone was not statistically significant (p>0.05) compared to the combination of Tiotropium/Formoterol. However, Salmeterol/Fluticasone was found to be better than Tiotropium/Formoterol in improving the lung function of moderate to severe COPD patients.Conclusions: Salmeterol/Fluticasone is efficacious and better than Tiotropium /Formoterol combination for maintenance therapy in moderate to severe COPD patients.

Pharmaceutical Care for a AECOPD Patient with Benign Prostatic Hyperplasia and Bronchodilators-in-duced Acute Urinary Retention / 中国药房

OBJECTIVE:To investigate the role of clinical pharmacists on drug therapy for acute exacerbations of chronic ob-structive pulmonary disease(AECOPD)patients with benign prostatic hyperplasia(BPH). METHODS:Clinical pharmacists partici-pated in drug therapy for a AECOPD patient with BPH. According to clinical guideline and relevant literatures,based on the history of disease,the characteristics of bronchodilators and the symptoms of acute urinary retention,it was suggested to stop taking Ip-ratropium bromide solution for inhalation but receive Finasteride capsules 5 mg,po,qd,to reduce prostate volume and improve ob-struction+Terazosin hydrochloride tablets 2 mg,po,qd,to relax urethral smooth muscle;the occurrence of ADR was monitored closely. Salmeterol xinafoate and fluticasone propionate powder for inhalation was suggested and medication guidance for patients af-ter discharge was given by clinical pharmacists. RESULTS:Physicians adopted some suggestions of clinical pharmacists. The pa-tient was stable and had no dysuria. The patient was allowed to leave the hospital with drugs. CONCLUSIONS:Rational use of bronchodilators is directly related to the remission of clinical symptoms and prognosis in AECOPD patients. In view of patient's dis-ease history,drug characteristics and clinical symptoms,clinical pharmacists point to possible risks of anticholinergics use,and as-sist physicians to formulate and adjust therapy plan so as to guarantee the safety and effectiveness of drug use.

Feasibility of body surface electrodes instead of multipair esophageal electrodes for assessment of neural re-spiratory drive in COPD patients / 实用医学杂志

Objective To analyze the feasibility of body surface electrodes instead of multipair esophageal electrodes for the evaluation of neural respiratory drive in patients with COPD. Methods Diaphragm electromyo-gram(EMG)from body surface electrodes and multipair esophageal electrodes,was recorded in 29 patients with stable COPD recruited from outpatient clinic. Changes of neural respiratory drive of two kinds of electrodes during resting and maximal isocapnic ventilation (MIV) were observed before and after inhalation of bronchodilators. Results Ventilation significantly improved ,RMS-sur and RMS-eso significantly decreased after the inhalation of bronchodilators during resting and MIV. RMS-sur and RMS-eso were significantly correlated(r=0.660,P<0.01). Conclusion EMG from the surface electrodes may be a useful and noninvasive technique to evaluate neural respi-ratory drive in patients with COPD.

Effect of Inhaled Anti-Cholinergic by Pressurized Metered Dose Inhaler (PMDI) or Dry Powder Inhaler (DPI) on Eyes of Patients of Chronic Obstructive Pulmonary Diseases (COPD).

Background: COPD is characterized by persistent airflow limitation associated with an enhanced chronic inflammatory response to noxious particles or gases in airways and lungs. Anticholinergics are bronchodilators which lead to side-effects like dry mouth, worsening glaucoma, dry cough and blurred vision on administration. Glaucoma is frequently seen in patients with chronic bronchitis who require treatment with nebulized bronchodilator drugs. Aims and objectives: The present study was done to find out the efficacy and safety of inhaled anticholinergics on intraocular pressure (IOP) in eyes of COPD and potential glaucoma patients. Methods: Total 110 patients of suspected COPD aged between 40 to 80 years were observed in this study. The diagnosis was also confirmed by spirometry and patient condition was allocated into stages as per GOLD 2014. Level of IOP before and after inhalation of drug in both eyes of patients at 2nd hour, 8th day, 15th day, 22nd day and at 28th day was analyzed. Study group (N=70) received ipratropium 40μg eight hourly or tiotropium 18 μg once a day and formoterol 6 μg twice a day plus fluticasone 125 μg twice a day and control group (N=40) received formoterol 6 μg twice a day and fluticasone 125 μg twice a day except anticholinergics. Comparison of IOP was done by statistical analysis. Results: In the present study, patients of COPD with mean age of 59± 8.84 years were observed for IOP. In study group, mean change in IOP was more (3.3±2.3 mmHg) in stage 2 than in stage 3 (1.5±1.5 mmHg) and least in stage 4 (1.3±1.06 mmHg) (p=0.035). During distribution of angle at 28th day after inhaled anticholinergics, 4 patients with narrow angle and 3 with open angle developed IOP beyond normal range(>20mmHg), but all were normal on fundoscopic examination (ocular hypertension). At the end of 28th day, there were 4 patients with ocular symptoms in study group which disappeared after discontinuing tiotropium inhaler. Conclusion: Inhaled formetrol and fluticasone with anticholinergic drugs given by PMDI leads to ocular hypertension in COPD patients whose eyes were normal at initial clinical examination whereas formetrol and fluticasone without anticholinergics did not cause any significant change in IOP. Inhaled anticholinergics increased intraocular pressure in COPD patients.

A Study of Prescription Pattern in the Management of COPD in a Tertiary Care Hospital.

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable condition characterized by persistent airflow obstruction that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lung to noxious particles or gases. Bronchodilators are mainstay of pharmacologic management of COPD and Inhaled corticosteroids (ICS) are the central of treatment of asthma but in management of COPD their role is controversial. Aim &Objectives: The sole aim and objective of this study is to evaluate the current prescription pattern of COPD management using data generated in a tertiary care hospital of UP India.. Methods: : In this prospective study, all patient data relevant to the study were obtained by examination of Case sheets of inpatients visiting the OPD of TB & Chest department. Results: In this prospective study, prescriptions of 74 patients were selected. Out of total patients, 60 (81.08%) were males and 14(18.9%) were females. Out of total 74 patients, 73 (98.64%) are smokers, in which 30 (40.54%) are currently smoking while 43(58.1%) are ex-smokers. Out of total patients 60(81.08%) have comorbidities. Hypertension is most common comorbidity having 36 (48.65%) of patients. Inhalational route was most common route of administration of drugs in the study. Oral route was second most common route; it was used for administration of 42.03% of drugs. Formoterol was maximum prescribed drug used in 60 (81.09%) of patients followed by Budesonide 57 (77.03%), Acebrophylline 48 (64.86%),followed by Levocetrizine 41 (51.41%), Salbutamol and Montelukast were used in equal no. of patients 40(54.06%) , followed by Ipratropium 39 (52.70%), Tiotropium which was used in 29 (39.19%) of patients, followed by Amoxicillin 16 (21.63%) followed by Theophylline and Azithromycin used in 8 (10.81%) patients ,followed by Doxophylline and Terbutaline which were also used in equal number and percent of patients that is 3 (4.05%). Conclusion: The prescribing trend observed in the study appears to be in concordance with the current GOLD guidelines for the management of COPD patients.

The effects of daily bathing on symptoms of patients with bronchial asthma

BACKGROUND: The influence of bathing in asthma patients is not yet fully known. OBJECTIVE: We conducted an observational study to investigate changes in symptoms and their degree by bathing in asthmatic patients. METHODS: A questionnaire focusing on ever experienced bathing-induced symptom changes and their degree, as well as contributing factors, was designed and administered to asthmatic patients in the outpatient department of our institute between January 2012 and November 2013. RESULTS: Two hundred fifteen cases were recruited. In 60 cases (27.9%), asthmatic symptoms appeared, including 20 cases of chest discomfort (33.3%), 19 cases of cough (31.7%), and 21 cases of wheezing (35.0%). The triggering factors included vapor inhalation (32 cases, 53.3%), hydrostatic pressure on the thorax due to body immersion in the bathtub (26 cases, 43.3%), and sudden change of air temperature (16 cases, 26.7%). Thirty-eight cases (17.7%) experienced improvement in active asthmatic symptoms by bathing. Vapor inhalation was the most common contributing factor (34 cases, 89.5%), followed by warming of the whole body (13 cases, 34.2%). There was no relationship between asthma severity and the appearance of bathing-induced symptoms or improvement of active asthmatic symptoms by bathing. CONCLUSION: The effects of bathing in asthmatic patients widely differed from patient to patient and their etiology includes several factors. For those who suffer from bathing-induced asthma symptoms, preventive methods, such as premedication with bronchodilators before bathing, should be established. This study is registered in the University Hospital Medical Information Network (UMIN) clinical trials registry in Japan with the registration number UMIN000015641.

The Role of Bronchodilators in Preventing Exacerbations of Chronic Obstructive Pulmonary Disease / 결핵및호흡기질환

Bronchodilators are the cornerstone of symptomatic chronic obstructive pulmonary disease (COPD) treatment. They are routinely recommended for symptom reduction, with a preference of long-acting over short-acting drugs. Bronchodilators are classified into two classes based on distinct modes of action, i.e., long-acting antimuscarinics (LAMA, once-daily and twice-daily), and long-acting β2-agonists (LABA, once-daily and twice-daily). In contrast to asthma management, evidence supports the efficacy of both classes of long-acting bronchodilators as monotherapy in preventing COPD exacerbations, with greater efficacy of LAMA drugs versus LABAs. Several novel LAMA/LABA fixed dose combination inhalers are currently approved for COPD maintenance treatment. These agents show superior symptom control to monotherapies, and some of these combinations have also demonstrated superior efficacy in exacerbation prevention versus monotherapies, or combinations of inhaled corticosteroids plus LABA. This review summarizes the current data on clinical effectiveness of bronchodilators alone or in combination to prevent exacerbations of COPD.

Cellular and molecular mechanisms of action of polyherbal preparation UNIM-352 in experimental models of bronchial asthma.

Bronchial asthma is a chronic inflammatory disorder of the airways and pharmacotherapy is dependent on anti-inflammatory and bronchodilator agents. However, adverse effects of these agents on chronic administration and sometimes non-responsiveness to these drugs have prompted the search for viable alternatives from medicinal plant sources. UNIM-352 is a polyherbal preparation traditionally used in the Unani system of Indian medicine for the treatment of bronchial asthma. The present study defines the possible cellular and molecular mechanisms of action of UNIM-352 in experimental models of bronchial asthma and validates the observed therapeutically beneficial effects. Wistar rats were immunized and challenged with ovalbumin, and blood and bronchoalveolar lavage (BAL) fluid were assayed for cytological and biochemical markers. UNIM-352 (200 and 400 mg/kg) markedly reduced the eosinophil and neutrophil counts in both blood and BAL compared to control. The polyherbal agent also attenuated the levels of TNF-α, IL-4, GM-CSF and NF-κB whereas histone deacetylase (HDAC) levels were elevated, in both blood and BAL fluid. All effects of UNIM-352 were comparable with the standard drug, prednisolone. The results demonstrated possible cellular and molecular mechanisms of UNIM-352 and thus explain its beneficial effects in bronchial asthma.

Patrones de prescripción de broncodilatadores y corticoides inhalados en pacientes adultos de Colombia / Prescription patterns of bronchodilators and inhaled corticosteroids in adults of Colombia

Introducción: las enfermedades pulmonares obstructivas son frecuentes en pacientes mayores de 40 años y son causa de alta morbimortalidad a nivel mundial. En el presente estudio se describen los patrones de prescripción de medicamentos para su tratamiento en pacientes de Colombia. Material y métodos: estudio descriptivo observacional con pacientes, mayores de 40 años de ambos sexos, afiliados al Sistema General de Seguridad Social en Salud, en tratamiento continuo con broncodilatadores y/o corticoides inhalados entre septiembre y diciembre del año 2013, seleccionados a partir de una base de datos de dispensación de 6.5 millones de personas. Se recolectaron variables sociodemográficas, farmacológicas (fármacos con sus dosis diarias definidas), medicamentos concomitantes y clínicas (comorbilidades). Análisis mediante SPSS 22. Resultados: se incluyeron 6856 pacientes con una edad promedio de 73.8 ± 11.3 años, 54%fueron mujeres. Del total de pacientes 17.2% recibían monoterapia y 82.8% terapia combinada. El 74.3% de sujetos recibía β2-adrenérgicos, la mayoría (81.5%) de corta duración (BDCA), mientras que 33.3% de larga acción (BDLA). El 73.1% recibía anticolinérgicos distribuidos entre ipratropio (87.1%) y tiotropio (16.9%) y 71.7% recibía corticoides inhalados. Los medicamentos prescritos concomitantemente con mayor frecuencia fueron antihipertensivos (68.9%), antiulcerosos (56.1%) e hipolipemiantes (46.2%). Tener entre 40 y 55 o más de 80 años, recibir alguna medicación concomitante, utilizar corticoides inhalados, emplear monoterapia broncodilatadora y ser tratado en Bogotá y Cali, se asociaron de manera estadísticamente significativa con menor riesgo de recibir BDLA. Conclusiones: predomina la prescripción de BDCA, pese al limitado beneficio clínico reportado. La mayoría de broncodilatadores se emplean a dosis superiores a las recomendadas. Se considera necesario establecer estrategias educativas que mejoren los hábitos de prescripción. (Acta Med Colomb 2015; 40: 218-226).

Introduction: obstructive lung diseases are common in patients older than 40 years and cause high morbidity and mortality worldwide. The patterns of drugs prescription for its treatment in Colombian patients are described in this study. Methods: descriptive observational study with patients over 40 years of both sexes, members of the General System of Social Security in Health, in continuous treatment with bronchodilators and / or inhaled steroids between September and December 2013, selected from a dispensing database of 6.5 million people. Sociodemographic and pharmacological variables (drugs with defined daily doses), concomitant medications and co-morbidities were collected. Analysis using SPSS 22. Results: A total of 6856 patients were included with a mean age of 73.8±11.3 years, 54% were women. Of the total of patients, 17.2% received monotherapy and 82.8% combined therapy. 74.3% of subjects received β2-adrenergics, most (81.5%) short-acting bronchodilators, while33.3% long acting bronchodilators. 73.1% received anticholinergics distributed between ipratropium (87.1%) and tiotropium (16.9%) and 71.7% received inhaled steroids. The medications that were most often concomitantly prescribed, were antihypertensive (68.9%), antiulcerants (56.1%) and lipid lowering drugs (46.2%). To be between 40 and 55 or over 80 years, receive any concomitant medication, inhaled corticosteroid use, bronchodilator monotherapy use and being treated in Bogota and Cali, was statistically significantly associated with lower risk of receiving long-acting bronchodilators. Conclusions: the prescription of short-acting bronchodilators predominate despite the limited clinical benefit reported. Most bronchodilators are used at higher than recommended doses. It is necessary to establish educational strategies to improve prescribing habits. (Acta Med Colomb 2015; 40: 218-226).

Doença pulmonar obstrutiva crônica / Chronic obstructive pulmonary disease

A doença pulmonar obstrutiva crônica (DPOC) será abordada quanto ao quadro clínico, critérios diagnósticos e tratamento. Serão ainda discutidas as principais manifestações sistêmicas da doença, bem como a importância da identificação e tratamento destas no seguimento de pacientes portadores de DPOC.

Use of digital media for the education of health professionals in the treatment of childhood asthma / Uso de mídia digital na educação de profissionais de saúde para tratamento da asma infantil

OBJECTIVES: Inhalation therapy is the main treatment for asthma and its adequate use has been a factor responsible for disease control; therefore, the aim of the study was to determine whether a digital media tool, which features portability on mobile phones, modifies the assimilation of the inhalation technique. METHODS: A total of 66 professionals working in the health care area with the pediatric population were selected. They were submitted to a pre-test on their knowledge of inhalation therapy. The professionals were randomized into two groups (A and B). Group A received a media application on their mobile phones showing the steps of inhalation therapy, while group B received the same information in written form only. A post-test was applied after 15 days. The results (pre- and post-) were analyzed by two pediatric pulmonologists. RESULTS: Of the 66 professionals, 87.9% were females. Of a total possible score of ten, the mean score obtained in the pre-test was 5.3 ± 3, and in the second test, 7.5 ± 2 (p < 0.000). There were no significant differences when comparing the two groups (p = 0.726). The nurses had the lowest mean scores in the initial test (2.3 ± 2); however, they were the group that learned the most with the intervention, showing similar means to those of other groups in the second test (6.1 ± 3). CONCLUSION: There was significant improvement in knowledge about inhalation therapy in all professional categories using both methods, demonstrating that education, when available to professionals, positively modifies medical practice. .

OBJETIVOS: A inaloterapia representa a principal forma de tratamento da asma e seu uso adequado tem sido fator responsável pelo controle da doença. Desse modo, o objetivo do estudo foi determinar se uma ferramenta de mídia digital, dotada de portabilidade na forma de telefonia móvel, modifica a assimilação da técnica inalatória. MÉTODOS: Foram selecionados 66 profissionais que atuam na área da saúde com população pediátrica e submetidos a um pré-teste sobre seus conhecimentos de inaloterapia. Os profissionais foram randomizados em dois grupos (A e B). O grupo A recebeu em seu telefone móvel um aplicativo de mídia com os passos da inaloterapia, enquanto o grupo B recebeu as mesmas informações apenas de forma escrita. Após 15 dias, fez-se um pós-teste. Os resultados (pré e pós) foram analisados por dois pneumologistas pediátricos. RESULTADOS: Dos 66 profissionais, 87,9% eram do sexo feminino. Num escore total possível de 10, a média das notas obtidas no pré-teste foi de 5,3 ± 3 e as do segundo teste 7,5 ± 2 (p < 0,000). Não houve diferenças significativas na comparação os dois grupos (p = 0,726). Os profissionais de enfermagem apresentaram a menor média nas provas iniciais (2,3 ± 2), porém foi o grupo que aprendeu mais com a intervenção e apresentou média similar aos outros grupos na segunda prova (6,1 ± 3). CONCLUSÃO: Houve melhoria significativa no conhecimento sobre inaloterapia em todas as categorias profissionais com o uso de ambos os métodos. Isso comprovou que a educação, quando oferecida aos profissionais, modifica positivamente a prática médica. .

Effect of bronchodilators on dyspnea and pulmonary function in patients with COPD at different degrees / 中国生化药物杂志

Objective To investigate the effect of bronchodilators on dyspnea and pulmonary function in patients with chronic obstruction pulmonary disease (COPD) at different degrees.Methods 50 patients with COPD from January 2014 to January 2015 in pneumology department of Tongchuan City People's Hospital were selected.According to the standard of Global initiative for chronic obstructive lung disease (GOLD), the patients were divided into mild degree of 14 cases, moderate degree of 18 cases and severe degree of 18 case.The changes of Borg score of dyspnea, forced expiratory volume in one second (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF) and inspiratory capacity (IC) after received tiotropium bromide inhalation in each group.Results FEV1, FVC, PEF and IC values significant improved in mild, moderate and severe degree groups after received tiotropium bromide inhalation and the values of improvement rate changed significantly with degrees of disease ( P <0.05 ).The improvement rates of FEV1, FVC and IC were highest in patients at severe degree, improvement rate of PEF was highest in patients at mild degree (P<0.05).After received tiotropium bromide inhalation, the Borg score improved significantly compared with that of pre-treatment in mild, moderate and severe degree groups (P<0.05), the improvement rate of Borg score was highest in severe degree group(P<0.05).There were significantly positive correlations between Borg score and FEV1(r=0.372),FVC(r=0.296),PEF(r=0.284),IC(r=0.704)(all P<0.05).Conclusion Bronchodilator could significantly improve dyspnea and lung function in patients with COPD, and the improvement rate of FEV1, FVC and IC is highest in patients with COPD at server degree, PEF is highest at mild degree and Borg score is highest at server degree, which need the comprehensive analysis of each indicators for reversibility of airflow obstruction.

Dispositivos inalatórios broncodilatadores em terapia intensiva / Bronchodilators and inhalers devices in ICU

A densidade de uso de ventilação mecânica em Terapia Intensiva varia de 10% a 100%, apesar de na média ficar entre 20 – 40% nas Unidades Intensivas Gerais. Uma parcela substancial dos pacientes em ventilação mecânica é formada por pacientes portadores de distúrbios ventilatórios obstrutivos, nos quais o uso de broncodilatadores inalatórios é um dos eixos centrais de tratamento. O objetivo desta classe de medicamentos em pacientes com doença pulmonar obstrutiva crônica (DPOC) ou asma e sob ventilação mecânica seria reduzir a hiperinsuflação dinâmica, a resistência de vias aéreas e o trabalho ventilatório, favorecendo desmame precoce.Este artigo tem por objetivo atualizar sobre as apresentações dos mais variados broncodilatadores inalatórios bem como as técnicas de uso das medicações em um cenário de alta prevalência de doentes sob ventilação mecânica...

The use of mechanical ventilation in Intensive Care Units ranges from 10% to 100%, although the average stays between 20-40% in the General Intensive Unit. A substantial portion of mechanical ventilation in patients consists of patients with obstructive lung disease, in which the use of inhaled bronchodilators is a central strategy of treatment. The purpose of this therapy in patients with chronic obstructive pulmonary disease (COPD) or asthma on mechanical ventilation is to reduce dynamic hyperinflation, increased airway resistance and excessive respiratory workload, favoring early weaning. This article aims to update on the indications, and techniques of inhaled bronchodilation in a substantial group of patients on mechanical ventilation...

Pituitary Adenylate Cyclase Activating Peptide (1-38) and its analog (Acetyl-[Ala15, Ala20] PACAP 38-polyamide) reverse methacholine airway hyperresponsiveness in rats

The aim of this study was to investigate both functionally and structurally bronchodilator effects of Pituitary adenylate cyclase activating peptide (PACAP38) and acetyl-[Ala15, Ala20] PACAP38-polyamide, a potent PACAP38 analog, in rats challenged by methacholine (MeCh). Male Wistar rats were divided randomly into five groups. Groups 1 and 2 inhaled respectively aerosols of saline or increasing doses of MeCh (0.5, 1, 2.12, 4.25, 8.5, 17, 34 and 68mg/L). The other groups received terbutaline (Terb) (250 µg/rat) (10-6 M), PACAP38 (50 µg/rat) (0.1 mM) or PACAP38 analog (50 µg/rat) associated to MeCh from the dose of 4.25 mg/L. Total lung resistances (RL) were recorded before and 2 min after MeCh administration by pneumomultitest equipment. MeCh administration induced a significant and a dose-dependent increase (p<0.05) of RL compared to control rats. Terb, PACAP38 and PACAP38 analog reversed significantly the MeCh-induced bronchial constriction, smooth muscle (SM) layer thickness and bronchial lumen mucus abundance. PACAP38 analog prevents effectively bronchial smooth muscle layer thickness, mucus hypersecretion and lumen decrease. Therefore, it may constitute a potent therapeutic bronchodilator.

O objetivo deste estudo foi investigar funcionalmente e estruturalmente efeito broncodilatador do peptídeo ativador da adenilato ciclase pituitária (PACAP1-38) e da acetil-[Ala15, Ala20]PACAP 38-poliamida, potente análogo do PACAP-38, nos ratos desafiados pelo metacolina (MeCh). Ratos Wistar machos foram aleatoriamente divididos em cinco grupos. Grupos 1 e 2, inalando aerossóis de solução salina ou doses crescentes de MeCh (0,5, 1, 2,12, 4,25, 8,5, 17, 34 e 68 mg/L). Os outros grupos recebendo terbutalina (Terb) (250 µg/rato) (10-6M), PACAP-38 (50 µg/rato) (0.1 mM) ou análogo do PACAP-38 (50 µg/rato) associados a MeCh na dose de 4,25 mg/L. A resistência pulmonar total (RL) foi registrada antes e 2 min após a administração de Mech pelo equipamento pneumomultiteste. A administração MeCh induziu aumento significativo e dose dependente (p<0,05) de RL em comparação com ratos do grupo controle. Terb e PACAP1-38 e análogo do PACAP-38 reverteram, significativamente, a constrição brônquica induzida por Mech, a espessura do músculo liso (SM) e abundância de muco do lume brônquico. O análogo PACAP-38 do mesmo modo que a Terb impediu a responsividade brônquica a MeCh e pode se constituir em um importante regulador no desenvolvimento da doença inflamatório pulmonar. Contudo, o uso do peptídeo nativo para aplicações terapêuticas é limitado por sua baixa estabilidade metabólica. Consequentemente, o análogo metabolicamente estável representa ferramenta promissora no tratamento de doenças pulmonares inflamatórias.

Efficacy of Bronchodilators in Wheeze Associated Respiratory Tract Infections.

To ascertain whether bronchodilators are indeed effective in WRTI and Compare efficacy of nebulised nonspecific adrenergic agonist (adrenaline) with beta2 specific agonist (salbutamol) for management of WRTI. Design: Randomized control trial. Setting: Urban tertiary care teaching hospital. Methods: 100 Children aged 2-24 months with clinical diagnosis of WRTI were enrolled in the study. Children were then randomly assigned to two groups and nebulised with adrenaline and salbutamol respectively. Three doses of each drug were given at 20 minute intervals. Respiratory rate, heart rate, RDAI score, clinical score and Pulse oxymetry was recorded before intervention and ten minutes after the first second and third doses of the drug. Results: The adrenaline group (Group A) had a significantly lower mean respiratory rate, RDAI score, clinical score as compared to the salbutamol group (Group B) after three doses of nebulisation. At the end of the intervention 6 out of 50 patients in the adrenaline group and 15 out of 50 patients in salbutamol group either shown no improvement or deteriorated and had to be admitted.

Comparative evaluation of doxofylline and theophylline in patients of mild bronchial asthma.

Background: Asthma is common chronic disease worldwide. Methylxanthines has been used in the treatment of asthma. The study was undertaken to compare two Methylxanthines theophylline and doxofylline at doses recommended and commonly used in clinical practice in Mild Bronchial Asthma Patients. Methods: Study was conducted in patients of Mild Bronchial Asthma in TB and chest disease department of a medical college hospital. It was randomized, prospective and open label. A total of 107 patients were divided in two group .Group I was administered 400 mg theophylline SR once daily and group II was administered doxofylline 400 mg twice a day orally. Spirometric variables symptom score, and adverse effects were recorded on day 0, 7 and 21 of therapy. Data were compared and analysed using SPSS version 16. Results: Results of the study showed that there was significant improvement in spirometric variables and clinical symptom score compared to pretreatment values after medication in both groups on 7th and 21st days of treatment. But there was no statistically significant difference between improvement in theophylline and doxofylline groups with respect to spirometric variables and symptom score. There was no significant difference in two groups with respect to side effects (p>0.05). Conclusions: It is concluded in Patients of mild Bronchial Asthma Theophylline and doxofylline improve the spirometric and clinical symptoms and doxofylline has no advantage over theophylline in terms of either efficacy or safety on the doses commonly used in current clinical practice.

Asma bronquial en la población infantil de 5 a 14 años de un área de salud de Santiago de Cuba / Bronchial asthma in children 5 to14 years from a health area of Santiago de Cuba

Se realizó un estudio observacional de 158 niños con asma bronquial -- seleccionados mediante un muestreo por conglomerado bietápico --, dispensarizados por dicha afección en el área de salud del Policlínico Docente "José Martí Pérez" de Santiago de Cuba, durante el 2011, a fin de estimar la prevalencia de las principales características clinicoepidemiológicas en ellos. En la investigación se obtuvo homogeneidad del sexo femenino en todos los grupos etarios, a pesar de un ligero predominio de los varones de 10 a 14 años de edad, así como primacía de la afección entre los precedentes patológicos personales y la conjuntivitis alérgica como antecedente familiar. Igualmente, el asma persistente grave tuvo un mayor porcentaje y los agentes desencadenantes de las crisis asmáticas fueron, en orden descendente de frecuencia, los alergenos domiciliarios, el humo del cigarro, las infecciones, los ejercicios, los contaminantes de tipo doméstico y los medicamentos. El tratamiento más empleado se basó en broncodilatadores y el menos habitual, en cromonas; en tanto el hacinamiento fue el factor desfavorable más observado en los hogares de estos niños y el control de la enfermedad resultó generalmente parcial.

An observational study was carried in 158 children with bronchial asthma -- selected by a two-stage cluster sampling -- attended and monitored by this disease in the health area from "José Martí Pérez" Teaching Polyclinic of Santiago de Cuba during 2011, in order to estimate the prevalence of the main clinical and epidemiological characteristics in them. In the study homogeneity of the female sex was observed in all age groups, in spite of a slight predominance of males 10 to 14 years, as well as primacy of the disease between past medical history and allergic conjunctivitis as family history. Likewise, severe persistent asthma had a higher percentage and triggers of asthma attacks were, in decreasing order of frequency, household allergens, cigarette smoke, and infections, exercises, domestic pollutants and medications. The most common treatment was based on bronchodilators and the less common on chromones; as long as the overcrowding was the most observed adverse factor in the homes of these children and the control of disease was usually partial.