ABSTRACT
Exacerbação aguda de asma é uma condição frequente na criança e no adolescente e uma das causas mais comuns de procura aos pronto atendimentos e de internações. Pode ocorrer em pacientes que ainda não foram diagnosticados como asmáticos, e mesmo naqueles cujo controle da doença não se encontre adequado. Reconhecer a exacerbação e iniciar seu tratamento desde o domicílio até o adequado manejo inicial em ambiente hospitalar é fundamental para evitar sua evolução para complicações que coloquem o paciente em risco de vida. O tratamento compreende o reconhecimento e tratamento da hipoxemia, da obstrução e do processo inflamatório, além de fornecer orientações na alta hospitalar e encaminhamentos para continuidade do tratamento.
Acute exacerbation of asthma is a frequent condition in children and adolescents and one of the most common causes of seeking emergency care and hospitalization. It can occur in patients who have not yet been diagnosed with asthma, and even in those whose disease control is not adequate. Recognizing the exacerbation and starting its treatment from home until proper initial management in a hospital environment is essential to avoid its evolution to complications that put the patient at risk of life. Treatment comprises the recognition and treatment of hypoxemia, obstruction, and the inflammatory process, in addition to providing guidance at hospital discharge and referrals for continued treatment.
Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Asthma , Societies, Medical , Therapeutics , Allergy and Immunology , Patients , Pediatrics , Referral and Consultation , Theophylline , Bronchial Spasm , Epinephrine , Adrenal Cortex Hormones , Ipratropium , Anesthetics, Inhalation , Emergency Medical Services , Adrenergic beta-2 Receptor Agonists , Noninvasive Ventilation , Aminophylline , Hospitalization , Ketamine , Magnesium Sulfate , Hypoxia , Anti-Bacterial AgentsABSTRACT
SUMMARY OBJECTIVES: To evaluate the treatment of wheezing and exacerbation of asthma in a pediatric emergency unit (ED), comparing it to that recommended by the guidelines for this purpose. METHODS: Descriptive cross-sectional study through medical records survey of children and adolescents (0-15 years of age) who received medication for wheezing or asthma exacerbation from January to April 2015 in the ED. The selected treatment was compared to that recommended by the guidelines, being analyzed the variables related to the medication (number and dose of short-acting β2 agonist, associated or not with anticholinergic, oral or parenteral corticosteroid) and the length of stay in ED (≤1 h, ≥8 h and hospital admission). RESULTS: One-thousand eleven patients were selected with 56.7% between 3 and 15 years and 56% male. Although the selected drugs were in accordance with what was recommended, errors were observed in relation to dose, drug of choice, and method and time of use with the most frequent finding being incorrect dose (short-acting β2 agonist: 66% and ipratropium bromide: 95.2%). CONCLUSION: The level of use of the measures recommended by the guidelines was low but compatible with other studies, leading to an increased risk of treatment failure and higher costs. Despite wide dissemination, the established concepts have not been sufficiently incorporated into clinical practice, suggesting the need for more effective educational actions for this process to occur.
RESUMO OBJETIVOS: Avaliar o tratamento da sibilância e da exacerbação da asma em unidade de emergência pediátrica (DE), comparando-o ao recomendado pelas diretrizes para esse fim. MÉTODOS: Estudo descritivo transversal, por meio do levantamento de prontuários de crianças e adolescentes (0 - 15 anos de idade) que receberam medicação para sibilância ou exacerbação da asma, no período de janeiro a abril de 2015, em DE. O tratamento empregado foi comparado ao preconizado pelas diretrizes sendo analisadas as variáveis referentes à medicação (número e dose de β2 agonista de curta ação, associado ou não a anticolinérgico, corticosteroide oral ou parenteral) e ao tempo de permanência na DE (≤1 h, ≥8 h e internação hospitalar). RESULTADOS: Foram selecionados 1011 pacientes, 56,7% com idades entre 3 e 15 anos e 56 % do sexo masculino. Embora os fármacos utilizados estivessem de acordo com o preconizado, foram observados erros com relação a dose, droga de escolha, forma de utilização, tempo de uso, sendo dose incorreta o achado mais frequente (β2 agonista de curta ação: 66% e brometo de ipratrópio: 95,2%). CONCLUSÃO: O nível de utilização das medidas recomendadas pelas diretrizes foi baixo e compatível com outros estudos, levando a risco aumentado de falha no tratamento e maior custo. Apesar da ampla divulgação, os conceitos estabelecidos não são suficientemente incorporados à prática clínica, sugerindo a necessidade de ações educativas mais efetivas para que isso ocorra.
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Asthma , Respiratory Sounds , Cross-Sectional Studies , Ipratropium , Emergency Service, HospitalABSTRACT
Resumen El salbutamol es un agonista adrenérgico β2 ampliamente empleado en pacientes con enfermedades pulmonares obstructivas y restrictivas. Sus principales efectos secundarios son la taquicardia y el temblor. Las mioclonías son contracciones musculares involuntarias, irregulares, bruscas, breves y repentinas, y pueden ser generalizadas, focales o multifocales. Se presenta el caso de un paciente de 61 años con mioclonías de difícil manejo que solo presentó mejoría tras la suspensión definitiva del agonista adrenérgico β2. Se describen los hallazgos clínicos, las intervenciones y el resultado en las mioclonías asociadas con el uso de salbutamol y se discuten la posible génesis y la importancia de este efecto adverso. Para documentar el caso, se siguieron las recomendaciones de las guías para el reporte de casos (CAse REport, CARE). Aunque en diversos estudios se han descrito mioclonías secundarias al uso de diferentes fármacos, hasta donde se sabe, este sería el cuarto reporte de un caso asociado específicamente con el uso del salbutamol.
Abstract Salbutamol is a β2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the β2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.
Subject(s)
Humans , Male , Middle Aged , Albuterol/adverse effects , Adrenergic beta-2 Receptor Agonists/adverse effects , Myoclonus/chemically induced , Oxygen Inhalation Therapy , Methylprednisolone/therapeutic use , Ipratropium/therapeutic use , Fatal Outcome , Combined Modality Therapy , Substance-Related Disorders/complications , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/drug therapy , Pulmonary Disease, Chronic Obstructive/therapy , Albuterol/therapeutic use , Drug Synergism , Drug Therapy, Combination , Emergencies , Fenoterol/adverse effects , Fenoterol/therapeutic use , Adrenergic beta-2 Receptor Agonists/therapeutic useABSTRACT
@#<p style="text-align: justify;"><strong>BACKGROUND:</strong>The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).<br /><strong>OBJECTIVES:</strong>To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.<br /><strong>METHODS:</strong>This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.<br /><strong>RESULTS:</strong> PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.<br /><strong>CONCLUSION:</strong>The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.</p>
Subject(s)
Humans , Male , Female , Aged , Clonazepam , Potentially Inappropriate Medication List , Spironolactone , Amiodarone , Clonidine , Ketorolac , Orphenadrine , Digoxin , Ipratropium , Insulin , Hydroxyzine , Fertility , Prescriptions , PatientsABSTRACT
BACKGROUND:The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).OBJECTIVES:To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.METHODS:This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.RESULTS: PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.CONCLUSION:The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.
Subject(s)
Humans , Male , Female , Aged , Clonazepam , Potentially Inappropriate Medication List , Spironolactone , Amiodarone , Clonidine , Ketorolac , Orphenadrine , Digoxin , Ipratropium , Insulin , Hydroxyzine , Fertility , Prescriptions , PatientsABSTRACT
Asma é uma doença respiratória crônica frequente no atendimento da Atenção Primária à Saúde (APS) com prevalência nacional de 4,4% em adultos e cerca de 20% em crianças e adolescentes. Conforme a gravidade da doença, apresenta diversos graus de incapacidade e piora na qualidade de vida. A doença tem características heterogêneas, usualmente com inflamação crônica das vias aéreas, sendo definida pela história de sintomas respiratórios (sibilância, dispneia, desconforto torácico e tosse), que variam no tempo e em intensidade, associados a limitação variável de fluxo aéreo expiratório. O diagnóstico é baseado nas características clínicas da doença e testes de função pulmonar que identificam limitação variável do fluxo aéreo. Esta guia apresenta informação que orienta a conduta para casos de asma no contexto da Atenção Primária à Saúde, incluindo: Avaliação clínica Teste de função pulmonar Controle dos sintomas Riscos para desfechos desfavoráveis Tratamento Farmacológico Medidas complementares Técnica inalatória Plano de ação Manejo da exacerbação Encaminhamento para serviço especializado.
Subject(s)
Humans , Asthma/diagnosis , Asthma/therapy , Telemedicine/methods , Education, Distance/methods , Primary Health Care , Respiratory Function Tests/instrumentation , Respiratory Therapy , Ipratropium/therapeutic use , Anesthetics, Inhalation/administration & dosage , Albuterol/therapeutic use , Formoterol Fumarate/therapeutic useABSTRACT
BACKGROUND:The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).OBJECTIVES:To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.METHODS:This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.RESULTS: PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.CONCLUSION:The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.
Subject(s)
Humans , Male , Female , Aged , Clonazepam , Potentially Inappropriate Medication List , Spironolactone , Amiodarone , Clonidine , Ketorolac , Orphenadrine , Digoxin , Ipratropium , Insulin , Hydroxyzine , Fertility , Prescriptions , PatientsABSTRACT
<p><b>OBJECTIVE</b>To investigate the effects of inhaled short-acting bronchodilators on diaphragm function and neural respiratory drive in patients with chronic obstructive pulmonary disease (COPD) during maximal isocapnic ventilation (MIV).</p><p><b>METHODS</b>Forty-seven patient with moderate to severe COPD were randomized into 4 groups: placebo group (n=12), salbutamol group (n=13), ipratropium group (n=10), and combined group (salbutamol and ipratropium, n=12). Each subject received an initial MIV for 3 min at baseline and inhaled placebo (400 µg), salbutamol (400 µg), ipratropium (80 µg), or both salbutamol and ipratropium, followed 30 min later by another 3 min of MIV. The parameters of diaphragm function and neural respiratory drive were monitored continuously and calculated during MIV.</p><p><b>RESULTS</b>During the initial MIV, all the patients experienced a linear increase in root mean square (RMS) of diaphragm electromyogram with a gradual decrease in transdiaphragmatic pressure (Pdi), minute ventilation (VE), and VE/RMS, and these parameters all improved significantly after inhalation of the bronchodilators. Compared with the placebo group at the same time point, the 3 bronchodilator-treated groups showed significantly decreased RMS and Borg score and increased Pdi, VE and VE/RMS; VE/RMS was the highest in the combined treatment group (P<0.05). The Delta Borg was significantly correlated with Delta Pdi, Delta VE, Delta RMS, and Delta VE/RMS (P<0.05).</p><p><b>CONCLUSIONS</b>In COPD patients, inhaled short-acting bronchodilators can alleviate diaphragm fatigue during MIV, increase lung ventilation, reduce neural respiratory drive, and improve neuro-ventilatory coupling to relieve dyspnoea, and the combination of β-2 agonists and anti-muscarinic antagonists produces a stronger efficacy.</p>
Subject(s)
Humans , Administration, Inhalation , Albuterol , Therapeutic Uses , Bronchodilator Agents , Therapeutic Uses , Diaphragm , Ipratropium , Therapeutic Uses , Pulmonary Disease, Chronic Obstructive , Drug Therapy , RespirationABSTRACT
<p><b>OBJECTIVE</b>To assess the efficacy and safety of inhaled nebulized hypertonic saline (HS) solution in infants with acute bronchiolitis.</p><p><b>METHOD</b>Totally 129 patients with acute bronchiolitis (clinical severity score ≥ 4, aged 2-18 months) admitted to the Capital Institute of Pediatrics from November 2012 to January 2013 were enrolled. All the subjects were assigned to receive 1.5 ml compound ipratropium bromide solution for inhalation and 1 ml budesonide firstly, twice a day. Then, the subjects were randomized to receive 2 ml doses of nebulized 5% HS (Group A), 3% HS (Group B) or 0.9% NS (Group C), twice a day. The treatment lasted for 3 days. Clinical severity scores before treatment and 24, 48, 72 h after treatment were documented. Bronchospasm, nausea and emesis were recorded to assess safety.</p><p><b>RESULT</b>A total of 124 patients completed this research.Group A included 40 cases, Group B included 42 cases, Group C included 42 cases. Demographic characteristics, pre-treatment duration and clinical severity score before treatment were similar among the 3 group.Seventy-two hours after treatment, the clinical severity score of Group A, B, and C were 3.5 (1.0) , 4.0 (1.0) and 5.0 (0) . At 24, 48, and 72 h after treatment, the clinical severity score were significantly different among the three groups (χ(2) = 36.000, 51.200, 50.800, P < 0.05) .One patient in Group A got paroxysmal cough everytime as soon as he received 5% HS (6 times).Other 3 patients in Group A got paroxysmal cough once. The incidence of adverse effect of Group A was 3.75% (9/240); no adverse event occurred in other group. The incidence of adverse effect among this three group was significantly different (χ(2) = 19.13, P < 0.01).</p><p><b>CONCLUSION</b>Inhalation of nebulized 5% and 3% hypertonic saline could decrease clinical symptoms of patient with acute bronchiolitis; 5% HS was superior to 3% HS. But 2 ml dose of 5% HS may induce paroxysmal cough.</p>
Subject(s)
Female , Humans , Infant , Male , Administration, Inhalation , Bronchiolitis , Drug Therapy , Pathology , Bronchodilator Agents , Therapeutic Uses , Budesonide , Therapeutic Uses , Cough , Ipratropium , Chemistry , Therapeutic Uses , Saline Solution, Hypertonic , Therapeutic Uses , Severity of Illness Index , Treatment OutcomeABSTRACT
Rhinitis is a global problem and is defined as the presence of at least one of the following: congestion, rhinorrhea, sneezing, nasal itching, and nasal obstruction. The two major classifications are allergic and nonallergic rhinitis (NAR). Allergic rhinitis occurs when an allergen is the trigger for the nasal symptoms. NAR is when obstruction and rhinorrhea occurs in relation to nonallergic, noninfectious triggers such as change in the weather, exposure to caustic odors or cigarette smoke, barometric pressure differences, etc. There is a lack of concomitant allergic disease, determined by negative skin prick test for relevant allergens and/or negative allergen-specific antibody tests. Both are highly prevalent diseases that have a significant economic burden on society and negative impact on patient quality of life. Treatment of allergic rhinitis includes allergen avoidance, antihistamines (oral and intranasal), intranasal corticosteroids, intranasal cromones, leukotriene receptor antagonists, and immunotherapy. Occasional systemic corticosteroids and decongestants (oral and topical) are also used. NAR has 8 major subtypes which includes nonallergic rhinopathy (previously known as vasomotor rhinitis), nonallergic rhinitis with eosinophilia, atrophic rhinitis, senile rhinitis, gustatory rhinitis, drug-induced rhinitis, hormonal-induced rhinitis, and cerebral spinal fluid leak. The mainstay of treatment for NAR are intranasal corticosteroids. Topical antihistamines have also been found to be efficacious. Topical anticholinergics such as ipratropium bromide (0.03%) nasal spray are effective in treating rhinorrhea symptoms. Adjunct therapy includes decongestants and nasal saline. Investigational therapies in the treatment of NAR discussed include capsaicin, silver nitrate, and acupuncture.
Subject(s)
Humans , Acupuncture , Adrenal Cortex Hormones , Allergens , Capsaicin , Cholinergic Antagonists , Eosinophilia , Estrogens, Conjugated (USP) , Histamine Antagonists , Immunotherapy , Ipratropium , Leukotriene Antagonists , Nasal Decongestants , Nasal Obstruction , Odorants , Pruritus , Quality of Life , Rhinitis , Rhinitis, Allergic, Perennial , Rhinitis, Atrophic , Silver Nitrate , Skin , Smoke , Sneezing , Therapies, Investigational , Tobacco Products , WeatherABSTRACT
With the establishment of HPLC and LC-MS methods to determine the related substances and the content of active pharmaceutical ingredient (API) in ipratropium bromide aerosol products, several packing material-related impurities were identified, including antioxygen BHT and antioxygen 2246. Results showed that these leachable additives from the packing materials may present at a relative high level in the drug solution, and the low content of API in the drug products is usually due to the adsorption of the packing material as well as the leaking of contents. The current available assay methods for the control of ipratropium bromide aerosol products are often lack of specificity and unable to assure the drug quality effectively. To meet the increasing attention on the regulations of drug packing materials, our research would be a pilot study, indicating that the inappropriate packing materials could cause the migration and adsorption of the active ingredients, and the importance to have compatibility studies between packing materials and drugs.
Subject(s)
Aerosols , Antioxidants , Bronchodilator Agents , Chemistry , Butylated Hydroxytoluene , Chromatography, High Pressure Liquid , Drug Incompatibility , Drug Packaging , Ipratropium , Chemistry , Quality Control , Spectrometry, Mass, Matrix-Assisted Laser Desorption-IonizationABSTRACT
We have shown that expiratory flows increase when expirations are rapidly interrupted in stable asthmatic patients. We hypothesized that a similar increase could be obtained in patients with acute exacerbation of bronchial asthma treated in the Emergency Room. A total of 30 asthmatic patients were randomly allocated into two groups, the study and the control groups. Patients in the study group were connected to a device with an inspiratory line designed to administer pressurized aerosols. The expiratory line passed through a valve completely interrupting flow at 4 Hz, with an open/closed time ratio of 10/3. The control group patients were also connected to the device, but with the valve kept open. Mean expiratory flow at tidal volume (MEFTV) was measured under basal conditions and at 4, 8 and 12 minutes after connecting the patients to the device. All patients received standard treatment throughout the procedure. At all time points MEFTV increased more in the study than in the control group (p < 0.003 by two-way ANOVA). There was no residual effect after disconnection from the device. We conclude that TEFI can rapidly improve expiratory flows in patients with acute exacerbations of asthma, while pharmacologic interventions proceed.
Demostramos que el flujo espiratorio máximo, en pacientes asmáticos en estado estable, se incrementaba cuando se generaban rápidas y transitorias interrupciones del flujo. Formulamos la hipótesis de que un incremento similar podría ser observado en pacientes con exacerbación aguda de asma tratados en la sala de emergencias. Un total de 30 pacientes asmáticos fueron distribuidos al azar en dos grupos. Los pacientes del grupo en estudio fueron conectados a un aparato con una vía inspiratoria diseñada para la administración de aerosoles. La vía espiratoria pasaba por una válvula que interrumpía el flujo completamente a 4 hz, con una relación tiempo abierta/tiempo cerrada de 10/3. Los pacientes del grupo control también fueron conectados al aparato pero con la válvula siempre abierta. Se midió el flujo medio de la espiración a volumen circulante en condiciones basales y a los 4, 8 y 12 minutos después de conectado el paciente al equipo. Todos los pacientes recibieron el tratamiento farmacológico estándar a lo largo del ensayo. Se observó un incremento significativamente mayor del flujo espiratorio medio a volumen circulante en el grupo en estudio en comparación al grupo control (p < 0.003 ANOVA de dos vías) durante todo el ensayo. No hubo efecto residual después de la desconexión del equipo. Concluimos que las interrupciones transitorias del flujo espiratorio pueden incrementar rápidamente el flujo espiratorio en pacientes con exacerbaciones agudas de asma dando tiempo a que el tratamiento farmacológico comience a actuar.
Subject(s)
Adult , Female , Humans , Male , Asthma/physiopathology , Bronchodilator Agents/administration & dosage , Forced Expiratory Flow Rates/physiology , Acute Disease , Albuterol/administration & dosage , Asthma/drug therapy , Budesonide/administration & dosage , Ipratropium/administration & dosage , Time FactorsABSTRACT
Objetivo: Costa Rica es uno de los países que ocupa una de las más altas prevalencias de asma bronquial en niños y adolescentes reportadas a nivel mundial. Se conoce muy poco sobre la prevalencia del asma grave en niños costarricenses y sobre la forma en que nuestro sistema de salud ha brindado apoyo y seguimiento médico a nivel ambulatorio, una vez que los pacientes pediátricos egresan de una unidad de cuidados intensivos posterior a una crisis asmática grave. Se plantea describir las características demográficas, epidemiológicas, las características clínicas, el plan de manejo ambulatorio, la condición actual y la mortalidad de niños asmáticos que egresaron de unidad de cuidados intensivos luego de una crisis asmática grave. Métodos: Se revisaron, en forma retrospectiva, los expedientes clínicos de todos aquellos niños de ambos sexos, con edades de 6 a 13 años, que egresaron de la unidad de cuidados intensivos con el diagnóstico de crisis asmática grave, entre enero 2000 a diciembre 2006. Posteriormente, en forma prospectiva, se contactó a una muestra de 20 pacientes y sus padres en la consulta externa de Neumología del Hospital Nacional de Niños Dr. Carlos Sáenz Herrera, donde se aplicó un cuestionario y se realizó una espirometría. Resultados: En total se revisaron 75 expedientes de los cuales 33 eran del género masculino y 42 del género femenino. Más de la mitad de los niños tenían entre 6 y 9 años. La mayoría provenían de San José. El internamiento en la unidad de cuidados intensivos en la mayoría de los niños estuvo entre 2 y 4 días. Casi todos los pacientes eran conocidos asmáticos y recibían tratamiento. La principal indicación para el ingreso a la unidad de cuidados intensivos fue la necesidad de una infusión de salbutamol. Dentro de las drogas administradas en la unidad de cuidados intensivos todos recibieron salbutamol y bromuro de ipratropium en nebulizción. Otras drogas utilizadas fueron los esteroides intravenosos, salbutamol intravenoso, am...
Subject(s)
Humans , Child , Adolescent , Albuterol , Asthma , Status Asthmaticus/diagnosis , Status Asthmaticus/drug therapy , Lung Diseases/diagnosis , Lung Diseases/drug therapy , Ipratropium , Pediatrics , Costa RicaABSTRACT
Asthma could be diagnosed by its characteristic presentation. Spirometry can help the diagnosis by revealing post-bronchodilator response. Classically, salbutamol [albuterol] is used for evaluating post-bronchodilator response. This drug causes paradoxical bronchospasm in less than 10% of asthmatic patients. This study aimed to evaluate the frequency of paradoxical bronchospasm with salbutamol during spirometry and compare it with other drugs that did not reveal paradoxical bronchospasm such as levalbuterol and ipratropium. One hundred-Ninety two asthmatic subjects were entered in this clinical trial. All patients showed clinical manifestations of asthma and revealed obstructive pattern during spirometry. They were randomly assigned into three groups of drugs included: salbutamol, levalbuterol and ipratropium. Two puffs of these drugs were administered via a spacer and patients waited for fifteen minutes for the maximal effect to take place. Then spirometry was obtained again and postbronchodilator FEV1 and its alterations were compared among the three groups. The mean +/- SD age of patients was 49.40 +/- 17.4 years; the mean age, demographic data, clinical findings and spirometry results showed no significant difference among groups. FEV1 percent of predicted was 58.6 +/- 19.5 which proved that most subjects were suffering from severe asthma. Improvement of FEV1 by salbutamol [22.2 +/- 3%] and levalbuterol [16 +/- 18%] was significantly more compared with ipratropium [9.4 +/- 11%] [t=2.5, P=0.01 and t=2.2, P=0.01, respectively]. Paradoxical bronchospasm [more than 12% decrease in FEV1] was seen in two [3%], one [1.5%] and four [6%] subjects of salbutamol, ipratropium and levalbuterol groups, respectively. Regarding clinical improvement, levalbuterol resulted in the higher frequency of clinical improvement compared to salbutamol and ipratropium. With the dosage recommended for reversibility testing during spirometry, salbutamol showed comparable bronchodilator response and paradoxical bronchospasm frequency compared to levalbuterol and ipratropium
Subject(s)
Humans , Male , Female , Spirometry , Asthma/diagnosis , Albuterol , Ipratropium , Prospective StudiesABSTRACT
<p><b>OBJECTIVE</b>To evaluate the efficacy of 3 commonly used protocols for management of acute exacerbation of asthma in children.</p><p><b>METHODS</b>Totally 113 asthmatic children were randomized into 3 groups. In group A (53 cases), the children were treated with inhalation of nebulized budesonide suspension plus salbutamol and ipratropium bromide twice daily for 5 days; in group B (41 cases), budesonide plus salbutamol and ipratropium aerosol was administered, and in group C (29 cases), dexathmisone plus aminophylline injection was given once daily for 5 days. All the children received basic treatment with fluid infusion, antibiotics or/and anti-virus medications.</p><p><b>RESULTS</b>The children in both groups A and C showed effectively controlled asthma attack, with significant differences in the therapeutic effects (P>0.05). In contrast, only a few children showed improvement in group B, suggesting the ineffectiveness of the treatment.</p><p><b>CONCLUSION</b>Nebulized medicine is one of the best means for management of acute asthma exacerbation in children, and inhalation of budesonide suspension plus salbutamol and ipratropium bromide can effectively relieve the asthmatic symptoms in these children with good compliance and convenient administration.</p>
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Acute Disease , Aerosols , Albuterol , Therapeutic Uses , Asthma , Drug Therapy , Bronchodilator Agents , Therapeutic Uses , Budesonide , Therapeutic Uses , Drug Therapy, Combination , Ipratropium , Therapeutic Uses , Treatment OutcomeABSTRACT
Introdução: O brometo de ipratrópio, medicamento derivado da atropina, é bastante utilizado na prática médica, com a finalidade de reduzir o broncoespasmo. Poucos são seus efeitos colaterais, mas pode levar ao desenvolvimento do glaucoma e, conseqüentemente, ao risco de cegueira. O objetivo foi verificar se existe alteração da pressão intra-ocular (PIO), ou da acuidade visual, após nebulização com brometo de ipratrópio, em adultos jovens, sem alteração ocular prévia. Metodologia: Estudo experimental utilizando voluntários saudáveis (alunos do curso de Medicina) que aceitassem participar da pesquisa. Foram excluídos aqueles com alterações oculares previamente identificadas, especialmente hipertensão ocular no exame basal, e cardiopatia grave. Os indivíduos foram submetidos à avaliação da acuidade visual e à medida da PIO, com tonômetro Carl Zeiss AT 020, antes e trinta minutos após a nebulização de uma solução contendo 1mL de brometo de ipratrópio em 5mL de soro fisiológico. As medidas da pressão ocular, antes e após a nebulização, foram comparadas. Resultados: Foram avaliados 60 indivíduos, sendo 51,7% do sexo feminino, com idade variando entre 21 e 33 anos. Excluímos um indivíduo por apresentar PIO inicial elevada. Não houve relato de borramento da visão, xeroftalmia ou alteração da medida da acuidade visual. Todos apresentaram uma PIO dentro da normalidade no exame pós NBZ, não havendo diferença significativa entre as medidas. Conclusão: O uso de brometo de ipratrópio, por meio de nebulização, não apresenta alterações oculares significativas em pacientes jovens sem lesão diagnosticada previamente.
Subject(s)
Humans , Male , Female , Adult , Cholinergic Antagonists , Glaucoma , Intraocular Pressure , Ipratropium , Nebulizers and Vaporizers , Ocular Hypertension , Clinical Trial , Risk Factors , Visual AcuityABSTRACT
To compare the improvement in peak expiratory flow rate [PEFR] of patients presenting to the emergency department with acute severe asthma by using the following two regimens of broncho-dilator therapy. a] Salbutamol nebulization. b] Salbutamol plus Ipratropium bromide nebulization. c] To compare the hospital admission rates in the above mentioned two treatment groups. A comparative study. Military Hospital Rawalpindi, Feb 2002 to Dec 2002. Sixty adult asthmatic patients with peak expiratory flow rate [PEFR] less than 200 liters per minute were randomly assigned to nebulization treatment with salbutamol [5.0 mg initial dose followed by 2 more doses at 30 and 60 minutes] or the same salbutamol regimen plus ipratropium bromide [0.5 mg]. The primary end point was change in PEFR. The PEFR was measured at 30 minutes, 60 minutes and 90 minutes after the onset of study protocol. The proportion of admission in the two groups was examined as secondary end point. The increase in PEFR over time was significantly greater in combined ipratropium plus salbutamol group [p = 0.01] also the proportion of admitted patients was less in combined salbutamol plus ipratropium bromide group 4/30 vs 11/30, p = 0.036. The data suggested that combined iratropium bromide plus salbutamol nebulization was superior to salbutamol nebulization alone and it should be used in the initial management of patients who present with acute severe asthma
Subject(s)
Humans , Acute Disease , Albuterol/administration & dosage , Albuterol , Ipratropium/administration & dosage , Ipratropium , Nebulizers and Vaporizers , Peak Expiratory Flow Rate/drug effects , Bronchodilator Agents , Patient Admission , Drug Therapy, CombinationABSTRACT
This is a clinical trial regarding the comparative effect of two drugs in COPD patients. The drugs were Salbutamol and Ipratropoim bromide that are being used commonly in the treatment of COPD. Salbotamol is less expensive in Iran and more available than Ipratropim. We chose 16 patients which were referred to Pulmonary Clinic in Imam Hospital, Sari. The Pulmonary function test was done for each patient prior and after administering 200 micro g salbotamol and 36 micro g Atrovent in 0.5 ml within a one and two hour period. Then, comparison was made regarding the results of FVC and FEV1, with paired T- test and SPSS. We found no difference between the effects of these two drugs
Subject(s)
Humans , Albuterol , Ipratropium , Clinical Trials as Topic , Respiratory Function Tests , Treatment Outcome , SpirometryABSTRACT
Brenchiolitis is the most common lower respiratory tract infection in infants with considerably increased rate of its associated hospitalizations in the last years. To date there is no a single, widely practiced, evidence- driven treatment approach for bronchiolitis. Different treatment modalities have been in practice for some years, some of these therapies are specific to the virus and others are symptomatic. The bronchodilators and corticosteroids are the most commonly used drugs. Some studies found some benefit in the use of these drugs and others didn't found any beneficial effect of its use. Bronchodilators like salbutamol showed a better effect in bronchiohtis with more agreement in its use than the other drugs but also to a limited extent of efficacy. The aim of the present study was to evaluate the efficacy of using two different drugs [budesonide and ipratrobium bromide] in addition to salbutamol in the management of acute bronchiolitis in infants in trial to search for an effective medical treatment of this condition. This study was a randomized, double- blind controlled trial. The studied infants were divided into three groups by systematic random sample: group A received ipratrobium bromide inhalation and salbutamol, group B received budesomde and salbutamol inhalation, and group C received salbutamol alone. The primary outcome was symptom improvement and secondary outcomes i,'ere length of stay in hospital, adverse events, and report of symptoms by parents in revisit to outpatient clinic one week after discharge. As regarding to O2 saturation, there were no statistically significant differences between the studied groups. There were a significant difference in the mean length of hospital stay between groups A and B and between groups B and C, but no significant difference between groups A and C. There was no statistically significant difference in severity of respiratory symptoms which was measured by Respiratory Distress Assessment Instrument [RDAI] in the studied groups. There were a significant difference between group [A] and group [B] and between group [B] and group [C] as regarding to the presence of respiratory symptoms one week after discharge. These results demonstrate that ipratrobium bromide has no significant effect if added to salbutamol in the treatment of acute bronchiolitis in infants. Adding budesonide decreasing significantly the duration of stay in the hospital and the prevalence of symptoms one week after discharge but has no effect on other outcomes, with the conclusion that the use of budesonide with salbutamol in acute bronchiolitis is recommended to decrease the post hospitalization symptoms and the duration of hospitalization
Subject(s)
Humans , Male , Female , Acute Disease , Ipratropium , Budesonide , Albuterol , Bronchodilator Agents , Infant, NewbornABSTRACT
OBJECTIVE: To evaluate effect of addition of ipratropium to salbutamol delivered by metered dose inhaler and spacer in the beginning of treatment of mild to moderate exacerbation of asthma. METHODS: Children between 5 to 15 years of age with mild to moderate exacerbation of asthma were randomized to receive either a combination of ipratropium bromide and salbutamol or salbutamol alone administered by metered dose inhaler and spacer. The effects on clinical asthma score and spirometric parameters were compared. RESULTS: A total of 60 children were randomized in the study. The baseline characteristics of two groups were comparable. Children getting combination of salbutamol and ipratropium showed significantly greater improvement in percent-predicted PEFR and FEF25-75% than children receiving salbutamol alone. CONCLUSION: There was beneficial effect of addition of ipratropium to salbutamol administered by MDI with spacer at the beginning of therapy for mild to moderate acute exacerbation of asthma in children.