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 Efficacy and Outcome Between Metered Dose Inhaled Corticosteroids and Oral Montelukast in Mild Persistent Childhood Asthma.

Asthma is a chronic relapsing inflammatory disorder characterized by hyper reactive airways, leading to episodic, reversible bronchi constriction, owing to increased responsiveness of the tracheobronchial tree to various stimuli1. Specific objectives of the study to compare the clinical efficacy of oral montelukast with metered dose inhaled steroids. The results of the study suggests that metered dose inhaled steroids are superior than oral montelukast in mild persistent childhood asthma.

Outcome of Acute Lower Respiratory Tract Infection in Children.

Objective: To identify the outcome of acute lower respiratory tract infection (ALRTI) and factors contributing in mortality. Design: Prospective cohort study. Setting: Urban tertiary care teaching hospital. Methods: 100 cases with ALRTI between 2 weeks to 5 years of age were prospectively enrolled and followed up to determine outcome. Detailed history and clinical evaluation were recorded on a pre-tested proforma.Outcome and significant independent factors contributing to mortality were determined by comparison of dead subjects (n=10) with surviving children (n=90) in a multiple logistic analytic framework. Results: The case fatality rate (CFR) was 10%. The significant (p <0.05) independent factors contributing to mortality were pallor (OR 10.7), age less than 1 year (OR 9.4), inability to feed (OR 9.3), weight for age Z score (WAZ) <-3 (OR 6.6), presence of loose stools (OR 5.3), Hb<10(OR 1.6). The CFR was related to severity of WHO classification (“pneumonia”-0%, “severe pneumonia”-8.7% and “very severe pneumonia”-47.0%). Factors contributing to prolonged hospital stay included lack of exclusive breastfeeding [OR (95%CI)-4.37(1.69-11.28) RR (2.04)] and fever [OR (95%CI)-5.59(1.92-16.2) RR (2.3)] on multivariate analysis. Conclusion: ALRTI in children is a major concern. Presence of factors like pallor, age below 1 year, inability to feed, presence of loose stools and severe malnutrition require urgent intervention.