Reações adversas do montelucaste no tratamento da asma pediátrica: uma revisão integrativa da literatura / Adverse reactions of montelukast in the treatment of pediatric asthma: an integrative literature review / Reacciones adversas de montelukast en el tratamiento del asma pediátrico: una revisión integrativa de la literatura

Buscou-se analisar as reações adversas do montelucaste quando prescrito para o tratamento da asma pediátrica. Revisão integrativa da literatura utilizando as bases de dados: U.S. National Library of Medicine (PubMed), Biblioteca Virtual da Saúde (BVS), SCOPUS e Business Source Complete (EBSCO), empregando os descritores: "asthma", "pediatric", "montelukast" e "adverse effects", unidos pelo booleano "AND''. Incluíram-se artigos na íntegra; publicados nos últimos 5 anos; redigidos em português, inglês ou espanhol; pesquisados em humanos e com uma relação com o nosso objetivo. Excluíram-se os que se enquadravam em nossos critérios de exclusão.Foram identificados 53 artigos, dos quais 11 compuseram a amostra final desta revisão. A exposição ao montelucaste foi associada a uma chance 2 vezes maior de reações neuropsiquiátricas em um dos artigos analisados, porém os estudos ainda não forneceram uma explicação fisiopatológica em comum. Reações neuropsiquiátricas foram as de maior prevalência, representando mais de 90% da amostra.

We analyzed the adverse reactions of montelukast when prescribed for the treatment of pediatric asthma. This is an integrative literature review using the databases: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS and Business Source Complete (EBSCO), using the descriptors: "asthma", "pediatric", "montelukast" and "adverse effects", connected by the Boolean " AND''. Articles in full were included, published in the last 5 years, written in Portuguese, English or Spanish, researched in humans and related to our objective. Those that met our exclusion criteria were excluded. Fifty-three articles were identified, of which 11 comprised the final sample of this review. Exposure to montelukast was associated with a 2-fold greater chance of neuropsychiatric reactions in one of the articles analyzed, but the studies have not yet provided a common pathophysiological explanation. Neuropsychiatric reactions were the most prevalent, representing more than 90% of the sample.

Se intentó analizar las reacciones adversas de montelukast cuando se prescribe para el tratamiento del asma pediátrica. Revisión integrativa de la literatura usando las bases de datos: U.S. National Library of Medicine (PubMed), Virtual Health Library (BVS), SCOPUS y Business Source Complete (EBSCO), utilizando los descriptores: "asma", "pediátrico", "montelukast" y "efectos adversos", unidos por el booleano " Y". Se incluyeron artículos completos, publicados en los últimos 5 años, escritos en portugués, inglés o español, investigados en humanos y relacionados con nuestro objetivo. Se excluyeron aquellos que cumplieron con nuestros criterios de exclusión. Se identificaron cincuenta y tres artículos, de los cuales 11 constituyeron la muestra final de esta revisión. La exposición a montelukast se asoció con una probabilidad 2 veces mayor e reacciones neurosiquiátricas en uno de los artículos analizados, pero los estudios aún no han proporcionado una explicación fisiopatológica común. Las reacciones neurosiquiátricas fueron las más prevalentes, representando más del 90% de la muestra

Evidence-based anti-viral and immunomodulatory potential of Black cumin (Nigella sativa L) in COVID-19 / Potencial antivírico e inmunomodulador en COVID-19 del comino negro (Nigella sativa L) basado en la evidencia

Currently, the whole world is facing a life-threatening novel coronavirus 2019 (COVID-19) pandemic. Natural products are well-known for their potential role against viral disease, and some anti-viral agents have been developed to combat these diseases. Herein, the authors investigated the possible effects of this Holy plant Nigella sativa L. (NS), against coronavirus, using evidence-based and mechanistic approaches to conclude the immune-boosting and alleviation of respiratory systemeffects of NS. The pharmacological studies established a prominent role in treating various respiratory, immune systems, cardiovascular, skin, and gastrointestinal disorders. Literature supported the significant anti-viral role and showed an inhibitory role for NS against MHV-A59 CoV (mouse-hepatitis virus­A59) infected Hela, i.e., HeLaCEACAM1a (HeLa-epithelial carcinoembryonic antigen-related cell adhesion molecule 1a) cell. NS is a safe herbal product or dietary supplement and could be an effective and affordable community adjuvant treatment for coronavirus in the current scenario.

Actualmente, el mundo entero se enfrenta a una pandemia del nuevo coronavirus 2019 (COVID-19) que amenaza la vida. Los productos naturales son bien conocidos por su papel potencial contra las enfermedades virales, y se han desarrollado algunos agentes antivirales para combatir estas enfermedades. En este documento, los autores investigaron los posibles efectos de esta planta sagrada Nigella sativa L. (NS), contra el coronavirus, utilizando enfoques mecanicistas y basados en la evidencia para concluir el refuerzo inmunológico y el alivio de los efectos del SN en el sistema respiratorio. Los estudios farmacológicos establecieron un papel destacado en el tratamiento de diversos trastornos respiratorios, del sistema inmunológico, cardiovasculares, cutáneos y gastrointestinales. La literatura apoyó el importante papel antivírico y mostró un papel inhibidor de NS contra células Hela infectadas con MHV-A59 CoV (virus de la hepatitis de ratón-A59), es decir, HeLaCEACAM1a (molécula de adhesión celular 1a relacionada con el antígeno carcinoembrionario epitelial de HeLa). NS es un producto a base de hierbas o un suplemento dietético seguro y podría ser un tratamiento adyuvante comunitario eficaz y asequible para el coronavirus en el escenario actual.

Anti-asthmatic effect of agarwood alcohol extract in mice and its mechanism / 中国中药杂志

As recorded, agarwood has the function of improving qi reception and relieving asthma, but the underlying mechanism is unclear and rarely reported. Therefore, this study explored the anti-asthmatic effect of the alcohol extract of agarwood produced by the whole-tree agarwood-inducing technique(Agar-Wit) in the asthma mouse model induced by intraperitoneal injection of ovalbumin(OVA) + Al(OH)_3 combined with intranasal administration of OVA and the mechanism, and compared the anti-asthmatic effects of agarwood induced with different methods. Firstly, the anti-inflammatory and anti-asthmatic effects of Agar-Wit agarwood in mice were evaluated based on the asthma frequency, lung tissue injury, and peripheral inflammatory white blood cell(WBC) count and eosinophil count. Then, the levels of interleukin-1β(IL-1β), IL-17, and IL-10 in serum of mice were detected by enzyme-linked immunoassay(ELISA) and the expression of inflammation-and apoptosis-related genes in tissues was measured by reverse transcription polyme-rase chain reaction(RT-PCR) so as to preliminarily explore the anti-asthmatic mechanism. RESULTS:: showed that the alcohol extract of Agar-Wit agarwood significantly reduced asthma frequency, relieved pathological injury, improved peripheral WBC count and eosinophil count, decreased the levels of inflammatory cytokines IL-1β and IL-17, elevated the level of anti-inflammatory cytokine IL-10, and down-regulated the mRNA expression of IL-1 R, tumor necrosis factor receptor R(TNFR), nuclear transcription factor-kappa B(NF-κB), Bax, and caspase 3, but had no significant influence on the expression of high-mobility group box 1(HMGB1) protein, caspase 8, and Bcl-2. The effect of Agar-Wit agarwood alcohol extract was better than that of wild agarwood alcohol extract and alcohol extract of agarwood induced with the burning-chisel-drilling method at the same dose. In conclusion, Agar-Wit agarwood can significantly alleviate inflammation and asthma, which is related to its anti-inflammation and anti-apoptosis activity.

Research Progress on Chemical Constituents， Pharmacological Effect and Clinical Applications of Daturae Flos / 中国实验方剂学杂志

Daturae Flos is a traditional antitussive and antiasthmatic medicine， its flowers and leaves are rich in a variety of compounds， including withanolides， alkaloids， terpenes， flavonoids and amides. Because of its antiasthmatic， antitussive， antispasmodic and analgesia effect， it is traditionally used for the treatment of asthma， cough， cold pain in abdominal cavity， rheumatic arthralgia， infantile chronic eclampsia， and can also be used as raw material for surgical anesthesia. Modern pharmacological studies have shown that in addition to the traditional efficacy， Daturae Flos also has anti-inflammatory， immunosuppression， anti-convulsion and other effects， and is often used in the treatment of psoriasis， Parkinson's disease， epilepsy， rheumatoid arthritis and other diseases. At present， the chemical constituents of Daturae Flos are mainly focused on withanolides and alkaloids. At the same time， there is a lack of clear classification of chemical components and the distribution of chemical components in medicinal parts of this medicine， and little information is available for the pharmacological effects of polysaccharides. Based on this， this paper systematically searched relevant literature of Daturae Flos， and summarized and analyzed its chemical composition， pharmacological effect and clinical application， in order to provide reference for further development and utilization of Daturae Flos.

Evaluation of anti-asthmatic and anti-cholinergic activity of ethanolic extract of Tectina grandis Linn. bark

Background: Asthma is a chronic disease that affects approximately 300 million people worldwide. Tectona grandis Linn. bark, also known as Teak (English), is traditionally used to treat asthma. However, the scientific data on anti-asthmatic and anti-cholinergic of this plant has got little attention. An attempt has been based on ethanolic extract of bark of Tectona grandis Linn. shown a tremendous effect on asthma when comparative study was done with normal and treated group.Methods: The anti-asthmatic activity of a 95% ethanol and 5% distilled water extract of dried and fresh Tectona grandis Linn. bark, was evaluated against histamine and acetylcholine-induced preconvulsive dyspnea (PCD) in guinea pigs fasted for 24 h were exposed to an atomized fine mist of 2% histamine dihydrochloride and acetylcholine aerosol (dissolved in normal saline) using nebulizer at a pressure of 300 mmHg in the histamine chamber (24�� cm, made of perplex glass. They were divided in groups Mepyramin (8 mg/kg) intraperitonially, atropine aerosol and Tectona grandis bark formulation (2.5, 5, 10 gm/kg) were administered orally 30 min prior to exposure. Animals, which did not develop typical asthma within 6 minutes, were taken as protected.Results: Ethanolic extract of Tectona grandis Linn. bark at 5 and 10 gm/kg significantly reduce bronchoconstriction as compared to control group along with significant mast cell stabilization activity.Conclusions: In conclusion, the present study shows that the ethanolic bark extract of Tectona grandis Linn. has potential antiasthamatic and antichlolinergic action in histamine and acetylcholine broncocontraction in guinea pigs.

Study of prescribing pattern of drugs used in the treatment of bronchial asthma at tertiary care hospital of northern India

Background: Asthma is a chronic inflammatory disease requiring long term treatment. For an effective control of asthma symptoms background knowledge of the prescribing pattern of anti-asthmatic drugs is a must.Methods: A prospective, observational study was conducted in the Department of Respiratory Medicine OPD, King George's Medical University, Lucknow. 114 patients of asthma were recruited for the study. A case report form was filled from patient’s prescription containing the demographic details of the patients, presenting complaints, investigations and drugs prescribed along with their dose, duration, frequency, route of administration.Results: 114 patients’ prescriptions were assessed which showed average number of drugs per prescription - 3.22. 42.8% and 50% of the drugs were prescribed in accordance with World Health Organization model list of essential medicines and National list of essential medicines. Short acting ?2 agonist (salbutamol), 61.4% was the most commonly and frequently prescribed single anti asthmatic drug. Combination of inhaled corticosteroid and long acting ?2 agonist, 86.8% was the most commonly prescribed fixed dose combination anti asthmatic drug. Inhalational route (75%) was the most preferred one over oral route (25%).Conclusions: Asthma being a chronic disease requires prolonged treatment which imposes economic burden on the patients. Judicious prescription of drugs not only improves the patient clinically but also removes the unnecessary burden. Data obtained from these studies can be used as a guide to make future decisions regarding standard prescription.

Use of dupilumab on the treatment of moderate-to-severe asthma: a systematic review

SUMMARY OBJECTIVE The objective of this article was to conduct a systematic review of the treatment of moderate-to-severe asthma by administrating Dupilumab. METHODS A search on the online databases EBSCO, Scielo, PubMed, Medline Bireme, Lilacs, and The New England Journal of Medicine was conducted, publications from 2010 to 2018 were selected. The inclusion criteria were articles which contained control groups, tested the validity of Dupilumab, and verified the response of patients through controlled tests. For the search of such articles, the following keywords were used: "Dupilumab", "asthma", "Bronchial Asthma" AND "Asthma, Bronchial" AND their correspondent in Portuguese "asma", "Asma brônquica" and "Asma brônquica". The exclusion criteria were literature reviews, news, articles without control groups, articles on different subjects, Dupilumab studies on other diseases, articles concerning asthma without the use of Dupilumab, and repeated articles on the databases were discarded. RESULTS The literature considers that the medication shows a good response for the treatment of moderate-to-severe asthma and assists in the improvement of lung function, aside from resulting in few side effects. It presents good efficacy, safety, and tolerance by patients. CONCLUSIONS Dupilumab is promising for the treatment of asthma, whereas conventional therapy is deemed to be insufficient. More additional studies are needed to confirm the long-term safety and effectiveness.

RESUMO OBJETIVO Este artigo teve como objetivo fazer uma revisão sistemática sobre o tratamento da asma moderada a grave, administrando Dupilumabe. MÉTODOS Foi realizada uma busca nas plataformas on-line Ebsco, SciELO, PubMed, Medline Bireme, Lilacs e New England Journal of Medicine. Foram selecionadas publicações de 2010 a 2018 referentes a artigos que continham grupos controle, que testaram a validade de Dupilumabe e verificaram a resposta dos pacientes por meio de testes controlados. Para a busca desses artigos, foram utilizadas as seguintes palavras-chave: "Dupilumab", "asthma", "Bronchial Asthma" and "Asthma, Bronchial". E o correspondente em português: "asma", "Asma brônquica" and "Asma brônquica". Os critérios de exclusão, revisões de literatura, notícias, artigos sem grupos de controle, artigos sobre diferentes assuntos, estudos de Dupilumabe sobre outras doenças, artigos sobre asma sem uso de Dupilumabe e artigos repetidos em plataformas de busca foram descartados. RESULTADOS A literatura aponta que a medicação apresenta boa resposta no tratamento da asma moderada a grave e auxilia na melhora da função pulmonar, além de resultar em poucos efeitos colaterais. Apresenta boa eficácia, segurança e tolerância pelos pacientes. CONCLUSÕES Dupilumabe é promissor para o tratamento da asma em que a terapia convencional se revela insuficiente. Maiores estudos adicionais são necessários para confirmar a segurança e a eficácia em longo prazo.

Evaluation of smooth muscle relaxant potential of Bismarckia nobilis (Hildebr. & Wendl.) in diarrhea, hypertension and asthma by ex-vivo and in-vivo method / Evaluación del potencial relajante en músculo liso de Bismarckia nobilis (Hildebr. & Wendl.) en diarrea, hipertensión y asma por métodos ex vivo e in vivo

To explore the mechanistic basis behind smooth muscle relaxant prospective of Bismarckia nobilis in gastrointestinal, respiratory and cardiovascular ailments. The methanolic extract of B. nobilis and sub-fractions have been evaluated in vitro rabbit isolated tissues, in vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice. The B. nobilis extract relaxed spontaneous and K+(80 mM)- induced contractions in rabbit isolated jejunum preparations, CCh (1 µM) and K+ (80 mM)-induced contractions in tracheal and bladder preparations, PE (1 µM) and K+ (80 mM)-induced concentrations in aorta preparations, likewise verapamil. Spasmolytic activity of dichloromethane fraction is stronger as compared to aqueous fraction. In vivo castor oil-induced diarrhea in rats and charcoal meal activity in mice further supported spasmolytic activity. B. nobilis extract possess anti-spasmodic, anti-diarrheal, airway relaxant and vasodilator activities possible mediated through calcium channel blocking mechanism, justifying therapeutic utility of B. nobilis in diarrhea, asthma and hypertension.

El objetivo de trabajo fue explorar el mecanismo de acción relacionado con el efecto relajante del músculo liso inducido por Bismarckia nobilis (B. nobilis) en enfermedades gastrointestinales, respiratorias y cardiovasculares. El extracto metanólico de B. nobilis y subfracciones fue evaluado in vitro en tejidos aislados de conejos. Además se evaluó diarrea in vivo inducida con aceite de ricino en ratas y la actividad de harina de carbón vegetal en ratones. El extracto de B. nobilis relajó tanto las contracciones espontáneas como las inducidas por K+(80 mM) en preparaciones de yeyuno aisladas de conejos, las contracciones inducidas por PE (1 µM) y K+(80 mM) inducidas en preparaciones de aorta; de manera similar a verapamilo. La actividad espasmolítica de la fracción de diclorometano es más potente en comparación con la fracción acuosa. La diarrea inducida in vivo por el aceite de ricino en ratas y la actividad de la harina de carbón vegetal en ratones apoyaron aún más la actividad espasmolítica. El extracto de B. nobilis posee actividades antiespasmódicas, antidiarreicas, relajantes de las vías respiratorias y vasodilatadoras, posibles a través del mecanismo de bloqueo de los canales de calcio, lo que justifica la utilidad terapéutica de B. nobilis en la diarrea, el asma y la hipertensión.

Estimated cost of asthma in outpatient treatment: a real-world study / Estimativa de custo da asma em tratamento ambulatorial: estudo com dados de mundo real

ABSTRACT OBJECTIVE To estimate the cost of diagnosis and treatment of asthma. METHODS We used the perspective of society. We sequentially included for 12 months, in 2011-2012, 117 individuals over five years of age who were treated for asthma in the Pneumology and Allergy-Immunology Services of the Piquet Carneiro Polyclinic, Universidade do Estado do Rio de Janeiro. All of them were interviewed twice with a six-month interval for data collection, covering 12 months. The cost units were identified and valued according to defined methods. We carried out a sensitivity analysis and applied statistical methods with a significance level of 5% for cost comparisons between subgroups. RESULTS The study consisted of 108 patients, and 73.8% of them were women. Median age was 49.5 years. Rhinitis was present in 83.3% of the individuals, and more than half were overweight or obese. Mean family income was U$915.90/month (SD = 879.12). Most workers and students had absenteeism related to asthma. Total annual mean cost was U$1,291.20/patient (SD = 1,298.57). The cost related to isolated asthma was U$1,155.43/patient-year (SD = 1,305.58). Obese, severe, and uncontrolled asthmatic patients had higher costs than non-obese, non-severe, and controlled asthmatics, respectively. Severity and control level were independently associated with higher cost (p = 0.001 and 0.000, respectively). The direct cost accounted for 82.3% of the estimated total cost. The cost of medications for asthma accounted for 62.2% of the direct costs of asthma. CONCLUSIONS Asthma medications, environmental control measures, and long-term health leaves had the greatest potential impact on total cost variation. The results are an estimate of the cost of treating asthma at a secondary level in the Brazilian Unified Health System, assuming that the treatment used represents the ideal approach to the disease.

RESUMO OBJETIVO Estimar o custo do diagnóstico e tratamento da asma. MÉTODOS Foi utilizada a perspectiva da sociedade. Foram incluídos por 12 meses em 2011-2012, sequencialmente, 117 indivíduos maiores de cinco anos de idade, em tratamento por asma nos Serviços de Pneumologia e Alergia-Imunologia da Policlínica Piquet Carneiro, Universidade do Estado do Rio de Janeiro. Todos realizaram duas entrevistas com seis meses de intervalo para coleta de dados, cobrindo 12 meses. As unidades de custos foram identificadas e valoradas de acordo com métodos definidos. Foi feita análise de sensibilidade e foram aplicados métodos estatísticos com nível de significância de 5% para comparações de custos entre subgrupos. RESULTADOS Cento e oito pacientes completaram o estudo, 73,8% eram mulheres. Mediana de idade foi de 49,5 anos. Rinite esteve presente em 83,3%, e mais da metade tinha sobrepeso ou obesidade. A renda familiar média foi de R$1.566,19/mês (DP = 1.503,30). A maioria dos trabalhadores e dos estudantes teve absenteísmo relacionado à asma. O custo médio anual total foi de R$2.207,99/paciente (DP = 2.220,55). O custo relacionado à asma isolada foi de R$1.984,17/paciente-ano (DP = 2.232,55). Asmáticos obesos, graves ou não controlados tiveram maiores custos em comparação aos não obesos (p = 0,001), não graves e controlados (p = 0,000). O custo direto correspondeu a 82,3% do custo total estimado. O custo com medicamentos para asma correspondeu a 62,2% dos custos diretos da asma. CONCLUSÕES Medicamentos para asma, medidas de controle ambiental e licenças de saúde prolongadas tiveram maior impacto potencial na variação do custo total. Os resultados são uma estimativa do custo do tratamento da asma em nível secundário no Sistema Único de Saúde, assumindo-se que o tratamento utilizado represente a abordagem ideal da doença.

Asthma-Related Outcomes in Patients Initiating Extrafine Ciclesonide or Fine-Particle Inhaled Corticosteroids

PURPOSE: Extrafine-particle inhaled corticosteroids (ICS) have greater small airway deposition than standard fine-particle ICS. We sought to compare asthma-related outcomes after patients initiated extrafine-particle ciclesonide or fine-particle ICS (fluticasone propionate or non-extrafine beclomethasone). METHODS: This historical, matched cohort study included patients aged 12-60 years prescribed their first ICS as ciclesonide or fine-particle ICS. The 2 cohorts were matched 1:1 for key demographic and clinical characteristics over the baseline year. Co-primary endpoints were 1-year severe exacerbation rates, risk-domain asthma control, and overall asthma control; secondary endpoints included therapy change. RESULTS: Each cohort included 1,244 patients (median age 45 years; 65% women). Patients in the ciclesonide cohort were comparable to those in the fine-particle ICS cohort apart from higher baseline prevalence of hospitalization, gastroesophageal reflux disease, and rhinitis. Median (interquartile range) prescribed doses of ciclesonide and fine-particle ICS were 160 (160-160) µg/day and 500 (250-500) µg/day, respectively (P<0.001). During the outcome year, patients prescribed ciclesonide experienced lower severe exacerbation rates (adjusted rate ratio [95% CI], 0.69 [0.53-0.89]), and higher odds of risk-domain asthma control (adjusted odds ratio [95% CI], 1.62 [1.27-2.06]) and of overall asthma control (2.08 [1.68-2.57]) than those prescribed fine-particle ICS. The odds of therapy change were 0.70 (0.59-0.83) with ciclesonide. CONCLUSIONS: In this matched cohort analysis, we observed that initiation of ICS with ciclesonide was associated with better 1-year asthma outcomes and fewer changes to therapy, despite data suggesting more difficult-to-control asthma. The median prescribed dose of ciclesonide was one-third that of fine-particle ICS.

Tratamiento del asma severo con omalizumab: experiencia pediátrica en Chile y revisión de la literatura / Omalizumab treatment on severe asthma patients: pediatric experience in Chile and literature review

This paper presents clinical experience with Omalizumab treatment in 8 pediatric patients in Chile. All children presented difficult to control asthma despite receiving high intensity treatment, with low quality of life. All patients were studied in order to discard errors in asthma diagnosis and to evaluate asthma treatment adherence and inhalation technique. After evaluation, patients proven to have severe therapy resistant asthma were indicated treatment with Omalizumab. Significant clinical improvement was observed, with reduced asthma symptoms and number of exacerbations, as well as an improved quality of life. Omalizumab showed a good safety profile with mild and transient adverse reactions in 6 administrations of a total of 122.

Se presenta la experiencia clínica con el uso de Omalizumab en 8 pacientes pediátricos en nuestro país. Todos los pacientes presentaban asma sin control a pesar de recibir terapia de alta intensidad, asociado a una muy deficiente calidad de vida. La totalidad de los pacientes fueron sometidos en cada centro a un estudio exhaustivo para poder descartar error en el diagnóstico y se evaluó la adherencia y la técnica inhalada. Al comprobarse que estos pacientes tenían asma severo resistente a tratamiento se indicó Omalizumab, el cual produjo una mejoría clínica significativa. Se observó una reducción de las exacerbaciones y de los síntomas de asma acompañado de una mejoría de la calidad de vida, asociado a un buen perfil de seguridad. Se observaron reacciones adversas leves y transitorias en 6 administraciones de un total de 122.

Antipyretic and anti-asthmatic activities of traditional Chinese herb-pairs, Ephedra and Gypsum / 中国结合医学杂志

<p><b>OBJECTIVE</b>Mahuang-Shigao herb-pair is a famous formula composed of Ephedra and Gypsum. The herb-pair is frequently used for treating cold symptoms and bronchial asthma in the clinical practice of Chinese medicine (CM). In the present study, we evaluated evidence for the benefit of combined use of Ephedra and Gypsum by analyzing the antipyretic and anti-asthmatic activities of Ephedra-Gypsum.</p><p><b>METHODS</b>The antipyretic effects of Ephedra-Gypsum were evaluated in yeast-induced hyperthermia test. Thirty male Wistar rats were randomly divided into 5 groups, including control group, standard aspirin group, and 3 Ephedra- Gypsum groups of different doses (6, 12, 24 g/kg). Ephedra-Gypsum extract and asprin were administered orally 6 h after the injection of yeast solution and body temperature was measured every 1 h for 8 h. The antiasthmatic effects of Ephedra-Gypsum were evaluated using an ovalbumin (OVA)-induced asthmatic rat model. Thirty-six male SD rats were randomly divided into 6 groups. Rats were alternately sensitized and OVA+Al(OH) challenged by exposure to mists of ovalbumin. Ephedra-Gypsum extracts (6, 12, 24 g/kg) or dexamethasone were administered 45 min prior to the allergen challenge for 8 days. Latent period and the weight of wet to dry ratio of lung were determined. In addition, the eosinophils in blood and white blood cell (WBC) were counted by an YZ-Hemavet Analyzer.</p><p><b>RESULTS</b>The Ephedra-Gypsum extracts at test dose (6, 12, 24 g/kg) significantly and dose-dependently attenuated yeast-induced fever in rats. The Ephedra-Gypsum extracts also prolonged the latent period, reduced OVA-induced increases in eosinophils and WBC, and decreased the wet and dry weight ratio of the lungs in the anti-asthmatic test.</p><p><b>CONCLUSIONS</b>These findings indicate that the Ephedra-Gypsum extract has antipyretic and anti-asthmatic properties. Hence, the results support additional scientific evidence in prescriptions.</p>

Pharmacoeconomical analysis of inhaled glucocorticosteroids in the treatment of children with cough variant asthma / 中国基层医药

Objective To discuss the clinical curative effect and pharmacoeconomics of inhaled glucocortico-steroids(ICS)in the treatment of children with cough variant asthma(CVA),in order to provide the reference for reasonable and economic drug -use of clinic treating children with CVA.Methods 128 children with CVA were divided into A,B,C three groups according to random number table method in our hospital from March 2013 to May 2014.The children with CVA of A,B,C groups were respectively given budesonide aerosol(200 -800μg/day,twice per day),fluticasone propionate aerosol(50 -100μg/time,twice per day),beclometasone dipropionate aerosol(50 -100μg/time,three times per day)on the basis of bronchodilator,smooth wheezing and expectorant.The clinical effica-cy and cost -effectiveness was evaluated after 12 weeks of treatment.Results The clinical total effective rates of A, B,C group were 90.0%,93.4%,90.7% respectively,and there were no statistically significant difference(χ2 =25.215,22.878,21.336,all P >0.05 ).The per capita cost of A,B,C group were 498.68yuan,671.20yuan, 541.14yuan respectively,and A group had the lowest cost -effectiveness ratio(C /E =5.54).Conclusion Budes-onide aerosol has better economy in treating of children with CVA.

Phytochemistry, anti-asthmatic and antioxidant activities of Anchomanes difformis (Blume) Engl. leaf extract

Objective: To study the phytochemistry, anti-asthmatic and antioxidant activities of the aqueous leaf extract of Anchomanes difformis (Blume) Engl. (A. difformis) and to verify claims of use in folk medicine. Methods: For anti-asthmatic activity, male and female guinea pigs with average body weight of (451.4 ± 118.1) g were divided into six groups of six animals each. Group 1 served as control (distilled water); Group 2 was administered with salbutamol (reference drug) only; Group 3 served as ovalbumin sensitized group, Group 4, 5 and 6 were treated with A. difformis extract at doses of 100, 200 and 400 mg/kg, respectively. Described methods were used to test fluid viscosity, fluid volume and quantitative phytochemistry analysis. Absorbance was read using a UV-Vis spectrophotometer and results computed in percentage. Total antioxidant assays [2, 2-diphenyl-1-picrylhydrazyl (DPPH) and lipid peroxidation assay], were carried out using reported procedures. Results: The anti-asthmatic evaluation showed that protection from asthma of the animals in Group 6 (400 mg/kg, 32.7%) were similar to that in Group 2 (salbutamol, 33.0%). Excised trachea was free of mucus secretion in Group 5 (200 mg/kg) as was observed in the control group. Fluid volume increase in Groups 3 and 6 indicated mucus secretion. DPPH radical scavenging activity of extract was effective as ascorbic acid which served as standard at 20 μg/mL. But, the extract elicited low lipid peroxidation activity compared with the reference (tocopherol) at concentrations tested. Conclusions: A. difformis aqueous leaf extract is safe and possesses positive anti-asthmatic and antioxidant activities as claimed by traditional herbal practitioners in Delta State.

Survey on the usage of antiasthmatic drugs in community hospitals in Shanghai / 中华全科医师杂志

Objective To observe the usage of antiasthmatic drugs and seek problems of following the guidelines of asthma and COPD prevention & treatment in community hospitals.Methods The prescribed quantity in 2013 of antiasthmatic drugs was recorded for 5 community hospitals in a district of Shanghai.Basing on the defined daily dose (DDD),the dosing frequency of drugs (DDDs) and the percentages of each category of drugs were calculated.Then comparisons were made with the data of a grade Ⅱ hospital and a grade Ⅲ hospital in the same district.Results Among three level hospitals,no significant difference existed in the percentages of oral antiasthmatic drugs.But the major category of oral drugs at grades Ⅱ-Ⅲ hospitals was leukotriene receptor antagonist whereas only oral theophylline and oral β2-receptor agonists were available at community hospitals.Among inhaled drugs,inhaled corticosteroids (ICS) dominated at grades Ⅱ-Ⅲ hospitals.But at community hospitals,inhaled short-acting beta-agonists (SABA) predominated.Among inhalants,dry powder inhaler (DPI) dominated at grades Ⅱ-Ⅲ hospitals and metered dose inhaler (MDI) at community hospitals.Conclusions The usage of antiasthmatics at community hospitals is not consistent with the guidelines.Optimizing drug purchasing at hospitals,strengthening continued medical education,modifying the medication concept of patients and boosting the production of domestic inhalants should be urgently undertaken.

Anti-tussive, muco-suppressant and expectorant properties, and the safety profile of a hydro-ethanolic extract of Scoparia dulcis.

Background: Scoparia dulcis is used in Ghanaian folkloric medicine for the management of asthma and its related complications. This study was therefore aimed at evaluating the anti-tussive, muco-suppressant and expectorant properties of hydroethanolic extract of S. dulcis (SDE), and to ascertain its safety for use in asthma and obstructive pulmonary disease management. Methods: The number of coughs induced in guinea pigs using citric acid and the concentration of phenol red secreted in tracheae of mice were measured. Preliminary phytochemical analysis was conducted on the extract using standard procedures. Safety for use of the extract was assessed by conducting an acute and delayed toxicity test. Results: The extract showed a dose-independent inhibition (p ≤ 0.001) of cough elicited by 7.5% citric acid, and a dose-dependent increase (p ≤ 0.05) in the amount of phenol red output in mice tracheae similar to that of ammonium chloride. For the muco-suppressant activity, SDE dose-dependently reduced (p ≤ 0.001) the concentration of ammonium chloride-induced phenol red secretions from mice tracheae. Phytochemical screening showed the presence of tannins, alkaloids, glycosides, saponins, steroids, and phenolic compounds. No acute and/or delayed toxic symptoms were observed after an oral administration of up to 5 g/kg of S. dulcis extract. Conclusion: The results showed that S. dulcis extract has anti-tussive, muco-suppressant and, expectorant and/or mucolytic properties; making it a possible remedy for asthma, and obstructive pulmonary disease.

Eficácia e segurança de dois inaladores de pó seco usados para a aplicação de furoato de mometasona em pacientes com asma / Efficacy and safety of two dry-powder inhalers for the administration of mometasone furoate in asthma patients

OBJETIVO: O furoato de mometasona (FM) é um novo corticosteroide inalatório sintético potente. Internacionalmente, o FM é fornecido em um inalador de pó seco que permite sua administração em múltiplas doses. Para se obter uma preparação com melhor relação custo-eficácia, foram desenvolvidas no Brasil formulações de FM em cápsulas de pó seco para serem administradas em dose única. O presente estudo teve como objetivo avaliar a eficácia e a segurança dos dois inaladores usados para a administração de FM em pacientes asmáticos. MÉTODOS: Estudo clínico, aberto, comparativo, paralelo e multicêntrico com 74 adultos portadores de asma persistente e moderada, randomizados em dois grupos para receber FM em uma dose de aproximadamente 400 µg, fornecida por um inalador de dose múltipla ou pelo novo inalador de dose única, uma vez ao dia durante 60 dias. RESULTADOS: Não foram observadas diferenças significantes entre os dois grupos estudados nos desfechos primários (VEF1 e frequência do uso de medicação de resgate) ou nos desfechos secundários (PFE matinal, tolerabilidade e segurança, essa última avaliada pelo estudo do eixo hipotálamo-hipófise-adrenal). CONCLUSÕES: A administração de FM com o novo inalador de dose única desenvolvido no Brasil tem eficácia e segurança comparáveis à administração com o inalador de dose múltipla no tratamento de pacientes asmáticos.

OBJECTIVE: Mometasone furoate (MF) is a new, potent synthetic inhaled corticosteroid. Worldwide, MF is administered via a dry-powder inhaler that contains multiple doses. As a preparation that would be more cost-effective, single-dose MF capsules were developed in Brazil. The objective of the present study was to evaluate the efficacy and safety of the two inhalers for MF administration in patients with asthma. METHODS: A randomized, multicenter, open-label, parallel-group clinical trial involving 74 adult patients with moderate, persistent asthma who were randomized into two groups to receive approximately 400 µg of MF once a day for 60 days, either via the multiple-dose inhaler or via the newly developed single-dose inhaler. RESULTS: No significant differences were observed between the two groups regarding the primary endpoints (FEV1 and rescue medication use) or the secondary endpoints (morning PEF, tolerability, and safety, the last as assessed on the basis of hypothalamic-pituitary-adrenal axis function). CONCLUSIONS: The use of the single-dose inhaler developed in Brazil for MF administration is as effective and safe as is that of a standard inhaler in the treatment of patients with asthma.

Study on Cough-preventing and Asthma-relieving Effect of Shaonianhong Fanxing Anti-asthmatic Syrup / 国际中医中药杂志

Objective To observe the cough-preventing and asthma-relieving effect of Shaonianhong Fanxing Anti-asthmatic Syrup(SFAS).Methods The cough-preventing effect was observed in the experiment of cough induced by ammonia in mice;the phlegm-removing effect was observed in the experiment of eliminating phlegm with phenol red in mice;and the and-asthmatic effect was observed in the experiments of histamine inducing asthma and isolated tracheal smooth muscles of cavies.Results SFAS Can prolong the coughing time induced by ammomia,enhance the excretion of sputum,extend the delitescence period of ohosphoric acid hismmine induced asthma and restrain the contraction of isolated tracheal smooth muscles.Conclusion SFAS has phlegm-removing,cough-preventing and anti-asthmatic effects.

Effect observation of 115 children with asthma treated with salmeterol/flutieasone propionate inhalation / 中国基层医药

Objective To observe the effect of salmeterol/flutieasone propionate on children with asthma. Methods Salmeterol/flutieasone propionate inhalation of different dosages were given according to different illness condition of asthma. Investigate the effects of 180 days inhalation of SM/FP among children. Results After 180 days' treatment, the PEFam and PEFpm of those children of asthma were significantly increased. The lung function has a perceptible improvement. In addition, the daytime and noctural symptom scores and asthma symptom were improved. Moreover, the shore-acting β2 agonist was used with decreasing frequency. The effects of SM/FP inhalation were marvelous after 1 week of treatment and should make a long persisting time alter six months of treatment. Conclusion SM/FP is an effective medicine for children with asthma and should be make more widespread.

Zhichuan decoction with glucocorticoid in treatment of bronchial asthma / 中华全科医师杂志

Three hundred and ninety five patients with bronchial asthma were randomly divided into 4 groups:patients in group A received inhaled beclomethasone dipropionate(BDP)100μg and Zhichuan decoction;patients in group B were given inhaled BDP 200μg;patients in group C took Zhichuan decoction only;patients in group D were given inhaled BDP 100 μg.Methacholine airway reactivity,pulmonary ventilation function,serum acidophilia cationic protein and symptom score were determined before and after treatment.All above indicators were significantly improved in groups A and B,which suggests that Zhichuan decoction could reduce hormone dosage in control of airway chronic inflammation,reduction of airway reactivity and improvement of pulmonary ventilation function of patients with bronchial asthma.