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.

Combining montelukast with exercise in the clinical treatment of children with mild asthma / 中华物理医学与康复杂志

Objective:To observe any effect of combining the anti-asthmatic drug montelukast with exercise therapy on the pulmonary function, clinical symptoms, functional exercise capacity and quality of life of children with asthma.Methods:Seventy children (between 7 and 14 years old) with mild asthma were randomly divided into an observation group ( n=35) and a control group ( n=35). Both groups were given the anti-asthmatic drug montelukast, while the observation group was additionally provided with breathing training and aerobic pedaling training. Before and after the intervention, both groups′ forced expiratory volume in 1 second, forced vital capacity and 6min walking test (6MWT) distance were tested. Their asthma symptoms were scored using the pediatric asthma quality of life questionnaire (PAQLQ). Any adverse events during the study were recorded. Results:After 8 weeks the observation group′s average 6MWT distance, total PAQLQ score, as well as the scores on each domain of the PAQLQ (symptoms, activity restriction, emotions) had improved significantly. The observation group′s average heart rate and perceived exertion rating after the 6MWT had also improved significantly, as had their average daytime and nighttime asthma symptom scores. The control group also demonstrated significant improvement in their PAQLQ symptom scores and their daytime and nighttime asthma symptom scores after the intervention. There was no significant difference in the incidence of adverse reactions between the two groups.Conclusions:Supplementing montelukast with exercise is effective and feasible in the treatment of children with mild asthma, with good safety and tolerance. Such combined therapy is worthy of further research and promotion.

People with asthma: care during the COVID-19 pandemic and the importance of regular exercise for the immune system

Abstract Aim: To show the possible immunologic pathways of protection for asthmatics against infection of Covid-19 through the capacity of recognition and cytotoxicity to eliminate pathogens improved by regular exercise aerobic. Methods: The bibliographic search was conducted on the following databases: Pubmed/Medline, Scielo, and Scholar Google from 2020 to 2021. The following keywords and Boolean operators were used: asthma, aerobic training (AT), immune system, and Covid-19. Results: After the screening, 349 were initially found, after evaluation only 20 studies had all criteria. Twelve studies showed that AT induces changes in the immune system with a reduction of inflammation. In complement, the literature showed an innate pathway that improves immune function against COVID-19 by reducing angiotensin-converting enzyme 2 (ACE2) in the lung, which seems to hinder the multiplication of the COVID-19 virus in the lung. Apparently, asthmatics patients are less susceptible to respiratory infection caused by COVID-19 because they have low levels of ACE2. Furthermore, trained asthmatics showed a lower risk of infection for SARS-CoV-2. Conclusion: The findings reported that asthmatics people can benefit from AT, and these individuals seem not to be a risk group for covid-19 because they have low levels of ACE2 protein. Taken together, this review reinforces the importance of asthmatic patients be physically active throughout their lifetime, but specially during the pandemic to prevent contamination by SARS-CoV-2.

Therapeutic Effect and Antioxidant Mechanism of Xiaochuanning Granule on Psychological Stress Related Asthma in Rats / 中国实验方剂学杂志

ObjectiveTo observe the therapeutic effect and antioxidant mechanism of Xiaochuanning granule on psychological stress-related asthma in rats. MethodThe 6-week-old male SD rats were randomly divided into the normal group， asthma group， stress group， stress-related asthma group， western medicine group （atomization of budesonide suspension） and traditional Chinese medicine （TCM） group （Xiaochuanning granule 2.48 g·kg-1）. The asthma model was established during 28 days by intraperitoneal injection of 10% ovalbumin（OVA）on the 1st and 8th days and inhaling of vapourized 1% OVA started at the 15th day. Stress group， stress-related asthma group， western medicine group and TCM group were given restraint stimulation during the 28 days to establish the psychological stress-related asthma model. Rats in each group were administered with corresponding drug for 14 days from the 15th day. The sucrose preference test and open field test were performed at the 15th and 28th days. At the end of experiment， the body weight， serum interleukin-4 （IL-4）， interleukin-5 （IL-5） and interleukin-13 （IL-13） levels， as well as the levels of malondialdehyde （MDA）， superoxide dismutase （SOD） and glutathione （GSH） in lung tissues were detected by assay kits. Hematoxylin-eosin（HE） staining was conducted to observe the pathological changes in lung tissues. Meanwhile， Western blot was used to detect the protein expression of nuclear factor erythroid 2-related factor 2 （Nrf2） and hemeoxygenase-1 （HO-1） in lung tissues. ResultCompared with the stress-related asthma group， the body weight， sugar water consumption rate and open field distance in the TCM group were significantly increased （P<0.05）， and the serum IL-4， IL-5， IL-13 levels were significantly decreased （P<0.05）， the levels of SOD and GSH in lung tissues increased significantly （P<0.05）， while the level of MDA decreased significantly （P<0.05）. HE staining showed that the bronchial mucosal injury， inflammatory cell infiltration， gland hyperplasia， epithelial degeneration and necrosis were significantly ameliorated in the TCM group than in the stress-related asthma group. The expression of Nrf2 and HO-1 protein in lung tissues also increased significantly （P<0.05）. ConclusionXiaochuanning Granule can regulate the psychological stress state of stress-related asthmatic rats， alleviate airway inflammatory reaction， and suppress oxidation， which is related to its up-regulation of the Nrf2/HO-1 protein expression.

Effects of budesonide on proliferation and apoptosis of airway smooth muscle cells in asthmatic rats / 解剖学报

Objective To investigate the effect of budesonide ( BUD) inhalation on the proliferation and apoptosis of airway smooth muscle cells ( ASMCs) in asthmatic rats and its molecular biological mechanism. Methods Totally 40 SD rats were randomly divided into control group, asthma model group, low (0. 25 mg/kg) and high (2 mg/kg) BUD group. The rat asthma model was induced by ovalbumin (VOA) combined with aluminium hydroxide Gel sensitization stimulation. After sensitization, the intervention group inhaled different doses of BUD before stimulation. The related parameters of lung tissue and airway were measured and calculated by medical image analysis system, immunofluorescence was used to detect the expression of type I collagen ( Col I ) and Col III in rat airway smooth muscle ( ASM ), and the protein expressions of Bcl-2, Bax, Caspase-3, phosphorylated ERK 1 and 2(p-ERK 1 / 2), p-p38 MAPK were detected by Western blotting. The proliferation activity of ASMCs was detected by MTT method, and the apoptosis rate of ASMCs was detected by flow cytometry. Results Compared with the control group, airway remodeling occurred in the asthmatic model group, and the airway wall thickness ( WAt/Pbm ), inner wall thickness ( WAi/Pbm ) and smooth muscle thickness ( WAm/Pbm ) increased, compared with the model group, the airway remodeling was inhibited in BUD intervention group, and the tracheal WAt/Pbm, WAi/Pbm and WAm/Pbm decreased in bud treatment group. BUD could decrease the proliferation activity of ASMCs, increase the apoptosis rate of ASMCs, inhibit the expression of Col I and Col III, deregulate the expression of Bcl-2, upregulate the expression of Bax and Caspase-3 ( all P<0. 05), and inhibit the activity of ERK 1/2 and p38 MAPK signal pathway. Conclusion BUD can inhibit the proliferation and the promote apoptosis of ASMCs in asthmatic rats, which may be related to the inhibition of ERK 1/2 and p38 MAPK signal pathways.

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.

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.

Serum Periostin Level in Asthmatic Children with Exercise Induced Bronchospasm

Background:There are few biomarkers that can be easily accessed in clinical settings and may reflect refractory Th2-eosinophlic inflammation and remodeling of the asthmatic airways. Serum periostin may be one such biomarker to aid our understanding of the patho-bio-physiology of asthma and exercise induced asthma. The aim of the study is to explore the relationship between serum periostin level and exercise induced bronchoconstriction in asthmatic children.Materials and Methods: This cross-sectional study was carried out on (90) children both sexes aged from 6 to 15 years including, (60) children with bronchial asthma and (30) children were enrolled as control group in the period from January 2018 to January 2019. Patients were randomly classified into two groups: I) Patient group: divided into 2 groups according to standardized treadmill exercise challenge test: Group A: (30) asthmatic children with positive test. Group B: (30) asthmatic children with negative test. II-Control group: (30) children apparently healthy with no personal or family history of asthma. All children were subjected to the following Investigations: Chest x-ray, pulmonary functions tests (FEV1& PEFR) except controls, Laboratory investigations as CBC and Serum periostin level Results:The mean values of both the percentage of PEFR and FEV1 after exercise in group A were significantly lower than those in group B and the percentage of PEFR and FEV1after exercise in each group were significantly lower than the percentage before exercise in the same group. The mean value of eosinophilic count in group A was significantly higher than (group B and control group) and the mean value of eosinophilic countin group B was significantly higher than control group. The mean value of serum level of periostin in group A was significantly higher than (group B and control group), however, there was no significant difference between group B and control group as regard to serum level of periostin.Chest tightness, cough and wheezes after exercise and eosinophilic count in patients with high serum periostin level were significantly higher than patients with low serum periostin level, and both PEFR and FEV1after exercise in patients with high serum periostin level were significantly lower than patients with low serum periostin level. Also the normal serum periostin levels vary among different age groups.Conclusion:Serum periostin level can be considered as a useful biomarker for diagnosis of Exercise induced bronchospasm (EIB) in asthmatic children especially when lung function test cannot be done However, cautious is required in evaluating serum periostin levels in children because it varies with age.

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.

Meta-analysis of the Effectiveness of Inhaled Corticosteroids Combined with Tiotropium Bromide versus Inhaled Corticosteroids Alone in the Treatment of Asthmatic-COPD Overlap Syndrome / 中国药房

OBJECTIVE：To systematically e valuate the effectiveness of inhaled corticosteroids combined with tiotropium bromide versus inhaled corticosteroids alone in the treatment of asthmatic-COPD overlap syndrome ，and to provide evidence-based reference for clinical use. METHODS ：Retrieved from PubMed ，Web of Science ，Embase，Cochrane Library ，CBM，CNKI， VIP，Wanfang database ，during the establishment of the database to Nov. 2019，randomized controlled trials （RCT）about inhaled corticosteroids combined with tiotropium bromide （trial group ）versus inhaled corticosteroids alone （control group ）in the treatment of asthmatic-COPD overlap syndrome were collected. After data extraction of included literatures met inclusion criteria ，quality evaluation with modified Jadad scale ，Meta-analysis was performed for response rate ，forced expiratory volume in the first second （FEV1），forced vital capacity （FVC），FEV1/FVC，inspiratory fraction （IC/TLC），residual to total ratio （RV/TLC），asthma symptom（ACT）score，chronic obstructive pulmonary symptom （CAT）score，the times of acute exacerbations by Rev Man 5.3.0 software. RESULTS ：A total of 25 RCTs were included ，involving 2 828 patients. The results of Meta-analysis showed that the response rate [RR ＝1.16，95％CI（1.10，1.22），P＜0.001]，FEV1[MD＝0.44，95％CI（0.35，0.54），P＜0.001]，FVC [MD ＝0.70， 95％CI（0.46，0.95），P＜0.001]，FEV1/FVC [MD= 8.79，95％CI（6.22，11.37），P＜0.001]，IC/TLC [MD ＝4.93，95％CI（3.01， 6.85），P＜0.001]，RV/TLC [MD ＝－9.22，95％CI（－9.79，－8.66），P＜0.001]，ACT score [MD ＝5.38，95％CI（4.30，6.47）， P＜0.001]，CAT score [MD ＝－3.67，95％CI（－4.89，－2.45），P＜0.001] and the times of acute exacerbations [MD ＝－1.49， 95％CI（－2.82，－0.17），P＝0.03] in trial group were significantly higher than control group ，with statistical significance. CONCLUSIONS：Compared with inhaled corticosteroids alone ，inhaled hormone combined with tiotropium bromide can improve the response rate and pulmonary function ，but increase the times of acute exacerbation of patients with asthmatic-COPD overlap syndrome.

Effect of moxibustion on clinical symptoms, peripheral inflammatory indexes and T lymphocyte subsets in COVID-19 patients / 中国针灸

OBJECTIVE@#To explore the therapeutic effect and the mechanism of the adjuvant treatment with moxibustion on coronavirus disease 2019 (COVID-19).@*METHODS@#A total of 95 patients with COVID-19 were randomly divided into a moxibustion group (45 cases) and a basic treatment group (50 cases). The routine treatment of western medicine was applied in the patients of both groups. In the moxibustion group, on the base of the treatment of western medicine, moxibustion was applied to Dazhui (GV 14), Feishu (BL 13), Qihai (CV 6) and Zusanli (ST 36), once daily and consecutively for 14 days. At the end of treatment courses, clinical symptom scores for cough, asthmatic breathing, chest oppression and short breath, as well as their remission rates were compared between the two groups before and after treatment. Before and after treatment, the white blood cell (WBC) count, the levels of c-reactive protein (CRP) and interleukin-6 (IL-6) and the absolute number of T lymphocyte subsets, i.e. , and of the peripheral blood were compared in the patients between the two groups. The principal component analysis was adopted to analyze the common data extracted from the above 10 clinical indexes variables and comprehensively evaluate the differences in the therapeutic effect of two regimens.@*RESULTS@#The clinical symptom scores were all decreased after treatment in both of the moxibustion group and the basic treatment group as compared with those before treatment (@*CONCLUSION@#On the base of the routine treatment with western medicine, moxibustion therapy supplemented relieves the clinical symptoms, reduces the levels of inflammatory indexes, i.e. IL-6 and CRP as well as improves the absolute number of peripheral T lymphocyte subsets. The clinical therapeutic effect of such regimen with moxibustion supplemented is significantly better than the simple routine treatment of western medicine.

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.

Acercamiento a la tos crónica en adultos / An approach to chronic cough

RESUMEN La tos crónica en los adultos puede ser causada por muchas causas, existen cuatro principales: el síndrome de tos de la vía aérea superior, enfermedad por reflujo gastroesofágico, reflujo laringofaríngeo, asma bronquial, y bronquitis eosinofílica no asmática. Todos los pacientes deben evaluarse clínicamente con espirometria, y comenzar con tratamiento empírico. Otras causas potenciales incluyen el uso de inhibidores de la enzima convertidora de la angiotensina, cambios medioambientales, uso del tabaco, enfermedad pulmonar obstructiva crónica, y la apnea obstructiva del sueño. La radiografía del tórax puede orientar hacia causas infecciosas, inflamatorias, y malignas. Los pacientes con tos crónica refractaria pueden remitirse a la consulta especializada de un neumólogo u otorrinolaringólogo, además de un ensayo terapéutico con gabapentin, pregabalin, y psicoterapia.

ABSTRACT Although chronic cough in adults can be caused by many etiologies, four conditions account for most cases: upper airway cough syndrome, gastro-esophageal reflux disease, also known as laryngo- pharyngeal reflux disease, bronchial asthma, and non-asthmatic eosinophilic bronchitis. All patients should be evaluated clinically with spirometry, and empiric treatment should be initiated. Other potential causes include angiotensin-converting enzyme inhibitor use, environmental triggers, tobacco use, chronic obstructive pulmonary disease, and obstructive sleep apnea. Chest radiography can rule out concerning infectious, inflammatory, and malignant thoracic conditions. Patients with refractory chronic cough should be referred to a pulmonologist or otolaryngologist in addition to a therapeutic trial of gabapentin, pregabalin, and psychotherapy.

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.

Estudio del estado clínico-funcional en pacientes asmáticos / Study of the clinical and functional conditions of asthmatic patients

Introducción: Las principales alteraciones funcionales del asma bronquial son la obstrucción del flujo aéreo, su reversibilidad, variabilidad y la hiperrespuesta bronquial. Objetivo: Determinar el estado clínico-funcional en pacientes con asma que asisten por primera vez a consulta de neumología. Material y Métodos: Se realizó un estudio descriptivo transversal con 110 pacientes que asistieron por primera vez y fueron atendidos por asma en la consulta externa del Hospital Neumológico Benéfico Jurídico (HNBJ) en el año 2014-2015, se comprobó por la clínica y la espirometría la severidad de la enfermedad. Entre las variables de estudio están: edad, sexo, antecedentes patológicos familiares de asma o alergia, índice de masa corporal, gravedad o severidad del asma. Resultados: Predominó el asma de mayor gravedad entre los pacientes comprendidos entre los 40-59 años, con riesgo 4,4 veces superior en mayores de 40 años. El sexo femenino presentó 2,1 veces más riesgo. El 75,5 por ciento de pacientes tenía antecedentes patológicos familiares (APF) de asma o alergia y riesgo 3,4 veces superior de mayor gravedad. Más de la mitad presentó antecedentes patológicos personales (APP) de otras enfermedades y mayor proporción de asma de mayor gravedad. El 53.6 por ciento presentó sobrepeso u obesidad y 4,1 veces más riesgo de mayor gravedad. La mayoría de los pacientes no presentó adicción tabáquica. Conclusiones: Los pacientes mayores de 40 años, sexo femenino y con APF de asma o alergia, presentan asma de mayor gravedad. La obesidad es frecuente en pacientes asmáticos y constituye un riesgo importante de padecer asma más grave. Existe bajo porcentaje de asmáticos fumadores aunque esta condición favorece a padecer un asma más grave(AU)

Introduction: The main functional alterations in bronchial asthma are the obstruction of the air flow, its reversibility, variability, and bronchial hyper- responsiveness. Objective: To determine the clinical and functional conditions in patients with asthma who go to the outpatient pneumology service for the first time. Material and Methods: A cross-sectional descriptive study was conducted in 110 patients with asthma that were treated for the first time in the outpatient department of the Pneumology Service at the "Benéfico Jurídico" Teaching Hospital in Havana from June 1st,2014 to June 31st,2015. The severity of asthma was confirmed by clinical diagnosis and spirometric tests. The variables consisted of age, sex, family pathological antecedents of asthma or allergy, body mass index, and seriousness or severity of asthma. Results: The most serious asthma prevailed in patients aged 40 to 59 years, and the patients 40 years old and older presented 4.4 times higher risks. The female sex exhibited 2.1 times higher risks. 75.5 percent of patients with family pathological antecedents (FPA) of asthma or allergy showed 3.4 times higher risk levels for more serious conditions. More than half of patients presented personal pathological antecedents (PPA) of other diseases and a more serious asthma. 53.6 percent were overweight or obese who were 4.1 times at higher risks of suffering from more serious conditions. Most patients did not report smoking addiction. Conclusions: Asthmatic patients over 40 years showed a more serious asthma during their first visit to the outpatient pneumology service, and the female sex prevailed. Asthma or allergy, FPA and PPA were the risk factors for suffering from both asthma and more serious conditions. There is a low percentage of smoking asthmatics although this condition provokes more serious symptoms(AU)

Equivalencia terapéutica y tiempo de administración de los esteroides sistémicos en la exacerbación del asma / Therapeutic equivalence and time of administration of systemic steroids in the exacerbation of asthma

Introduction. The early use of systemic steroids has been associated with a decrease in the rate of hospitalizations in pediatric patients with asthma exacerbation. The objective was to compare the equivalence of two forms of administration, as well as to determine the optimal time for its indication. Material and methods: Observational, randomized, open study of equivalence, comparing oral versus parenteral steroids. The primary outcomes were changes in the severity scale and the rate of hospitalizations. The secondary result was the time until improvement was reached. ANOVA and Chi square tests were used to determine the statistical significance; it was considered significant when p <0,05. Results: In both groups both the severity scale and the hospitalization rate were considerably modified with early administration. At 30 minutes after using hydrocortisone (p<0,05). The greatest variation in the severity scale was observed. Conclusion: both routes of administration proved to be effective and should be used early.

Introducción: El uso precoz de los esteroides sistémicos ha sido asociado con disminución de la tasa de hospitalizaciones en los pacientes pediátricos con exacerbación asmática. El objetivo de este estudio es comparar la equivalencia de dos formas de administración, así como determinar el tiempo óptimo para su indicación. Material y métodos: Estudio observacional, aleatorizado, abierto de equivalencia, comparando esteroides por via oral contra parenteral. Los outcomes primarios fueron los cambios en la escala de gravedad y la tasa de hospitalizaciones y el secundario fue el tiempo en alcanzar la mejoría. Se utilizó ANOVA, prueba Chi cuadrado para determinar las significaciones estadísticas, se consideró significancia p<0,05. Resultados: En ambos grupos tanto la escala de gravedad como la tasa de mortalidad se modificaron de forma importante con la administración precoz. A los 30 minutos de administrar hidrocortisona (p<0,05) se observó la mayor variación en la escala de gravedad. Conclusión: ambas vías de administración demostraron ser efectivas y deben ser usadas de forma precoz.

Understanding causes of Sub-acute cough in community - A clinico-pathological research

Cough is one of the most common complaints of patients seeking medical attention. A number of patients attend our OPD for complaint of Sub acute cough lasting 3-8 weeks. Majority of such cough are due to Ear, Nose and Throat pathologies. This study aims to evaluate the Otorhinolaryngology causes of Cough in these patients. Inflammation of Sinuses (Acute/Sub-acute) and Gastro-oesophageal reflux disorder (Reflux) form a bulk of cases presenting with Sub-acute cough in community. Clinicians need to maintain a high degree of suspicion for these two most common entities in cough patients not responding to conventional line of management.

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.