Asthma symptoms improvement in moderate persistent asthma patients with gastroesophageal reflux disease (GERD): the role of proton-pump inhibitor.

This study aimed to evaluate effect of proton pump inhibitor (esomeprazole) on asthma symptoms, use of inhaled bronchodilator and peak expiratory flow rate (PEFR) in moderate persistent asthma with gastroesofageal refluks disease (GERD). This randomized single blind, controlled clinical trial study was conducted at Persahabatan Hospital, Jakarta from July 2004 until October 2005. Samples were moderate persistent asthma patients with GERD. GERD is diagnosed GERD symptoms and proof of oesophagitis from endoscopy and or histapatologic examination from oesophagus biopsy. Phase 1:2 week run-in period patient received inhaled budesonide 2x200 ug/day. Phase 2: patient randomised to receive inhaled budesonide 2 x 400 ug/day with esomeprazole 40 mg/day or without esomeprazole (control group) for 8 weeks. Phase 3: 4 week wash out period, patient receive inhaled budesonide 2 x 200 ug/day. Diary cards were assessed at run-in periode, after treatment 4 weeks, 8 weeks and wash out. There were 32 patients (23 female and 9 male) completed the study. Mean total asthma symptoms score daily were significantly decreased on esomeprazole vs without esomeprazole after 8 weeks (-2.29 vs -0.90; p < 0.05). Mean use of inhaled bronchodilator was significantly decreased on esomeprazole vs without esomeprazole after 8 weeks (-1.09 vs -0.42; p < 0.05). Morning and evening PEFR improved higher on esomeprazole than without esomeprazol but were not significantly difference. In conclusion, administration esomeprazole 40 mg daily improved asthma symptoms and lower the use of inhaled bronchodilator in moderate persistent asthma patients with GERD.

Effectiveness of intravenous clarithromycin followed by oral clarithromycin in acute exacerbation of asthma with respiratory tract infection.

In addition to its antimicrobial activity, macrolides have an immunomodulatory effect that may be beneficial to patients with asthma. This quasi-experimental study aimed to determine the effect of intravenous clarithromycin followed by oral administration in 37 patients with acute exacerbations asthma caused by respiratory tract infection during January - December 2005. Patients with mild to moderate exacerbations of asthma with respiratory tract infection meeting the inclusion and exclusion criteria were given intravenous clarithromycin 2 x 500 mg/day for not more than 5 days and followed by oral clarithromycin 2 x 500 mg/day for 7 days. Outcome variables were improvement of clinical symptoms according to the asthma exacerbation score and peak expiratory flow rate (PEFR). After 10 days, treatment resulted significant improvement in total asthma exacerbation score and morning PEFR in 35 patients enrolled this project. Based on clinical improvement and laboratory findings, the number of days required for intravenous clarithromycin was less then 3 days for 21 subjects, 3-5 days in 14 subjects. The most common causative pathogens were S. β-haemolyticus and Streptococcus sp. It was concluded that clarithromycin improved clinical symptoms and PEFR in exacerbation of asthma caused by respiratory tract infection.

The benefit of pulmonary rehabilitation against quality of life alteration and functional capacity of chronic obstructive pulmonary disease (COPD) patient assessed using St George’s respiratory questionnaire (SGRQ) and 6 minutes walking distance test (6MWD).

Patients with chronic obstructive pulmonary disease (COPD) have been shown to be benefit from pulmonary rehabilitation programs. We assessed an entirely outpatient-based program of pulmonary rehabilitation in patients with COPD, using the St George’s Respiratory Questionnaire (SGRQ) and six minutes walking distance test (6MWD) (which measures health-related quality of life and functional exercise tolerance) as the primary outcome measure. We undertook a randomized, opened, prospective, parallel-group controlled study of outpatient rehabilitation program in 56 patients with COPD (52 men and 4 women). The active group (n=27) took part in a 6-weeks program of education and exercise. The control group (n=29) were reviewed routinely as medical outpatients. The SGRQ and 6MWD were administered at study entry and after 6 weeks. Outcome with SGRQ and 6MWD before and after therapy was performed. Decrease score SGRQ and increase 6MWD in both groups of study, it was analyzed by statistic study and in active group the decrease of SGRQ and the increase of 6MWD was statistically significant. In conclusion 6-weeks outpatient-based program significantly improved quality of life and functional capacity in mild-to-moderate COPD patient.