Eficacia del indacaterol como broncodilatador en un grupo de pacientes asmáticos / Effectiveness of Indacaterol as bronchodilator in a group of asthmatic patients

La búsqueda de nuevas opciones terapéuticas para tratar las enfermedades obstructivas bronquiales representa un reto permanente y los broncodilatadores constituyen unos de los fármacos más empleados para la atención de estos pacientes. En los últimos años han ido ganando fuerza los broncodilatadores de acción prolongada, pero el mayor efecto alcanzado era 12 h, superado por un broncodilatador nuevo salido al mercado en el año 2011, denominado indacaterol, del grupo de los beta agonistas, se diferencia de estos por la duración de su efecto que llega a alcanzar 24 h. Se realizó un estudio prospectivo, a ciego, tipo ensayo clínico, aleatorizado, con 90 pacientes asmáticos, entre 18 y 59 años de edad, que acudieron al departamento de pruebas funcionales respiratorias para estudiarles la función pulmonar. Todos recibieron de manera aleatoria indacaterol, salbutamol o placebo, y se les repitió la espirometría a los 15 min y a las 24 h de aplicado cada medicamento. Se evidenció que la respuesta broncodilatadora obtenida en los que usaron indacaterol, a las 24 h, fue muy superior a la respuesta de los que usaron otros fármacos. Se muestra además un discreto aumento de la frecuencia cardiaca y de la tensión arterial en los que usaron indacaterol y salbutamol, principalmente a los 15 min de empleados dichos medicamentos, pero dentro de los límites considerados como normales. No se evidenciaron efectos adversos

The search for new therapeutic options to treat bronchial obstructive diseases represents a permanent challenge and bronchodilators constitute one of the most used drugs in the treatment of these patients. In recent years, long acting bronchodilators have grown importance, but the greatest effect has been 12 h, superseded by a new bronchodilator that came on to the market in the year 2011 named Indacaterol, which belongs to the group of ß2-agonists and differentiates from the rest for its effect on the duration which lasts 24 hours. A randomized, essay-type, blind, prospective study was performed in 90 asthmatic patients, ranging from 18 to 59 years of age that presented to the department of respiratory functional tests for a study of their pulmonary functions. All the patients randomly received Indacaterol, Salbutamol or Placebo and spirometry was repeated 15 minutes and 24 hours after treatment. It was evidenced that the bronchodilator response obtained at the 24 hours in those patients that used Indacaterol, was higher than the response in the patients that used other drugs. The patients that used Indacterol and Salbutamol also showed a discrete increase of the cardiac frequency and blood pressure, mainly 15 minutes after receiving such drugs, but this increase is considered within the normal limits. Adverse effects were not evidenced

Benign superior mediastinal syndrome due to intrathoracic tuberculosis in a child-association with endobronchial tuberculosis.

A 5-year-old boy presented with fever, cough, breathlessness and facial swelling. He was pale with distended veins over neck and chest, cervical and axillary lymphadenopathy and bilateral expiratory wheeze. Chest radiographs showed superior mediastinal widening. A computed tomography scan of the chest revealed mediastinal lymph nodes compressing superior vena cava and trachea. Bronchoscopy revealed nodular lesions in trachea and bronchi and compression of trachea. Broncho-alveolar lavage revealed acid fast bacilli. Diagnosis of superior mediastinal syndrome (SMS) secondary to tuberculosis was made and child was treated with antitubercular treatment along with oral prednisolone with good response.

Extranodal Marginal Zone Lymphoma Occurring along the Trachea and Central Airway

Extranodal marginal zone lymphoma is a low-grade B cell lymphoma that presents with an indolent clinicopathologic nature. Although this tumor can occur in various sites, including the gastrointestinal tract and lungs, it develops and spreads extremely rarely along the trachea and central airway. We report a case of extranodal lymphoma of mucosa-associated lymphoid tissue with tracheobronchial involvement. An 83-year-old woman presented with a cough and dyspnea. Bronchoscopic evaluation confirmed diffuse, multiple nodular lesions in both the trachea and large bronchi, and she was diagnosed with an extranodal marginal zone lymphoma of the tracheobronchial tree. After systemic chemotherapy, she survived for more than 18 months.

Montelukast in pediatric asthma management.

Leukotriene modifiers (receptor antagonist and biosynthesis inhibitor) represent the first mediator specific therapeutic option for asthma. Montelukast, a leukotriene receptor antagonist is the only such agent approved for use in pediatric patients. Montelukast modifies action of leukotrienes, which are the most potent bronchoconstrictors, by blocking Cysteinyl leukotriene receptors. Systemic drug like mountelukast can reach lower airways and improves the peripheral functions which play a crucial role in the evolution of asthma. Review of existing literature showed that montelukast compared to placebo has proven clinical efficacy in better control of day time asthma symptoms, percentage of symptom free days, need for rescue drugs and improvement in FEV 1. Studies also demonstrated improvement in airway inflammation as indicated by reduction in fractional exhaled nitric oxide, a marker of inflammation. Studies comparing low dose inhaled corticosteroids (ICS) with montelukast are limited in children and conclude that it is not superior to ICS. For moderate to severe persistent asthma, montelukast has been compared with long acting beta agonists (LABA) as an add-on therapy to ICS, montelukast was less efficacious and less cost-effective. It has beneficial effects in exercise induced asthma and aspirin-sensitive asthma. Montelukast has onset of action within one hour. Patient satisfaction and compliance was better with montelukast than inhaled anti-inflammatory agents due to oral, once a day administration. The recommended doses of montelukast in asthma are- children 1-5 years: 4 mg chewable tablet, children 6-14 years: 5mg chewable tablet, ADULTS: 10mg tablet; administered once daily. The drug is well tolerated. Based on the presently available data montelukast may be an alternative treatment for mild persistent asthma as monotherapy where ICS cannot be administered. It is also an alternative to LABA as an add-on therapy to ICS for moderate to severe persistent asthma. The other indications for use of montelukast include: allergic rhinitis, exercise induced bronchoconstriction and aspirin-induced asthma.

A Case of Endobronchial Actinomycosis

Actinomycosis is an infectious disease caused by certain Actinomyces species. Actinomyces are Gram-positive, non-spore forming organisms characterized by obligate or facultative anaerobic rods that normally inhabit anaerobic niches of the human oral cavity. Cervicofacial, abdominal, pelvic and thoracic infections of Actinomyces are not uncommon, but endobronchial actinomycosis is rarely reported. Endobronchial actinomycosis can be misdiagnosed as unresolving pneumonia, endobronchial lipoma or malignancies. Endobronchial actinomycosis should be included in the differential diagnosis of any endobronchial mass. We report a case of a 43-year-old man who presented with a productive cough and pulmonary consolidation at the right lower lobe on chest radiograph. Fiberoptic bronchoscopy revealed obstruction of the right superior segment of the lower bronchus with an exophytic endobronchial mass. Endobronchial actinomycosis was confirmed by demonstration of sulfur granules in the bronchoscopic biopsy of the mass. Intravenous administration of penicillin G followed by oral amoxacillin/clavulanic acid therapy for 3 months resulted in improving symptoms. Infiltrative consolidation on the chest X-ray was markedly decreased.

Selective histamine blockade in asthma: the effect of astemizole on resting bronchial tone and exercise induced broncho-constriction

The orally active histamine HI-blocker astemizole was investigated for its effect on resting bronchial tone and exercise-induced broncho-constriction in 20 asthmatic patients by a double-blind placebo-controlled study. Astemizole produced acute bronchodilation with an average 16% improvement in FEVl by 3 hours. After exercise challenge, astemizole partially inhibited exercise induced bronchoconstriction. These results suggest that asthmatic patients have augmented background resting histamine tone which is reversible by Hl blockade

Estenose bronquica de etiologia tuberculosa: patogenia e tratamento / Bronchial stenosis of tuberculous etiology: pathogenesis and treatment

Descrevemos quatro casos de estenose bronquica, uma complicacao rara de tuberculose pulmonar. No primeiro caso, uma mulher de 18 anos, sem tratamento previo para tuberculose, apresentou estenose bronquica como resultado da cicatrizacao de complexo primario. Nao havia lesao de parenquima ao raio X. Nos outros tres pacientes a estenose bronquica foi atribuida a tuberculose ativa com pesquisa positiva para bacilo alcool-acido resistente em escarro. Estes receberam tratamento para tuberculose. Em um deles isto foi suficiente para a resolucao da estenose, mas nos outros dois pacientes ocorreu estenose bronquica devido a fibrose.

Nebulizaciones de fenoterol-ipratropio en lactantes con síndrome bronquial obstructivo / Fenoterol-ipratropium nebulization in infants with acute obstructive bronchial syndrome

Se realizó estudio prospectivo doble ciego en 120 lactantes con síndrome bronquial obstructivo agudo. La mitad de ellos fue tratada con nebulizaciones de fenoterol-ipratropio en 3 dosis diferentes y los restantes con solución de cloruro de sodio 9%. Su estudio demostró una diferencia estadísticamente significativa (p < 0,001) a favor de los grupos que recibieron fenoterol-ipratropio al evaluarlos mediante puntuación de la severidad de su obstrucción, días de hospitalización y necesidad de recurrir a otro (s) broncodilatador (es). No se encontraron diferencias significativas (p > 0,05) al comparar entre ellos los grupos que recibieron fenoterol-ipratropio en dosis diferentes. La combinación fenoterol-ipratropio presenta un efecto broncodilatador muy favorable en este grupo de pacientes y constituye una posibilidad terapéutica efectiva en lactantes afectados por síntomas bronquiales obstructivos agudos

Eficácia clínica do ambroxol no tratamento da estase brônquica: ensaio clínico em 120 pacientes com dois diferentes esquemas terapêuticos / Clinical efficacy of ambroxol in the treatment of bronchic stasis: clinical assay in 120 patients with 2 different therapeutic schedules

O ambroxol é um "modificador do muco". O objetivo do nosso estudo foi determinar sua eficácia clínica no tratamento da estase brônquica, através da realizaçäo de dois estudos duplo-cegos sucessivos em dois grupos paralelos de pacientes, comparando o ambroxol com placebo, em tratamento de 10 dias. O primeiro ensaio, envolvendo 60 pacientes tratados com 120 mg de ambroxol diariamente, mostrou diferenças significativas (p<0.05) no volume do esputo, viscosidade do esputo, dificuldade de expectoraçäo e intensidade da tosse, quando comparados com o grupo placebo. Os dois grupos de pacientes estavam inicialmente bem pareados e a droga foi bem tolerada. Em um segundo ensaio envolvendo 60 novos pacientes tratados com 30 mg de ambroxol diariamente, a droga näo mostrou efeitos clínicos claros. Concluímos que o ambroxol é um "modificador do muco" eficaz e é bem tolerado na dose de 120 mg/dia

Tratamento de infecçöes brônquicas bacterianas agudas com a associaçäo trimetoprima-sulfadiazina (cotrimazina): resultados em 20 pacientes ambulatoriais / Treatment of acute bacterial bronchial infections with trimethoprim-sulphadiazine association (cotrimazine): results in 20 patients

Vinte pacientes portadores de infecçäo brônquica bacteriana foram tratados com a associaçäo Trimetoprima-Sulfadiazina (cotrimazina) (90 mg e 410 mg respectivamente por comprimido) - 1 comprimido a cada 12 horas por 10 dias. A média de idade dos pacientes foi 45,2 + ou - 20,4 anos e a média de duraçäo dos sintomas 10,7 + ou - 8,07 dias. Onze pacientes apresentavam patologia brônquica e/ou pulmonar pré-existente. Foram obtidas 33 culturas de escarro no pré e no pós-tratamento, das quais 30 foram consideradas adequadas pela citologia concomitante. Quinze pacientes foram considerados clinicamente curados (desaparecimento da expectoraçäo), 3 melhorados (permanência da expectoraçäo, mas com reduçäo da quantidade) e 2 como falha. A avaliaçäo bacteriológica foi dificultada por limitaçöes do próprio método. Seis pacientes apresentaram novos sintomas após o início do tratamento, tendo havido 2 abandonos por intolerância; contudo, muitos destes sintomas näo podem ser imputados diretamente ao medicamento. Os níveis de transaminases, uréia, hemoglobina e leucócitos no sangue periférico näo se alteraram com o tratamento

Ajuste de volumen en el cálculo del FEF 25 - 75 en la evaluación de la respuesta broncodilatadora / Volume adjustment in the stimation of FEF 25 - 75

Se realiza una pequeña experiencia comparando el efecto broncodilatador medido con determinación de FEF 25-75% basal, post broncodilatador y FEF 25-75% a isovolumen. Se logra determinar que las curvas a isovolumen permiten lograr mayores respuestas broncodilatadoras, con una mayor significación estadística que el método convencional

Estudo multicêntrico com ambroxol ampolas em afecçöes broncopulmonares e na profilaxia de complicaçöes pulmonares / A multicenter trial with ambroxol ampoules in bronchopulmonary diseases and in prophylaxis of pulmonary complications

Em ensaio multicêntrico aberto, do qual participaram 44 médicos, estudou-se a utilidade do ambroxol ampolas em pacientes hospitalizados, no tratamento de broncopneumonias e na profilaxia de complicaçöes pulmonares. Ao todo, foram avaliados 12 pacientes. O preparado foi administrado por via intra-muscular ou endovenosa e a dose variou de 1/2 a 2 ampolas (7,5 a 30 mg) 2 a 3 vezes ao dia. O período de tratamento foi de 1 semana, em média. Foram obtidos 65,8% de resultados bons (melhora acentuada da dificuladade respiratória à inspeçäo e ausculta ou manutençäo do quadro respiratório sem complicaçöes); em outros 26,7% dos casos, o reultado foi regular e nulo em 7,5%. A tolerabilidade geral foi excelente e boa em 87,5% dos pacientes estudados

Avaliaçäo crítica ao uso de Bromexine / Critical evaluation of the bromhexine use

Faz-se uma revisäo sobre mucolíticos, principalmente, sobre a Bromexine. Discute-se suas propriedades farmacológicas e seu perfil de prescriçäo em nosso meio