ABSTRACT
BACKGROUND: Comparisons of relative potency for the three inhaled corticosteroids in the United States are limited to assessment of skin blanching. OBJECTIVE: Development of a method for comparing relative potencies of inhaled corticosteroids for topical effect on human airway and systemic effect. METHODS: With use of partial suppression of immediate response to inhaled allergen and 24-hour urinary free cortisol output, three-point dose-response curves were constructed for beclomethasone dipropionate (50 micrograms/puff), triamcinolone acetonide (100 micrograms/puff), and flunisolide (250 micrograms/puff). A randomized, parallel, single-blind study design was used. Dosing began with one puff four times a day for flunisolide and two puffs four times a day for the others. Doses were doubled after 1 week and again after a second week. RESULTS: Twenty-five patients completed the study. Dose-response relationships were shown for each inhaled corticosteroid for both topical and systemic effect. Dose-response curves for the three preparations were similar when response was plotted against delivered dose in micrograms. CONCLUSION: Within the limits of the assays, relative potencies of the three preparations appeared to be approximately equivalent for both topical and systemic effect when dose was expressed in micrograms. Relative potency per puff is therefore approximately proportional to the dose delivered. This method has potential for evaluation of relative potency of newer inhaled corticosteroids and the relative advantage of alternative delivery systems.
Subject(s)
Anti-Inflammatory Agents/pharmacology , Asthma/drug therapy , Beclomethasone/pharmacology , Fluocinolone Acetonide/analogs & derivatives , Triamcinolone Acetonide/pharmacology , Administration, Inhalation , Administration, Topical , Anti-Inflammatory Agents/administration & dosage , Beclomethasone/administration & dosage , Biological Assay , Dose-Response Relationship, Drug , Drug Administration Schedule , Female , Fluocinolone Acetonide/administration & dosage , Fluocinolone Acetonide/pharmacology , Humans , Male , Single-Blind Method , Triamcinolone Acetonide/administration & dosageABSTRACT
In this review we have attempted to introduce bronchopulmonary dysplasia as a new chronic lung disease of infancy and childhood. The major risk factors for this illness are preterm birth and the respiratory distress syndrome. The precise etiology of BPD is not understood but trauma from mechanical ventilation and toxicity from exposure to supplemental oxygen are thought to be important. Problems in diagnosis and diagnostic criteria have been discussed as have the details of the unfavorable pulmonary mechanics. We have mentioned some of our own practices in regard to a large and successful home oxygen therapy program. Suggestions have been made for establishing readiness for discharge and for follow-up of these children. Medical management of these patients presently suffers from a lack of prospective and controlled studies. Medical care draws heavily from experience with pediatric asthma. What is known about the long-term outcome of these children has been reviewed with an attempt to highlight controversies between published reports and underscore the need for further investigation. The greatest future success in this area would be the prevention of premature birth. Prior to this, we must await the completion of future controlled and prospective studies.
Subject(s)
Bronchopulmonary Dysplasia/therapy , Aftercare/organization & administration , Bronchopulmonary Dysplasia/diagnosis , Bronchopulmonary Dysplasia/epidemiology , Bronchopulmonary Dysplasia/physiopathology , Female , Follow-Up Studies , Home Care Services , Humans , Infant, Newborn , Male , PrognosisSubject(s)
Bronchiectasis , Bronchiolitis/diagnosis , Bronchitis/diagnosis , Child, Preschool , Female , HumansABSTRACT
The radiographic diagnosis of airway lesions, especially laryngomalacia and tracheomalacia, often is imprecise. Endoscopy, which allows detailed examination of the upper airway, is an invasive procedure requiring sedation or anesthesia. A prospective study was undertaken to show the value of cine-CT (Imatron) scanning in diagnosing airway lesions in children. Eleven patients, aged 10 days to 4 years old, with a history of stridor were evaluated by both cine-CT and flexible fiberoptic endoscopy. Cine-CT studies of 12 children imaged for other reasons and without clinical evidence of airway disease served as controls to assess normal airway motion. Endoscopy identified 13 abnormalities, 11 of which were identified by cine-CT. Cine-CT has the capacity to image common causes of chronic stridor in children. It is rapid, noninvasive, and requires no sedation in most children. Although additional work is needed to clarify the role of cine-CT, this study suggests that cine-CT is a sensitive and specific imaging technique for evaluation of chronic stridor in infants and children.
Subject(s)
Laryngeal Diseases/diagnostic imaging , Tomography, X-Ray Computed/methods , Tracheal Diseases/diagnostic imaging , Child, Preschool , Cineradiography , Fiber Optic Technology , Humans , Infant , Infant, Newborn , Laryngeal Diseases/diagnosis , Laryngoscopy , Respiratory Sounds/diagnosis , Respiratory Sounds/diagnostic imaging , Tracheal Diseases/diagnosis , Vocal Cord Paralysis/diagnosis , Vocal Cord Paralysis/diagnostic imagingABSTRACT
This report documents the use of a Cine CT scanner for documentation of pulmonary artery sling. The examination can be carried out on outpatients and involves only a peripheral venous contrast injection. Excellent visualization of the anatomy is obtained.
