Budesonide/formoterol (Symbicort) is well tolerated and effective in patients with moderate persistent asthma.

The aim of this study was to compare the safety and efficacy of budesonide/formoterol 160/4.5 microg, two inhalations twice daily, with that of the mono-products administered at the same daily doses via separate inhalers. A total of 586 patients (mean age 45 years) was included in this six-month, open, randomised, multicentre study. Patients received either budesonide/formoterol (n=390) or budesonide plus formoterol (n=190). Safety was assessed by adverse events, vital signs and laboratory values. Efficacy was evaluated using spirometry tests, the Mini Asthma Quality of Life Questionnaire and the Asthma Control Questionnaire. Both treatments were well tolerated, with no differences in safety parameters between the groups. Mean FEV1 increased by 5-6% over baseline in both groups. There was no significant difference in the change from baseline between the groups using the disease-specific questionnaires. Asthma exacerbations occurred with low frequency in both groups. Withdrawal rates were also comparable between the groups (p=0.085). Budesonide/formoterol in a single inhaler was as effective and as well tolerated as budesonide plus formoterol via separate inhalers.

Nebulized budesonide after hospitalization for recurrent bronchial obstruction in children younger than 18 months.

A multi-center, double-blind, randomized dose-response study was performed to assess the effect of 3 months of treatment with two different doses of inhaled nebulized budesonide in children with acute recurrent bronchial obstruction (BO) causing hospitalization. Steroid-naive children younger than 18 months were included when admitted to hospital because of BO for at least the second time, and were followed-up monthly for 15 months. Forty-five of 49 subjects (43 boys, 2 girls) (mean age 9.3 months upon inclusion) completed the study. Twenty-four patients (20 boys, 4 girls) received nebulized budesonide 0.5 mg twice daily for 1 month followed by 0.25 mg daily for the next 2 months, whereas 25 children received 0.1 mg twice daily throughout the 3-month treatment period. Outcome (number of BO episodes, time to first BO after start of treatment, and use of rescue medication), as well as height/length and weight, were assessed at the start of treatment and monthly for the following 3 months, as well as for 12 months after cessation of treatment (15 months in total). There was an overall tendency towards better symptom control (fewer episodes of acute BO during treatment and follow-up, fewer hospital visits because of acute BO, lower clinical score during follow-up, and less use of rescue medication during follow-up) in the high-dose treatment group vs. the low-dose treatment group. However, the differences did not reach statistical significance for any of the outcomes. The only significant difference in effect between the groups was fewer children in the high-dose group treated openly with nebulized budesonide during follow-up. Length/height and weight gain did not differ significantly between the two treatment groups throughout the study. There was no significant dose-dependent beneficial effect of 3 months of treatment with nebulized budesonide in infants and toddlers with at least two hospitalizations for acute bronchial obstruction.

Trends in hospital admissions for childhood asthma in Oslo, Norway, 1980-95.

BACKGROUND: The prevalence of asthma and quality of asthma care both influence hospital admission rates for childhood asthma. Therefore, we aimed to assess possible changes in the hospital admission rate for acute asthma in Oslo, Norway, from 1980 to 1995, as well as evaluate the possible effect of changes in asthma treatment upon hospitalization for acute asthma in this period. METHODS: All pediatric patient records from the two municipal hospitals in Oslo from 1980 through 1995 with the discharge diagnoses (ICD-9) acute asthma, acute bronchitis/bronchiolitis, pneumonia, and/or atelectasis were thoroughly reviewed. RESULTS: Of the 3,538 children admitted for acute asthma, 66% were boys and 75% were younger than 4 years, and the admittance rate increased significantly among children aged 0-3 years. First admissions increased throughout the study, whereas readmissions, as well as the mean duration of hospital stay, decreased significantly. Prophylactic treatment with inhaled steroids prior to admission increased over 1980-89, but stabilized thereafter. The use of a short course of systemic steroids during admission increased markedly from 1991. CONCLUSIONS: The findings of increasing first admission rate as well as overall admission rate for acute asthma in children under 4 years of age, but decreasing readmissions as well as number of treatment days in hospital, probably reflect changes in the management of the disease, as well as an increasing prevalence of childhood asthma.

Leukocyte adhesion deficiency in a Norwegian boy.

A Norwegian boy suffering from recurrent urinary and respiratory tract infections was examined. It was found that granulocyte random migration, respiratory burst activity and the proportions of CD11/CD18 receptor positive leukocytes were reduced, consistent with a diagnosis of leukocyte adhesion deficiency. An increased proportion of Fc gammaI-receptor-bearing granulocytes did not compensate for the CR3 deficiency.

Overnight protection by inhaled salmeterol on exercise-induced asthma in children.

The main aim of the present study was to evaluate whether inhaled salmeterol given in the evening protected against exercise-induced asthma the next morning. Twenty three children (12 males and 11 females) with a mean age of 11 yrs and with exercise-induced asthma participated in a double-blind, randomized, placebo-controlled study. The children inhaled salmeterol 25 micrograms, salmeterol 50 micrograms and placebo by Diskhaler at 10 p.m. on 3 separate days. Next morning, half of the children ran on a motor-driven treadmill for 6 min at submaximal load at 8 a.m. and the remainder at 10 a.m. Lung function was measured by maximal expiratory flow-volume loops before running, immediately after, and 3, 6, 10 and 15 min after running. The mean maximum reduction in forced expiratory volume in one second (FEV1) after treadmill run was 34% before inclusion in the study. Mean maximum fall in FEV1 was significantly greater after placebo: 30% (23-36) 95% confidence interval) than after salmeterol 25 micrograms: 19% (12-23) or salmeterol 50 micrograms: 18% (12-25). In addition to the reduced postexercise bronchoconstriction, pre-exercise lung function (FEV1) was significantly higher both after salmeterol 25 micrograms: 2.4 L.s-1 (2.1-2.7) and salmeterol 50 micrograms: 2.5 L.s-1 (2.2-2.8) than after placebo: 2.2 L.s-1 (1.9-2.5). No significant differences in pre- and postexercise lung function were found between children tested at 8 or 10 a.m., or in relation to salmeterol dosage. Thus, inhaled salmeterol 25 and 50 micrograms offered similar overnight protection against exercise-induced asthma and improved baseline lung function in the morning as compared to placebo.

Prevalence of bronchial asthma in schoolchildren in Oslo, Norway. Comparison of data obtained in 1993 and 1981.

In 1993, 4521 schoolchildren in Oslo, Norway, participated in a European study on air pollution and respiratory health. Incorporated in the primary questionnaire were five questions taken from a study performed 12 years earlier on 1772 schoolchildren in the same city. The response rate was 85% in 1993 vs 95% in 1981. The current and cumulative prevalences of doctor-diagnosed asthma in 1993 were 4.2% and 8.0%, respectively, compared to 2.2% (P < 0.01) and 3.4% (P < 0.01) in 1981. Attacks of breathlessness during the last 3 years were experienced by 7.1% in 1993 and 3.3% in 1981 (P < 0.05). Wheezing or breathlessness on exposure to pollen in 1993 and 1981 was reported by 6.1% and 3.7% (P < 0.01), respectively; to animals by 4.0% and 2.8% (P < 0.05); and to exercise by 10.2% and 4.8% (P < 0.01). The prevalence of occasional wheezing and the cumulative prevalence of doctor-diagnosed eczema, urticaria, and hay fever were not significantly altered. To summarize, a higher prevalence of both doctor-diagnosed asthma and symptoms of obstructive airways disease was reported by children attending primary school in Oslo in 1993 than 12 years earlier. No increase was observed in the prevalence of other atopic diseases.

[Rubber allergy. An increasing health problem?]. / Gummiallergi. Et økende helseproblem?

Allergic reactions to rubber (latex) are now being reported more frequently. Symptoms include urticaria, contact dermatitis, rhinitis, local angioedema, asthma and anaphylactic shock. Medical workers and some groups of patients seem to be at risk of developing rubber allergy. The increased use of rubber gloves and condoms to prevent the spread of infections seems to lead to increased incidence of latex hypersensitivity. We report the case of a patient who experienced an immediate allergic reaction after using a condom. We then discuss latex antigens, the incidence and diagnosis of latex allergy, and associated risk factors.

Allergic alveolitis in a 12-year-old boy: treatment with budesonide nebulizing solution.

Allergic alveolitis due to bird antigens was diagnosed in a 12-year-old boy. He suffered from cough, dyspnea, easy fatigue, anorexia, and severe weight loss. The diagnosis was verified by a gradual improvement when he was removed from the birds, exacerbation upon re-exposure, and the demonstration of serum precipitating antibodies against bird antigens. The patient recovered completely after a short course of oral prednisolone, treatment with inhaled nebulized budesonide for 3 months, and removal of the birds from his home.

Nebulised beclomethasone dipropionate in recurrent obstructive episodes after acute bronchiolitis.

Forty four children with recurrent obstructive episodes after acute bronchiolitis in infancy were treated with nebulised beclomethasone dipropionate or placebo for eight weeks in a randomised double-blind study. They were seen monthly for a year afterwards, and also if they had acute respiratory illnesses with or without bronchopulmonary obstruction. The two treatment groups were well matched. The children receiving active treatment had significantly fewer symptomatic respiratory illnesses and fewer episodes of bronchopulmonary obstruction during the follow up period. The children given placebo had significantly higher obstructive scores during the study period, and they were treated with inhaled beta 2 agonists and theophylline for longer periods of time during the follow up period. The results suggest that nebulised beclomethasone dipropionate may have prolonged effects on subsequent asthmatic symptoms after termination of treatment in children with recurrent obstructive episodes after acute bronchiolitis.

Acute bronchiolitis: predisposing factors and characterization of infants at risk.

Fifty-one infants hospitalized because of acute bronchiolitis and 24 control children were prospectively followed until 2 years of age. Respiratory syncytial virus was detected initially in 31 index children, parainfluenza virus in two, and rhinovirus in one. More index children were born during the months April through September, and six index children had neonatal respiratory complications. The index children were breast-fed for shorter periods, lived in more crowded homes, and had more siblings. No significant differences were found for atopic background and atopic illness at 2 years of age. The index children had more respiratory infections and episodes of bronchopulmonary obstruction during the follow-up period (60% with three or more episodes). To characterize the hospitalized children, a discriminant analysis was performed. A discriminant function classified 47 of 51 index children as belonging to the index group and 21 of 24 control children to the control group.

Respiratory virus infections and aeroallergens in acute bronchial asthma.

Two hundred and fifty six attacks of acute bronchial asthma occurring in 169 children aged over 2 years were studied during a two year period. More attacks occurred during spring and autumn than at other times of the year. In 73 patients (29%) a respiratory virus infection was diagnosed, with the same seasonal variation as the asthmatic attacks. Most of the virus infections were caused by rhinovirus (45%) and respiratory syncytial virus (19%). There was no significant correlation between asthmatic attacks in patients with birch pollen, grass pollen, or Cladosporium herbarum allergy and counts of the respective pollen or spores in the air. More seasonal attacks occurred in patients with cladosporium allergy than in patients without cladosporium allergy but there was no seasonal variation among birch or grass pollen allergic patients. Information about exposure to animals was obtained in only 12% of attacks occurring in 121 patients with allergy to animal dander. The single precipitating factor most frequently associated with acute asthma was respiratory virus infection.

Immediate type hypersensitivity to common moulds. Comparison of different diagnostic materials.

Extracts of five common atmospheric moulds (Alternaria, Aspergillus, Cladosporium, Mucor and Penicillium) obtained from different manufacturers were compared by means of skin prick testing and, partly, with the radioallergosorbent test. Considerable differences were found between the extracts with respect to positive tests found in mould-allergic individuals and controls. A purified allergen preparation of Cladosporium herbarum was superior to the crude allergen extracts. The results suggest that the allergen contents of the extract differed both with respect to total allergenic potency and to allergenic composition.

RAST in the diagnosis of hypersensitivity to horse allergens. A comparison with clinical history and in vivo tests.

Case history, skin tests and RAST were compared in a group (n = 40) of children with a history suggesting allergy to horses and in a group (n = 43) in whom there was no suspicion of hypersensitivity to horses. There was an agreement of 91% between case history and prick test. The same magnitude of agreement was found between case history and RAST (89%), and the agreement between RAST and prick test was 90%. The results of this investigation are clearly in contrast to earlier earlier reports, in that there was a very good correlation between prick test, RAST and case history. The results suggest that: (a) a proper evaluation of the skin test is of critical importance for the degree of correlation with other diagnostic tests; and (b) RAST is as reliable as carefully performed and evaluated skin tests.