Treatment adherence and level of control in moderate persistent asthma in children and adolescents treated with fluticasone and salmeterol / Adesão ao tratamento e nível de controle da asma persistente moderada em crianças e adolescentes tratados com fluticasona e salmeterol

Abstract Objective: There is a scarcity of studies that assessed the association between adherence to combination therapy and asthma control in pediatric patients. The authors investigated the association between adherence to fluticasone propionate/salmeterol xinafoate combination-metered aerosol and the level of asthma control in children. Methods: This was a prospective observational study of 84 patients aged 5-16 years with moderate persistent asthma, who remained uncontrolled despite the use of 1000 µg/day of inhaled nonextrafine-hydrofluoric alkane-beclomethasone dipropionate in the three months prior to study enrollment. Participants were prescribed two daily doses of FP (125 µg)/salmeterol xinafoate (25 µg) combination by metered aerosol/spacer for six months. Adherence rates were assessed using the device's dose counter after the 2nd, 4th, and 6th months of follow up. Asthma control was assessed using a simplified Global Initiative for Asthma 2014 Report classification. Results: Mean adherence rates after the second, fourth, and sixth months were 87.8%, 74.9%, and 62.1% respectively, for controlled asthma, and 71.7%, 56.0%, and 47.6% respectively, for uncontrolled asthma (all p-values ≤ 0.03). The proportion of children achieving asthma control increased to 42.9%, 67.9% and 89.3% after the 2nd, 4th and 6th months of follow-up, respectively (p ≤ 0.001). Conclusion: Adherence rates between 87.8% in the 2nd month and 62.1% in the 6th month were strong determinants of asthma control.

Resumo Objetivo: São escassos os estudos que avaliaram a relação entre a taxa de adesão à combinação de proprionato de fluticasona/xinafoato de salmeterol e o nível de controle da asma na infância. O presente estudo teve como objetivo avaliar essa relação. Métodos: Estudo prospectivo observacional com 84 participantes, de 5 a 16 anos, todos eles com asma persistente moderada que permaneceram não controlados apesar do uso de 1.000 µg/dia de dipropionato de beclometasona em partículas não extrafinas nos três meses que antecederam a admissão no estudo. Os participantes receberam prescrição de 125 µg de propionato de fluticasona e 25 µg xinafoato de salmeterol através de inalador pressurizado, duas vezes ao dia, e foram avaliados após o 2°, 4° e 6° meses de tratamento. A taxa de adesão foi obtida por meio do contador analógico de doses incorporado ao inalador. A classificação do nível de controle da asma foi baseada numa simplificação das recomendações da Global Initiative for Asthma. Resultados: As taxas de adesão aos 2, 4 e 6 meses para a asma controlada foram 87,8%, 74,9% e 62,1% e para a asma não controlada de 71,7%, 56,0% e 47,6% (p ≤ 0,03), respectivamente. A proporção de pacientes com asma controlada elevou- se para 42,9%, 67,9% e 89,3% nas três avaliações subsequentes (p ≤ 0,001). Conclusões: Taxas de adesão entre 87,8% no 2° mês e de 62,1% no 6° mês foram determinantes para o nível de controle da asma.

Treatment adherence and level of control in moderate persistent asthma in children and adolescents treated with fluticasone and salmeterol.

OBJECTIVE: There is a scarcity of studies that assessed the association between adherence to combination therapy and asthma control in pediatric patients. The authors investigated the association between adherence to fluticasone propionate/salmeterol xinafoate combination-metered aerosol and the level of asthma control in children. METHODS: This was a prospective observational study of 84 patients aged 5-16 years with moderate persistent asthma, who remained uncontrolled despite the use of 1000µg/day of inhaled nonextrafine-hydrofluoric alkane-beclomethasone dipropionate in the three months prior to study enrollment. Participants were prescribed two daily doses of FP (125µg)/salmeterol xinafoate (25µg) combination by metered aerosol/spacer for six months. Adherence rates were assessed using the device's dose counter after the 2nd, 4th, and 6th months of follow up. Asthma control was assessed using a simplified Global Initiative for Asthma 2014 Report classification. RESULTS: Mean adherence rates after the second, fourth, and sixth months were 87.8%, 74.9%, and 62.1% respectively, for controlled asthma, and 71.7%, 56.0%, and 47.6% respectively, for uncontrolled asthma (all p-values≤0.03). The proportion of children achieving asthma control increased to 42.9%, 67.9% and 89.3% after the 2nd, 4th and 6th months of follow-up, respectively (p≤0.001). CONCLUSION: Adherence rates between 87.8% in the 2nd month and 62.1% in the 6th month were strong determinants of asthma control.

Assessment of brachial plexus blockade in chickens by an axillary approach.

OBJECTIVE: To assess the brachial plexus block in chickens by an axillary approach and using a peripheral nerve stimulator. STUDY DESIGN: Prospective, randomized, double-blinded study. ANIMALS: Six, 84-week old, female chickens. METHODS: Midazolam (1 mg kg(-1)) and butorphanol (1 mg kg(-1)) were administered into the pectoralis muscle. Fifteen minutes later, the birds were positioned in lateral recumbency and following palpation of the anatomic landmarks, a catheter was inserted using an axillary approach to the brachial plexus. Lidocaine or bupivacaine (1 mL kg(-1)) was injected after plexus localization by the nerve stimulator. Sensory function was tested before and after blockade (carpus, radius/ulna, humerus and pectoralis muscle) in the blocked and unblocked wings. The latency to onset of motor and sensory block and the duration of sensory block were recorded. A Friedman nonparametric one-way repeated-measures ANOVA was used to compare scores from baseline values over time and to compare the differences between wings at each time point. RESULTS: A total of 18 blocks were performed with a success rate of 66.6% (12/18). The latency for motor block was 2.8 +/- 1.1 and 3.2 +/- 0.4 minutes for lidocaine and bupivacaine, respectively. The latencies for and durations of the sensory block were 6.0 +/- 2.5 and 64.0 +/- 18.0 and 7.8 +/- 5.8 and 91.6 +/- 61.7 minutes for lidocaine and bupivacaine, respectively. There was no statistical difference between these times for lidocaine or bupivacaine. Sensory function was not abolished in nonblocked wings. CONCLUSIONS AND CLINICAL RELEVANCE: The brachial plexus block was an easy technique to perform but had a high failure rate. It might be useful for providing anesthesia or postoperative analgesia of the wing in chickens and exotic avian species that have similar wing anatomy.

Oral cavity evaluation and dental chart registration of coati (Nasua nasua) in captivity.

The aims of this study were to develop a dental evaluate any oral cavity disease, develop gypsum models of the dental arches, and to register the occlusions found in coatis (Nasua nasua) in captivity Formulation of the dental chart was assisted by intraoral radiographs from the head of an adult coati cadaver of the same species with the following dental formula.: I 3/3, C 1/1, P 4/3, M 2/2. Seven live coatis of the Nasua nasua species were evaluated. Five of the seven coatis presented with various dental abnormalities as follows: dental plaque (71.4 0%), gingivitis (71.4 %), periodontitis (57.1 %), dental stain (42.9 %), dental abrasion (57.1 %), dental fracture (57.1 %), pulp exposure (42.9 %), malocclusion (57.1 %) and supernumerary teeth (14.2 %).

Comparison of medetomidine-ketamine and dexmedetomidine-ketamine anesthesia in golden-headed lion tamarins.

The cardiovascular, respiratory, and anesthetic effects of medetomidine-ketamine (20 microg/kg bodyweight [BW] and 10 mg/kg BW) (MK group) or dexmedetomidine-ketamine (10 microg/kg BW and 10 mg/kg BW) (DK group) were studied in golden-headed lion tamarins. Heart rate decreased after administration of both combinations; this reduction was statistically greater in the DK group than in the MK group after 15 and 45 minutes. Systolic arterial pressure decreased in a similar way in both groups, except at 15 minutes, when systolic arterial pressure was significantly lower in the DK group. Diastolic arterial pressure, mean arterial pressure, respiratory rate, and rectal temperature were progressively reduced in all groups. Sedation time was significantly shorter and anesthesia time was significantly longer in the DK group compared with MK group. Anesthetic quality and analgesia scores were significantly greater at 5 and 15 minutes in the DK group compared with the MK group. The administration of dexmedetomidine-ketamine is as safe and effective as the administration of medetomidine-ketamine in tamarins.

Effects of tiletamine/zolazepam-romifidine-atropine in ocelots (Leopardus pardalis).

OBJECTIVES: To evaluate the effects of a combination of tiletamine-zolazepam-romifidine-atropine in ocelots. DESIGN: Prospective experimental trial. ANIMALS: Eight captive adult ocelots (three females and five males). METHODS: Calculated doses of tiletamine-zolazepam (3.75 mg kg(-1)), romifidine (50 microg kg(-1)) and atropine (0.04 mg kg(-1)) were administered intramuscularly. After immobilization, animals were weighed and the real doses determined. Heart rate, respiratory frequency, noninvasive systolic, diastolic, and mean arterial pressure, arterial oxygen hemoglobin saturation, and rectal temperature were measured. Data were analyzed by means of anova for repeated measures, followed by the Tukey test to compare values over time. RESULTS: Doses administered were 3.4 +/- 0.6 mg kg(-1) of tiletamine-zolazepam, 0.04 +/- 7.0 mg kg(-1) of romifidine, and 0.03 +/- 0.007 mg kg(-1) of atropine. The mean time to recumbency and duration of immobilization were 7.0 +/- 4.5 and 109.2 +/- 27.9 minutes, respectively. The median times to standing and walking were 52.3 [0-90] and 2.3 [0-69.3] minutes, respectively. A decrease in heart rate was observed 45 minutes following drug administration. Arterial blood pressure was maintained during the study. CONCLUSIONS AND CLINICAL RELEVANCE: This protocol produced good immobilization in ocelots with minimal changes over time in cardiovascular parameters.

Assessment of dexmedetomidine/ketamine anesthesia in golden-headed lion tamarins (Leontopithecus chrysomelas).

OBJECTIVE: To compare the anesthetic and cardiovascular effects of dexmedetomidine/ketamine combinations in golden-headed lion tamarins. STUDY DESIGN: Prospective blinded randomized study. ANIMALS: Six healthy golden-headed lion tamarins, three males and three females were studied (mean body weight +/- SD = 0.498 +/- 0.054 kg). METHODS: The animals were given one of the dexmedetomidine/ketamine combinations (0.005/10, 0.01/10, and 0.01/5 mg kg(-1) IM; treatments 5D/10K, 10D/10K, and 10D/5K, respectively) on three successive occasions. Time to sedation and recumbency, as well as anesthesia, standing, and walking times were recorded. Heart and respiratory rate, arterial blood pressure, hemoglobin saturation, and rectal temperature were recorded during anesthesia. Sedation, muscle relaxation, and auditory response were evaluated after drug administration. RESULTS: Heart rate decreased after two combinations (10D/5K and 10D/10K). Respiratory rate and rectal temperature progressively decreased in all the treatments. Arterial blood pressures were maintained in 5D/10K and 10D/5K treatments and decreased after 10D/10K administration. There were no differences in sedation and recumbency time between the treatments, but anesthesia time was significantly longer in treatment 10D/10K (67.80 +/- 13.30 minutes) compared to treatments 10D/5K (44.54 +/- 8.25 minutes) and 5D/10K (30.60 +/- 6.80 minutes). Standing time was shorter in treatment 10D/10K (11.13 +/- 10.01 minutes) than in treatments 5D/10K (18.20 +/- 10.03 minutes) and 10D/5K (19.12 +/- 14.55 minutes), and walking time was longer in treatment 5D/10K (20.00 +/- 12.46 minutes) compared with treatments 10D/10K (16.00 +/- 3.43 minutes) and 10D/5K (12.40 +/- 5.02 minutes). Anesthetic quality was significantly better 5 and 15 minutes after treatments 10D/10K and 10D/5K than after treatment 5D/10K. Analgesia scores were higher after administration of 10D/10K than after the 5D/10K treatment. CONCLUSIONS AND CLINICAL RELEVANCE: Dexmedetomidine/ketamine is useful for chemical immobilization of golden-headed lion tamarins, but bradycardia and hypotension warrant close monitoring.

Use of a combination of propofol and fentanyl, alfentanil, or sufentanil for total intravenous anesthesia in cats.

OBJECTIVE: To determine the cardiorespiratory effects of an i.v. infusion of propofol alone or in association with fentanyl, alfentanil, or sufentanil in cats and, for each combination, the minimal infusion rate of propofol that would inhibit a response to noxious stimuli. DESIGN: Randomized crossover study. ANIMALS: 6 cats. PROCEDURE: Cats were anesthetized 4 times in random order. After i.v. administration of fentanyl, alfentanil, sufentanil, or saline (0.9% NaCl) solution, anesthesia was induced with propofol (7 mg/kg 13.2 mg/lb], i.v.) and maintained for 90 minutes with a continuous infusion of propofol in conjunction with fentanyl (0.1 microg/kg/min [0.045 microg/lb/min]), alfentanil (0.5 microg/kg/min [0.23 microg/lb/min]), sufentanil (0.01 microg/kg/min [0.004 microg/lb/min]), or saline solution (0.08 mL/kg/min [0.036 mL/lb/min]). RESULTS: Minimal infusion rate of propofol required to prevent a response to a noxious stimulus was higher when cats received saline solution. After 70 minutes, minimal infusion rate of propofol was significantly higher with fentanyl than with sufentanil. Decreases in heart rate, systolic blood pressure, rectal temperature, and respiratory rate were detected with all treatments. Oxygen saturation did not change significantly, but end-tidal partial pressure of carbon dioxide increased with all treatments. There were no significant differences in recovery times or sedation and recovery scores among treatments. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that infusion of propofol in combination with fentanyl, alfentanil, or sufentanil results in satisfactory anesthesia in cats.

Chemical restraint of peccaries with tiletamine/zolazepam and xylazine or tiletamine/zolazepam and butorphanol.

OBJECTIVE: To evaluate the use of a combination of tiletamine/zolazepam and xylazine (TZX) in collared and white-lipped peccaries and to compare its efficacy as an anesthetic technique with that of tiletamine/zolazepam and butorphanol (TZB). STUDY DESIGN: Prospective experimental trial. ANIMALS: Seven white-lipped peccaries (Tayassu pecari) (four females and three males) and four collared peccaries (Tayasu tajacu) (two males and two females). METHODS: Animal immobilization was attempted with TZX and TZB (IM) on two different occasions. Heart and respiratory rates (HR, RR), rectal temperature (RT), sedation, muscle relaxation, posture, auditory response and analgesia were evaluated every 15 minutes during immobilization. Induction, anesthesia, standing and walking time were determined after drug administration. RESULTS: Doses for white-lipped peccaries were 1.23 +/- 0.26 mg kg(-1) (mean +/- SD) of TZ and 1.23 +/- 0.26 mg kg(-1) of X, and 1.46 +/- 0.09 mg kg(-1) of TZ and 0.14 +/- 0.008 mg kg(-1) of B; doses for collared peccaries were 1.51 +/- 0.29 mg kg(-1) of TZ and 1.51 +/- 0.29 mg kg(-1) of X and 1.68 +/- 0.02 mg kg(-1) of TZ and 0.17 +/- 0.002 mg kg(-1) of B. In white-lipped peccaries, both drug combinations provided a smooth induction and good immobilization for more than an hour. Anesthesia and standing times were significantly longer in animals given TZB, whereas walking time was significantly longer in animals given TZX. A significant decrease in HR was observed with both treatments. Respiratory rate decreased significantly with TZX, but the rate remained higher than with TZB. Induction and recovery quality in white-lipped peccaries was better with TZB than with TZX. Neither protocol provided adequate immobilization in collared peccaries. CONCLUSION AND CLINICAL RELEVANCE: At the doses described, TZB is effective in providing a long period of immobilization, whereas TZX is adequate for short to medium immobilization in white-lipped peccaries. Neither drug combination was effective in collared peccaries at the doses given.

Evaluation of the sedative and cardiorespiratory effects of dexmedetomidine, dexmedetomidine-butorphanol, and dexmedetomidine-ketamine in cats.

OBJECTIVE: To determine sedative and cardiorespiratory effects of dexmedetomidine alone and in combination with butorphanol or ketamine in cats. DESIGN: Randomized crossover study. ANIMALS: 6 healthy adult cats. PROCEDURES: Cats were given dexmedetomidine alone (10 microg/kg [4.5 mg/lb], IM), a combination of dexmedetomidine (10 microg/kg, IM) and butorphanol (0.2 mg/kg [0.09 mg/lb], IM), or a combination of dexmedetomidine (10 microg/kg, IM) and ketamine (5 mg/kg [2.3 mg/lb], IM). Treatments were administered in random order, with > or = 1 week between treatments. Physiologic variables were assessed before and after drug administration. Time to lateral recumbency, duration of lateral recumbency, time to sternal recumbency, time to recovery from sedation, and subjective evaluation of sedation, muscle relaxation, and auditory response were assessed. RESULTS: Each treatment resulted in adequate sedation; time to lateral recumbency, duration of lateral recumbency, and time to recovery from sedation were similar among treatments. Time to sternal recumbency was significantly greater after administration of dexmedetomidine-ketamine. Heart rate decreased significantly after each treatment; however, the decrease was more pronounced after administration of dexmedetomidine-butorphanol, compared with that following the other treatments. Systolic and diastolic blood pressure measurements decreased significantly from baseline with all treatments; 50 minutes after drug administration, mean blood pressure differed significantly from baseline only when cats received dexmedetomidine and butorphanol. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that in cats, administration of dexmedetomidine combined with butorphanol or ketamine resulted in more adequate sedation, without clinically important cardiovascular effects, than was achieved with dexmedetomidine alone.

Intraocular pressure determination in clinically normal red-footed tortoise (Geochelone carbonaria).

Intraocular pressure (IOP) reflects a balance between aqueous humor production and outflow and is often an essential ophthalmic diagnostic procedure in animals. The objective of this study was to estimate IOP in clinically normal red-footed tortoises (Geochelone carbonaria) of various sizes by using applanation tonometry. Intraocular pressures were estimated for 25 captive red-footed tortoises (10 males, 10 females, and 5 animals of unknown sex) by using an applanation tonometer after topical anesthesia. Body length ranged from 5.1 to 54.9 cm, measured from nuchal to anal scutes. Five measurements from each eye were obtained by a single observer in an ambient temperature of approximately 30 degrees C. Observer's reliability was good (intraclass r = 0.75), and IOP did not change over the ordered sequence of five replicate measurements. For individual tortoises the correlation for IOP between the left and right eyes was low (r = 0.20). The paired t-test did not show any statistical effect (P = 0.426) for the difference in IOP between the left and right eyes. Mean IOP determined for 10 confirmed males and 10 confirmed females did not differ between sexes (P = 0.244). The mean IOP of five small tortoises (< 10 cm long) was not significantly different (P = 0.244) from that of 20 large tortoises (> 10 cm long). In red-footed tortoises there does not appear to be any relation between carapace length and IOP.

Evaluation of sedative and cardiorespiratory effects of romifidine and romifidine-butorphanol in cats.

OBJECTIVE: To determine sedative and cardiorespiratory effects of romifidine alone and romifidine in combination with butorphanol and effects of preemptive atropine administration in cats sedated with romifidine-butorphanol. DESIGN: Randomized crossover study. ANIMALS: 6 healthy adult cats. PROCEDURES: Cats were given saline (0.9% NaCl) solution followed by romifidine alone (100 microg/kg [45.4 microg/lb], i.m.), saline solution followed by a combination of romifidine (40 microg/kg [18.1 microg/lb], i.m.) and butorphanol (0.2 mg/kg [0.09 mg/lb], i.m.), or atropine (0.04 mg/kg [0.02 mg/lb], s.c.) followed by romifidine (40 microg/kg, i.m.) and butorphanol (0.2 mg/kg, i.m.). Treatments were administered in random order, with > or = 1 week between treatments. Physiologic variables were determined before and after drug administration. Time to recumbency, duration of recumbency, time to recover from sedation, and subjective evaluation of sedation, muscle relaxation, and analgesia were assessed. RESULTS: Bradycardia developed in all cats that received saline solution and romifidine-butorphanol or romifidine alone. Preemptive administration of atropine prevented bradycardia for 50 minutes in cats given romifidine-butorphanol. Oxyhemoglobin saturation was significantly decreased 10 minutes after romifidine-butorphanol administration in atropine-treated cats. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that administration of romifidine alone or romifidine-butorphanol causes a significant decrease in heart rate and that preemptive administration of atropine in cats sedated with romifidine-butorphanol effectively prevents bradycardia for 50 minutes.