Problems with the retrieval of long-standing inhaled foreign bodies in children.

In the last 7 yrs, we have removed 51 foreign bodies inhaled by children. In five cases involving long-standing foreign bodies, retrieval of the inhaled objects was complicated by their peripheral location in the bronchial tree and by the presence of abundant granulation tissue. In two of these children, the inhaled foreign bodies had been pushed further down the bronchial tree during a previous unsuccessful bronchoscopy. The use of a rigid bronchoscope with optical peanut forceps and 2-4 doses of an aqueous solution of epinephrine 1:100,000, at the dosage of 0.1 mL.kg-1.body weight (during removal of granulation tissue and after removal of the foreign bodies) permitted the complete removal of the foreign bodies in one session and a good control of bleeding.

The first 20 minutes after a single dose of inhaled salmeterol in asthmatic children.

Very little is known as yet about the effect of salmeterol in pediatric asthma, so a trial was performed on children with mild asthma to compare salmeterol with salbutamol in terms of how quickly they took effect. The double-blind study involved 11 children (mean age 13.4 years) randomly assigned to inhale salmeterol 50 micrograms, salbutamol 200 micrograms, or a placebo three times on alternate days. Peak expiratory flow (PEF), heart rate, and blood pressure were measured before and 5, 10, 15, and 20 min after administering the medication. With salbutamol, PEF was higher at 5 and 10 min, subsequently dropping off at 15 and 20 min; with salmeterol, PEF was better at 10 and 20 min. Forced expiratory volume at 1 s (FEV1) measurements taken at the baseline and after 10 and 20 min revealed an important and consistent rise in values after salmeterol, whereas salbutamol was more effective after 10 min than after 20 min. No significant changes were recorded in heart rate or blood pressure after salbutamol; after salmeterol, there was a significant increase in heart rate after 5 min, but not at subsequent measurements. In conclusion, salmeterol begins to take effect already within 10 min of a single administration in asthmatic children, although the onset of its effect is slower than with salbutamol.

Use of fiberoptic bronchoscopy in asthmatic children with lung collapse.

Segmental atelectasis during asthmatic attacks as a consequence of bronchospasm and hypersecretion are very frequent in children. The collapse of a lung instead is a very rare occurrence. We report two patients with acute exacerbation of asthma, showing an in complete response to bronchodilatory therapy. The clinical findings and chest X-ray were suggestive for collapse of a lung. An urgent fiberoptic bronchoscopy revealed obstruction of a stem main bronchus caused by sticky mucopurulent secretions. The aspiration improved dramatically the respiratory distress and the radiological picture. In these cases we recommended to perform an immediate bronchial aspiration by means of a flexible instrument without waiting a further deterioration of respiratory function before taking this decision.