Stridor in childhood asthma.

Three asthmatic children are reported with shortness of breath due to stridor. The stridor was preceded by a deterioration in asthma control necessitating the introduction or increased dosage of a pressurized beclomethasone inhaler. The stridor mimicked asthmatic symptoms and was only differentiated by auscultation directly over the neck and by response to nebulized adrenaline. One child had a laryngeal foreign body which probably gained entry via a pressurized inhaler.

Non-organic stridor in children.

A 4.75-year-old male presented with several episodes of expiratory stridor leading, on one occasion, to a respiratory arrest and intubation. A detailed evaluation emphasizing physiological and anatomical studies revealed no organic basis for the patient's upper airway obstruction. Emphasis is placed on one method found to be helpful in the differentiation of an organic versus a psychogenic type of respiratory disorder. Recognition of functional airway obstruction in children may prevent inappropriate therapy and allow proper psychiatric intervention.

Bronchodilator effect of fenoterol and ipratropium bromide in infants with acute wheezing: use of MDI with a spacer device.

Twenty-eight infants admitted to Exequiel González Cortes Children's Hospital because of acute wheezing (AW) were randomly assigned to three study groups. Fenoterol (FNT), ipratropium bromide (IB), and placebo were administered respectively to children in the different groups by means of metered dose inhalers (MDI) with spacers, using doses of 3 puffs every hour, for 4 hours. The degree of bronchial obstruction was assessed clinically and scored with the single-blind method every hour prior to each treatment. The criterion of a bronchodilator effect was a significant decrease in the degree of bronchial obstruction at subsequent scorings. The scores of the three groups were compared using the Student's t test for matched samples. The same test was also applied to the independent samples for determining the superiority of one treatment, FNT or IB, over the other. The results indicated a significant decrease in the scores of the groups receiving FNT and IB (P less than 0.05); this did not occur in the group in which placebo was used. FNT produced a more rapid and sustained effect than IB (P less than 0.05). Significant bronchodilator effect was obtained in infants with AW when repeated doses of FNT or IB were administered with MDI and spacers. This effect was significantly greater in the group treated with FNT.

Terbutaline pressurised aerosol inhaled via a Nebuhaler--an effective alternative to subcutaneous adrenaline for treatment of acute severe asthma.

The study was designed to compare terbutaline inhaled via a 750 ml spacer (Nebuhaler) with subcutaneous adrenaline injection as a first-line treatment for acute severe asthma. Patients were randomly allocated to two treatment groups, receiving either 2 X 4 mg of inhaled terbutaline followed by 2 X 0.5 mg subcutaneous adrenaline (22 patients) or the same drugs in reverse order (24 patients). All patients received a further 2 mg inhaled terbutaline to assess remaining bronchodilator reversibility. Initial treatment with terbutaline produced near maximal bronchodilation (FEV1, FVC), whilst initial treatment with adrenaline did not. Terbutaline also reduced symptoms of dyspnoea and wheeze to a greater extent than adrenaline, and was better tolerated with respect to heart rate and side-effects such as tremor. In conclusion, terbutaline inhaled via Nebuhaler was at least as effective as subcutaneous adrenaline, produced fewer side-effects, and hence can be recommended for initial treatment of acute severe asthma.

Tuberculosis presenting as stridor.

A 40-year-old woman was seen with stridor and mediastinal widening secondary to tuberculous mediastinal lymphadenopathy mimicking neoplasm. Initially, stridor could only be controlled with high-dose corticosteroids, but following initiation of antituberculous chemotherapy corticosteroids were withdrawn successfully and the mediastinal lymphadenopathy resolved.

Paradoxical deterioration in lung function after nebulised salbutamol in wheezy infants.

In 13 infants with a history of wheezing, airways resistance and specific conductance worsened after administration of nebulised salbutamol (0.5 ml sabutamol respirator solution in 1.5 ml normal saline). This paradoxical bronchoconstriction was greatest at 5 min and lasted for up to 15 min. The nebulised solution was found to be acidic and hypo-osmolar, both of which properties have been linked to bronchoconstriction in asthmatic subjects, but even with an initially iso-osmolar solution osmolality increased with time of nebulisation because of evaporation.

Wheezy bronchitis: results of treatment with ketotifen.

The authors consider that infants and young children with recurrent obstructive bronchitis require systematic follow-up care and treatment. To evaluate the severity of the disease, a rating scale was developed. Using this criteria, the severity of the disease in 132 infants and young children was evaluated. The patients were divided into a group of more severely ill and a group of less severely ill patients. The members of the more severely ill group were given long-term prophylactic treatment with ketotifen at a dose of 0.5 to 1.0 mg twice daily, in addition to standard symptomatic medication. Treatment with ketotifen afforded a decrease, although insignificant, in the number of coughing attacks, a significant decrease in the number of episodes of dyspnoea (p less than 0.025) and a significant decrease in the number of episodes of airway obstruction (p less than 0.0005). The authors conclude that patients with recurrent severe obstructive bronchitis should be given prophylactic treatment with ketotifen either during autumn and winter or throughout the year, depending on the severity of the symptoms.

Medical care of asthma and wheezing illness in children: a community survey.

A survey was carried out to investigate the medical care of asthma and wheezing illness in a school population. Children with current wheezing illness were identified by a screening questionnaire to the parents of 5100 children in one school cohort from all schools in an outer London borough. Of the 89% who responded, 11.1% reported wheezing within the past 12 months. Parents of a sample of 284 wheezy children aged about 9 were interviewed at home about their child's illness and the related use of drugs and services. There was evidence of substantial underuse of services and this was not associated with social, family, or general practice factors. Considerable proportions of children were not having drug treatment, were receiving only non-antiasthmatic drugs, or were using antiasthmatic drugs incorrectly. The most important social and family factor associated with undertreatment was poor maternal mental health, and this factor appeared to explain the observed association of manual social class with undertreatment. Only about half of the most severe group were labelled as having "asthma," and those with this label were more likely to be receiving treatment and using outpatient services. The results show that the potential of modern treatment to prevent disability due to wheezing illness is not being realised despite the existence of a free and accessible health service.