Comparative effectiveness of budesonide inhalation suspension and montelukast in children with mild asthma in Korea.

Objective: The comparative effectiveness of low-dose budesonide inhalation suspension (BIS) versus oral montelukast (MON) in managing asthma control among children with mild asthma was assessed in Korea.Methods: Claims from Korea's national health insurance database for children (2-17 years) with mild asthma (GINA 1 or 2) who initiated BIS or MON during 2015 were retrospectively analyzed. Pre- and post-index windows were 1 year each. Adherence, persistency, asthma control, asthma-related health-care resource utilization, and costs were evaluated using unadjusted descriptive statistics and propensity score-matched regression analyses.Results: The number of children identified was 26,052 for unmatched (n = 1,221 BIS; n = 24,831 MON) and 2,290 for matched populations (n = 1,145 per cohort). Medication adherence, measured by proportion of days covered, was low for both cohorts but significantly higher for MON versus BIS (13.8% vs. 4.5%; p < .001). Time to loss of persistency was longer for MON versus BIS (82.3 vs. 78.4 days, respectively; p < .001). Mean number of post-index asthma-related office visits was 6.6 for BIS versus 8.3 for MON (p < .001). However, a greater proportion of patients in the BIS cohort had an asthma exacerbation-related office visit than the MON cohort (78.3% vs. 56.1%; p < .001). Asthma-related total health-care costs were higher with MON versus BIS (₩ 190,185 vs. ₩ 167,432, respectively; p < .001), likely driven by higher pharmaceutical costs associated with MON (₩ 69,113 vs. ₩ 49,225; p < .001).Conclusions: Montelukast patients had better adherence, a longer time to loss of persistency, and were less likely to experience an exacerbation-related office visit in the post-index period than BIS patients.

Effect of mometasone furoate nasal spray on moderate-to-severe nasal congestion in seasonal allergic rhinitis: A responder analysis.

Background: Nasal congestion is consistently identified as the most bothersome symptom of seasonal allergic rhinitis (SAR), and, in guidelines, intranasal corticosteroids are the preferred treatment for nasal congestion. Objective: The aim of this post hoc cumulative responder analysis was to examine the nasal congestion response in detail by depicting the level of response obtained in two double-blind, placebo controlled studies of mometasone furoate nasal spray (MFNS) therapy for SAR, conducted from August to October 2008 at U.S. sites, in which nasal congestion was prespecified as the primary end point. Methods: Patients ≥12 years of age with a ≥2-year SAR history, positive skin test result, and moderate or severe nasal congestion were randomly assigned to once-daily treatment in the morning with MFNS or placebo for 15 days. The primary end point was the change from baseline in morning and evening reflective nasal congestion scores averaged over days 1-15. Treatment response, which ranged from >0% to >90% improvement, was evaluated at 10% intervals; >30% and >50% improvements were further evaluated by using the Mietinnen-Nurminen method weighted by study to test the differences of proportions. The Breslow-Day equal odds ratios test was used to justify pooling. Results: Of the 344 and 340 patients in the MFNS and placebo groups, respectively, the proportions of patients who experienced a >30% response in nasal congestion, averaged over 15 days, were 37% versus 19% in the MFNS and placebo groups, respectively (p < 0.001). Those who experienced a >50% response were 13% and 7%, respectively (p = 0.003). Among the patients treated with MFNS, the mean response was greater during the second versus the first week of treatment. There was no difference between responses in the morning versus evening or for patients with moderate versus severe nasal congestion at baseline. Conclusion: MFNS is effective in relieving moderate-to-severe nasal congestion in patients with SAR. The response to MFNS is maintained with once-daily administration and improves with continuous use over 2 weeks.

Practice Patterns for Chronic Respiratory Diseases in the Asia-Pacific Region: A Cross-Sectional Observational Study.

BACKGROUND: Allergic rhinitis (AR), asthma, chronic obstructive pulmonary disease (COPD), and rhinosinusitis are common and little studied in the Asia-Pacific region. OBJECTIVES: We sought to investigate real-world practice patterns for these respiratory diseases in India, Korea, Malaysia, Singapore, Taiwan, and Thailand. METHODS: This cross-sectional observational study enrolled adults (age ≥18 years) presenting to general practitioners (GP) or specialists for physician-diagnosed AR, asthma, COPD, or rhinosinusitis. Physicians and patients completed study-specific surveys at one visit, recording patient characteristics, health-related quality of life (QoL), work impairment, and healthcare resource use. Findings by country and physician category (GP or specialist) were summarized. RESULTS: Of the 13,902 patients screened, 7,243 (52%) presented with AR (18%), asthma (18%), COPD (7%), or rhinosinusitis (9%); 5,250 of the 7,243 (72%) patients were eligible for this study. Most eligible patients (70-100%) in India, Korea, Malaysia, and Singapore attended GP, while most (83-85%) in Taiwan and Thailand attended specialists. From 42% (rhinosinusitis) to 67% (AR) of new diagnoses were made by GP. On average, patients with COPD reported the worst health-related QoL, particularly to GP. Median losses of work productivity for each condition and activity impairment, except for asthma, were numerically greater for patients presenting to GP vs. specialists. GP prescribed more antibiotics for AR and asthma, and fewer intranasal corticosteroids for AR, than specialists (p < 0.001 for all comparisons). CONCLUSIONS: Our findings, albeit mostly descriptive and influenced by between-country differences, suggest that practice patterns differ between physician types, and the disease burden may be substantial for patients presenting in general practice.

Cross-sectional study on Asthma Insights and Management in the Gulf and Russia.

Background: Asthma is a chronic and complex lung disease that is not completely understood. It involves airway inflammation, reversible airflow obstruction, and bronchial hyperresponsiveness. The most common symptoms are recurrent wheezing, chest tightness, shortness of breath, and coughing. Objective: The Asthma Insights and Management study gathered information on the burden of asthma in the Gulf region (United Arab Emirates, Kuwait, Saudi Arabia) and Russia. Methods: This was a cross-sectional, multinational, noninterventional, two-phase study that collected data from patients ages ≥ 12 years, through interviews and a survey questionnaire. Phase 1 consisted of survey questions focused on estimating the asthma prevalence in the community. Phase 2 was designed to assess the level of asthma control, asthma-related perceptions and behaviors, and presentation patterns. Data were summarized by using descriptive analyses. Results: Analysis of data of 711 patients revealed that the prevalence of asthma among patients who lived in the community was 7.9% and that 66% subjectively perceived their asthma as being controlled. However, 97% of the patients' asthma were partially controlled or uncontrolled based on the Global initiative for Asthma control classification. Troubling symptoms were daytime coughing (33.3%) and shortness of breath (20.3%). With respect to medications for asthma, 76.2% of the patients reported the use of quick relief medication and 80.8% of maintenance medication during the past 4 weeks. Asthma exacerbation in the past year was reported by 40% of adults and adolescents in the study. Conclusion: The results showed that a significant proportion of the patients experienced bothersome symptoms and that many had a lack of knowledge about asthma control and treatment recommendations, which indicated that there is a need for improvements in patient education and asthma care in the Gulf and Russia regions.

Randomized, placebo-controlled study of cetirizine and loratadine in children with seasonal allergic rhinitis.

BACKGROUND: Pharmacologic treatment is a mainstay of allergy therapy and many caregivers use over-the-counter antihistamines for the treatment of seasonal allergic rhinitis (SAR) symptoms in children. OBJECTIVE: To assess the efficacy and safety of cetirizine 10 mg syrup versus loratadine 10 mg syrup versus placebo syrup in a randomized double-blind study of children, ages 6-11 years, with SAR. METHODS: This randomized, double-blind, parallel-group, placebo-controlled study was conducted at 71 U.S. centers during the spring tree and grass pollen season. After a 1-week placebo run-in period, qualified subjects were randomized to once-daily cetirizine 10 mg (n = 231), loratadine 10 mg (n = 221), and placebo (n = 231) for 2 weeks. The primary efficacy end point was change from baseline in the subject's mean reflective total symptom severity complex (TSSC) score over 14 days. RESULTS: Children treated with cetirizine experienced significantly greater TSSC score reductions versus children treated with placebo over 14 days (least square mean change, -2.1 versus -1.6; p = 0.006). The differences in TSSC score improvement over 14 days between the cetirizine versus loratadine groups (-2.1 versus -1.8; p = 0.124) and between the loratadine versus placebo groups (-1.8 versus -1.6; p = 0.230) were not statistically significant. Predominant adverse events in the cetirizine, loratadine, and placebo groups were headache (3.5, 3.6, and 3.1%, respectively) and pharyngitis (3.5, 2.7, and 3.5%, respectively). Somnolence was reported in three subjects (1.3%) treated with cetirizine and in none of the other subjects. CONCLUSION: Cetirizine 10 mg was statistically significantly more efficacious than placebo in the treatment of SAR symptoms in children ages 6-11 years. Symptom improvement was not significantly different between the loratadine 10 mg and placebo groups.

Effect of cetirizine on symptom severity and quality of life in perennial allergic rhinitis.

The effect of cetirizine on quality of life (QOL) in subjects with perennial allergic rhinitis (PAR) has been previously evaluated using generic instruments. While generic QOL tools are used across various conditions, disease-specific instruments evaluate the impact of treatment on areas that are affected by that particular condition. This study evaluated the effect of cetirizine on symptom severity and health-related QOL, using a disease-specific instrument, in adults with PAR. This randomized, double-blind, placebo-controlled study was conducted at 15 U.S. centers outside the pollen allergy season. After a 1-week placebo run-in period, qualified subjects aged 18-65 years with PAR were randomized to once-daily cetirizine 10 mg (n = 158) or placebo (n = 163) for 4 weeks. Change from baseline in total symptom severity complex (TSSC) and overall Rhinitis Quality of Life Questionnaire (RQLQ) scores were primary efficacy end points. Cetirizine produced significantly greater improvements in mean TSSC for each treatment week (p < 0.05) and for the entire 4-week treatment period (p = 0.005) compared with placebo. After 4 weeks, cetirizine-treated subjects reported significantly greater overall improvement in RQLQ scores compared with placebo-treated subjects (p = 0.004). After 1 week, cetirizine produced significant improvements in the nasal symptoms, practical problems, and activities RQLQ domain scores compared with placebo (p < 0.05). After 4 weeks, cetirizine-treated subjects reported significant reductions in these RQLQ domain scores and in emotion domain scores compared with placebo-treated subjects (p < 0.05). Cetirizine 10 mg daily produced significant improvements in symptom severity and allergic rhinitis-related QOL compared with placebo in adults with PAR.

Burden of chronic cough in the UK: results from the 2018 National Health and Wellness Survey.

Background: Chronic cough, defined as daily cough for at least 8 weeks, negatively affects quality of life and work productivity and increases healthcare resource utilisation. We aimed to determine the prevalence and burden of chronic cough in the UK. Methods: Study participants were general population respondents to the 2018 UK National Health and Wellness Survey (NHWS). Respondents completed survey questions relating to health, quality of life, work productivity and activity impairment, and use of healthcare resources. Prevalence estimates were projected to the UK population using post-stratification sampling weights to adjust for sampling bias. The population with chronic cough was matched 1:3 with a group without chronic cough, using propensity score matchingon age, sex and the modified Charlson Comorbidity Index. Results: Of 15 000 NHWS respondents, 715 reported chronic cough in the previous 12 months and 918 during their lifetime. Weighted to the UK adult population, the 12-month prevalence of chronic cough was 4.9% and lifetime prevalence was 6.2%. Prevalence of chronic cough was higher among older respondents and those with smoking histories. Chronic cough respondents experienced higher rates of severe anxiety and depression in the past 2 weeks than matched controls. Poor sleep quality and loss of work productivity were also observed. More chronic cough respondents visited a healthcare provider in the past 6 months than respondents without chronic cough with a mean of 5.8 and 3.7 visits per respondent, respectively. Conclusion: Adults with chronic cough report lower quality of life, reduced work productivity and greater healthcare resource utilisation than matched controls without chronic cough.

Treatment with inhaled mometasone furoate reduces short-acting ß(2) agonist claims and increases adherence compared to fluticasone propionate in asthma patients.

OBJECTIVES: Differences between mometasone furoate (MF), administered once daily, and fluticasone propionate (FP), administered twice daily, dosing regimens may affect adherence and short-acting ß(2) agonist (SABA) use. The objective of this analysis was to compare asthma control outcomes in matched cohorts of MF- and FP-treated asthma patients stratified by SABA claims. METHODS: A retrospective pharmacy claims database analysis identified matched cohorts of asthma patients (aged 12-65 years) who initiated treatment with MF or FP. Patients with none, one to four, five to eight, or more than eight SABA preindex claims were stratified to categories A, B, C, and D, respectively. Bivariate analyses compared postindex SABA canister claims, adherence, and exacerbations; multivariate analyses compared postindex SABA canister claims. RESULTS: Matched patients in categories A (n = 2517 per cohort) and B (n = 2329 per cohort) were analyzed; insufficient sample sizes were identified for categories C and D. Postindex bivariate analyses indicated that MF cohorts had fewer SABA claims compared to FP cohorts (category A, 0.80 vs. 1.17 [P < 0.0001]; category B, 1.39 vs. 1.58 [P < 0.0001]), better adherence to the index drug (category A, 24% vs. 15% [P < 0.0001]; category B, 27% vs. 15% [P < 0.0001]), and fewer exacerbations (category A, 0.17 vs. 0.19 [P = 0.011]; category B, 0.17 vs. 0.21 [P = 0.008]). Multivariate analyses indicated that MF cohorts had fewer postindex SABA claims compared to FP cohorts in categories A and B (P < 0.0001). CONCLUSIONS: Data for SABA claims, treatment adherence, and exacerbations suggest that, compared to twice-daily FP, once-daily MF may provide better asthma control.

Prevalence and Burden of Chronic Cough in the United States.

BACKGROUND: Chronic cough is a common complaint but there are little population-based data on its burden in the United States. OBJECTIVE: To determine the prevalence of chronic cough and its burden on individuals and the health care system. METHODS: This was a survey of respondents who completed the 2018 National Health and Wellness Survey and questions about sleep and health care resource use. Chronic cough was defined as having a daily cough for 8 or more weeks. Respondents without chronic cough were selected through propensity score matching. Chronic cough prevalence was estimated using poststratification sampling weights calculated using U.S. Census data and post-data Horvitz-Thompson sampling weights to adjust for sampling bias. RESULTS: Of 74,977 National Health and Wellness Survey respondents, 3,654 had experienced chronic cough in the previous 12 months, for a weighted prevalence of 5.0%. Respondents with chronic cough were older and more predominantly female than respondents without chronic cough (both P < .001). Compared with matched respondents without chronic cough, those with chronic cough had lower mean scores on the Medical Outcomes Study 36-item Short Form Survey v2 physical (P < .001) and mental (P < .001) component summary scores. More respondents with chronic cough than matched controls experienced severe anxiety and severe depression in the past 2 weeks, work productivity impairment, impaired sleep quality and daytime sleepiness, as well as more emergency department visits and hospitalizations in the past 6 months (P < .001 for all comparisons). CONCLUSIONS: The burden of chronic cough manifests itself as reduced health-related quality of life, increased anxiety and depression, impaired sleep and work productivity, and greater health care utilization.

Assessment of Different Cetirizine Dosing Strategies on Seasonal Allergic Rhinitis Symptoms: Findings of Two Randomized Trials.

BACKGROUND: Cetirizine has been shown to be effective for relief of seasonal allergic rhinitis (SAR) symptoms. Allergic rhinitis symptoms have been reported to have circadian variations, with symptoms tending to be most bothersome overnight and in the morning. OBJECTIVE: To evaluate the effects of different cetirizine dosing schedules in comparison to twice daily (BID) chlorpheniramine and placebo on SAR symptoms at 12 and 24 hours postdose. METHODS: Study 1 subjects received cetirizine 10-mg once daily in the morning (QAM), cetirizine 10-mg once daily at bedtime (QHS), cetirizine 5-mg twice daily, or placebo. Study 2 subjects received cetirizine 5-mg QAM, cetirizine 10-mg QHS, chlorpheniramine 8-mg BID, or placebo. The primary end point was total symptom severity complex (TSSC); TSSC was the sum of symptom severity ratings averaged over the 2-week study period. Post hoc analyses of reflective symptom severity assessed in the morning (TSSCAM) and in the evening (TSSCPM) were conducted to evaluate cetirizine's effects at 12 and 24 hours postdose. RESULTS: In study 1, subject- and investigator-assessed TSSC was significantly lower in all cetirizine groups versus placebo (P ≤ .003). In study 2, subject-assessed TSSC was significantly lower in all cetirizine groups versus placebo (P ≤ .04) and was numerically lower for investigator-assessed TSSC. Post hoc analyses demonstrated that cetirizine significantly improved TSSCAM at 12 and 24 hours postdose versus placebo in both studies regardless of dosing schedule. TSSCPM significantly improved at 12 and 24 hours postdose in all study 1 cetirizine groups versus placebo. In study 2, versus placebo, TSSCPM significantly improved at 12 hours postdose in cetirizine 5-mg QAM group and numerically improved at 24 hours postdose in cetirizine 10-mg QHS group. CONCLUSION: Regardless of dosing regimen, cetirizine demonstrates effective 24-hour relief of SAR symptoms, particularly on TSSCAM, which assesses overnight and early morning symptom control.

Mometasone furoate versus beclomethasone dipropionate: effectiveness in patients with mild asthma.

OBJECTIVES: To evaluate adherence to therapy and markers of asthma control among patients with mild asthma prescribed mometasone furoate dry powder inhaler or beclomethasone dipropionate hydrofluoroalkane aerosol inhaler. STUDY DESIGN: Retrospective healthcare claims database analysis (2005-2008). METHODS: Included were patients with mild asthma aged 12 to 65 years (1273 matched patients in each treatment cohort) who resided in the United States and were enrolled in their health plan for at least 1 year before (ie, preindex period) and after (ie, postindex period) they initiated treatment with mometasone furoate or beclomethasone dipropionate. Patients were propensity score matched based on demographic data and preindex variables. Claims were analyzed during the postindex period for adherence to mometasone furoate or beclomethasone dipropionate, measured as the percentage of days covered and the numbers of exacerbations and short-acting beta2-agonist (SABA) claims. RESULTS: Multivariate analyses indicated that the cohort receiving mometasone furoate had better outcomes than the cohort receiving beclomethansone dipropionate, including greater adherence (29.5% vs 20.2%, respectively, P <.001), fewer exacerbations (mean, 0.12 vs 0.19, P = .002), and decreased SABA canister claims (mean, 0.9 vs 1.1, respectively, P <.001). CONCLUSIONS: Adherence to prescribed therapy among patients with mild asthma may be better with mometasone furoate versus beclomethasone dipropionate, as reflected in fewer exacerbations and more limited use of SABA rescue medications. Improved adherence to mometasone furoate versus beclomethasone dipropionate may be related to a simpler dosing regimen (ie, once daily vs twice daily).

Mometasone furoate vs fluticasone propionate with salmeterol: multivariate analysis of resource use and asthma-related charges.

OBJECTIVE: Although current National Asthma Education and Prevention Program (NAEPP) guidelines indicate low-dose inhaled corticosteroid (ICS) monotherapy as the preferred treatment for patients with mild persistent asthma, many patients receive ICS and long-acting beta(2)-agonist (LABA) combinations. The objective of the current study was to evaluate asthma-related charges in patients with mild asthma who began treatment with mometasone furoate (MF) versus those who began treatment with a fluticasone propionate/salmeterol (FPS) combination. RESEARCH DESIGN AND METHODS: This retrospective administrative claims database analysis collected data from the 365-day periods before (preindex period) and after (postindex period) the study index date from patients with mild asthma aged 12 to 65 years who began treatment with MF or FPS. Asthma-related inpatient, outpatient, pharmaceutical, and total charges; exacerbations; short-acting beta(2)-agonist (SABA) canister claims; and adherence to therapy were assessed. Matched cohorts of MF and FPS patients were compared using multivariate generalized linear regression models. RESULTS: Among matched MF (n = 4094) and FPS (n = 4094) cohorts, MF patients had significantly lower postindex asthma-related total charges ($2136 vs $2315, respectively; P = 0.0003), lower pharmaceutical charges ($727 vs $925, respectively; P < 0.0001), fewer exacerbations (0.14 vs 0.16, respectively; P = 0.0306), fewer SABA canister claims (0.9 vs 1.0, respectively; P < 0.0001), and greater adherence measured by prescription fills (3.0 vs 2.8, respectively; P < 0.0001). Asthma-related inpatient charges, outpatient charges, and adherence measured by percent of days covered were not significantly different between treatment cohorts. Limitations included a lack of additional ICS and ICS/LABA therapies, a lack of pediatric patients, and the general limitations associated with retrospective database analyses (e.g., no patient records). CONCLUSIONS: These data suggest that MF may be more cost-effective than FPS for the treatment of mild asthma. To effectively and efficiently manage asthma, it is important for clinicians to follow current NAEPP guidelines, which indicate ICS monotherapy as preferred treatment for mild persistent asthma.

Tratamiento racional de la alergia respiratoria / Rational treatment of the respiratory allergy

Las enfermedades alérgicas son muy frecuentes, por lo que todos los médicos atienden pacientes con alguna de ellas. Este hecho justifica ampliamente el conocimiento de la inmunopatología de la respuesta frente a alergenos. Aún cuando existen diferencias entre algunas de estas enfermedades, una "respuesta inmediata" posterior a la exposición a un alergeno caracteriza a la mayoría y es común la presentación de otra fase "respuesta inmediata", que aparece pocas horas después de la reacción inicial y luego de la desaparición de los síntomas que la acompañan. Las consideraciones terapéuticas hacia ambas fases son de gran importancia para el control de las manifestaciones fisiopatológicas y clínicas, así como la aparcición de mediadas y formas de tratamiento orientadas a la profilaxis. Este artículo revisa la inmunopatología de la respuesta alérgica bifásica, empleando el modelo de rinitis alérgica, y sus consideraciones terapéuticas

Prevalencia de hepatitis A, hepatitis B y varicela según la edad en Caracas / Prevalent of hepatitis A, hepatitis B and chickenpox accord the age at Caracas

Conocer la situación epidemiológica de las enfermedades infecto-contagiosas es de gran importancia para diseñar programas de prevención y atención médica a la población. Los estudios de prevalencia con muestras de población, como el presente, aportan cifras que reflejan mejor la situación epidemiológica en comparación con los registros de mortalidad. La hepatitis A, B y varicela son enfermedades infecto-contagiosas frecuentes en Venezuela, poco investigadas en cuanto a su comportamiento epidemiológico, a pesar de ser consideradas de denuncias abligatoria. Métodos: en una muestra de 495 personas entre 1 y 40 años de edad, se determinó la presencia, en la sangre, de anticuerpos antivirus A (IgG anti VHA), anti virus B (IgG anticore y anti-superficie) y anti-varicela (IgG), además de obtener datos clínicos y epidemiológicos. Resultados: prevalencia encontrada: Hepatitis A, 55,6 por ciento con aumento progresivo de un 27,3 por ciento en el grupo 1-5 años hasta 88,9 por ciento en 31-40 años de edad, sin diferencia por sexo. Hepatitis B: 3,18 por ciento positivos para anticore, de los cuales 60 por ciento presentó además anti-superficie. El grupo 31-40 años presentó la mayor prevalencia (11,1 por ciento, hubo sólo 5 casos en menores de 15 años y no se encontró diferencia por sexo. La prevalencia anticuerpos anti-varicela alcanzó 72,9 por ciento en todo el grupo, 50,81 por ciento en el grupo de 1-5 años, 69 por ciento en 6-10 años y más de 80 por ciento en los mayores de 10 años, sin diferencia por sexo. La hepatitis A afecta a más de la mitad de nuestra población urbana. Las cifras se incrementan significativamente en el inicio del período preescolar y hay un importante número de adultos susceptibles (entre 11,1 y 34,6 por ciento). La prevalencia de la infección por virus B nos sitúa en el nivel intermedio (OMS), sin embargo las cifras de este estudio son relativamente bajas (3,18 por ciento) para anticore), particularmente al compararlas con estudios en poblaciones marginales e indígenas venezolanas. Los adultos fueron los más afectados sugirieron la importancia del patrón de transmisión sexual. La varicela es altamente prevalente, afectando hasta el 95 por ciento en algunos de los grupos de edad estudiados y presenta un patrón de transmisión temprana (en la infancia). Nuestros resultados refuerzan la necesidad de redimensionar los actuales programas de prevención y control de la hepatitis A, hepatitis B y varicela en nuetro país

Furoato de mometasona aerosol nasal (FMSN) en el tratamiento de la rinitis alérgica persistente / Furoato of mometasona aerosols nasal (FMSN) in the treatment of the rhinitis allergic perennial

En Venezuela la rinitis alérgica tiene una prevalencia estimada en 20-30 por ciento (escolares). Los síntomas son la obstrucción nasal, estornudos, rinorrea, y prurito nasal, ocular y lacrimeo. Las patologías asociadas son: otitis media, asma, sinusitis y goteo nasal posterior con tos o bronquitis. El consenso ARIA (Allergic Rhinitis and its Impact on Asthma) clasifica a la rinitis alérgica en intermitente y persistente, si tiene más o menos 4 semanas de duración. Entre las opciones terapéuticas, los corticoides nasales representan la más efectiva. Furoato de Mometasona (FM) ha demostrado poseer una alta potencia para reducir el número de mediadores involucrados en la respuesta inflamatoria tanto en su fase precoz como tardía; las experiencias controladas en Venezuela con FM en aerosol nasal (FMSN) u otros esteroides intranasales en rinitis alérgica persistente e intermitente son escasas.

Experiencia terapéutica con desloratadina en urticaria crónica idiopática / Therapeutic experience with desloratadine in idiopathic chronic urticaria

La urticaria es una afección común de la piel que puede presentarse en un 15 a un 20 por ciento de la población general. La desloratadina es un nuevo antagonista de los receptortes periféricos H1, de histamina, sin efectos sedantes. Estudios internacionales en urticaria crónica han demostrado que la desloratadina es segura y eficaz. El presente estudio observacional, fase IV, prospectivo, abierto multicéntrico evalúa la eficacia y seguridad y reporta la experiencia local con la desloratadina en el manejo de la urticaria crónica idiopática. Se administraron 5 mg de Desloratadina vía oral, una vez al día durante un período total de 30 días. La respesta clínica se evaluó de acuerdo a una escala que tomó en cuenta 4 parámetros: número de habones, severidad del prurito, interrupción de la actividad diaria e interrupción del sueño; cada parámetro con 4 grados en la evaluación (0-3). Se incluyeron 86 pacientes entre 12 y 73 años (39 ± 15). Sesenta y cinco por ciento de los sujetos fueron del sexo femenino. El Puntaje Total de Síntomas tuvo un promedio de 7,56 ± 2,32 al inicio, disminuyendo hasta 1,26 ± 1,59, al completar la terapia; la diferencia promedio observada resultó 6,20 (p<0,001). La propuesta fue señalada como excelente y buena por 76 médicos (88,37 por ciento) mientras que 75 pacientes se manifestaron como satisfechos o con resolución total de su enfermedad (87,2 por ciento). La incidencia de eventos adversos fue de 6,9 por ciento (ninguno serio). Así, Desloratadina, 5 mg diariamente, resulta una opción eficaz para controlar los síntomas de la urticaria idiopática crónica y los efectos que la misma produce en las actividades cotidianas y el sueño con baja incidencia de eventos adversos

Tratamiento radiológico-endoscópico de la obstrucción de la unión pieloureteral / Radiologic-endoscopic treatment of the pieloureteral union

El presente trabajo es el primer reporte sobre el uso del catéter Acucise en Venezuela. 6 pacientes con obstrucción del tracto urinario superior, (obstrucción de la unión pieloureteral), fueron tratados mediante incisiones internas con el catéter acucise. El tiempo operatorio promedio fue de 48 minutos y el período promedio fue de 48 minutos y el período promedio de hospitalización fue de 2 días. Se utilizó anestesia peridual en todos los casos. El seguimiento promedio fue de 12 meses. Las evaluaciones postoperatorios se realizaron en base a mejoría clínica, urogramas excretores y renogramas isotópicos. Se obtuvieron resultados exitosos en el 83 por ciento de los casos (mejoría clínica y radiológica). Esta experiencia preliminar, aunque limitada, permite concluir que el tratamiento de la obstrucción del tracto urinario superior con el catéter Acusive es efectivo y seguro, pudiendo convertirse en una alternativa menos invasiva que la endopielotomía endoscópica.

Tos persistente en el niño / Chronic caugh in children

En el presente trabajo el autor hace referencia a la tos en general, y a la tos persistente en particular, aquella que tiene una duración de 3 o más semanas es decir la tos crónica. Señalando esta patología como un importante problema, no solamente para los niños sino tambien para los adultos. Las recomendaciones, sobre el tratamiento usando agentes antitusígenos