Effects of using montelukast during acute wheezing attack in hospitalized preschool children on the discharge rate and the clinical asthma score.

BACKGROUND: In chronic asthma treatment, leukotriene receptor antagonists have been recommended, but it is not clear whether montelukast can be used in acute recurrent wheezing attacks in children. OBJECTIVE: To investigate the safety and effectiveness of oral montelukast in addition to standard treatment in hospitalized children aged between 6 and 72 months with acute recurrent wheezing attacks. METHOD: One hundred patients aged between 6 and 72 months who had wheezing attacks with clinical asthma scores (CAS) ≥3 and were hospitalized were included in this randomized, double-blind, placebo-controlled, parallel-group clinical trial. All the patients included in the study were given 0.15 mg/kg (maximum 5 mg) nebulized salbutamol (8 L/min and with 100% O2 ) with 4 h of intervals, 1 mg/kg prednisolone (maximum 5 days), nebulized ipratropium bromide (total eight doses) with 6 h of intervals. In addition to this treatment, one group received 4 mg montelukast, and the other group received a placebo. The CAS of the patients were evaluated with 4-h intervals. RESULTS: Total hospital length of stay (LOS) was not different between the montelukast and placebo groups (p = 0.981). There was no statistically significant difference between the two treatment groups in terms of discharge time, CAS, and oxygen saturation (p ≥ 0.05). CONCLUSION: Adding montelukast to standard treatment in patients hospitalized for moderate-to-severe wheezing attacks did not affect hospital LOS and CAS.

Efectos de la concentración de 25-hidroxi vitamina D sobre la gravedad y el control del asma en pacientes asmáticos en edad escolar / Effects of 25 hydroxy vitamin D levels on the severity and asthma control in school age asthma patients

Objetivo. Determinar la concentración de vitamina D en pacientes de entre 6 y 18 años de edad sometidos a un seguimiento por asma y la relación entre la concentración de vitamina D y el control y la gravedad del asma. Materiales y métodos. Se inscribió en el estudio a pacientes con asma y voluntarios sanos de entre 6 y 18 años de edad, asignados al grupo de pacientes y al grupo de referencia, respectivamente. Se registraron las características demográficas y los hallazgos clínicos de los pacientes, y se les realizó una prueba funcional respiratoria. Se estimaron el índice de masa corporal (IMC) y la concentración de 25-hidroxi vitamina D (25(OH)D), calcio, fósforo, fosfatasa alcalina, inmunoglobulina E total y eosinófilos de todos los pacientes. La gravedad del asma y las condiciones de control se determinaron según los criterios de la Iniciativa Global para el Asma (Global Initiative for Asthma, GINA). Resultados. Se incluyó a 72 pacientes con asma y a 66 niños sanos. En comparación con el grupo de referencia, en el grupo de pacientes se detectó una menor concentración de vitamina D. En 38 (52,8%) niños del grupo de pacientes con asma se observó deficiencia de vitamina D; en este grupo, el control del asma era deficiente y la gravedad, significativamente mayor. No se observó una correlación significativa entre la concentración de vitamina D y el sexo, la obesidad, las pruebas funcionales respiratorias, las pruebas cutáneas, la concentración sérica de eosinófilos e inmunoglobulina E (IgE) total. Conclusión. La deficiencia y la insuficiencia de vitamina D fueron más frecuentes en los niños con asma, en comparación con los niños del grupo de referencia. Una menor concentración de vitamina D se asocia con un control deficiente del asma y una mayor gravedad de esta.

Background. The objective was to determine vitamin D levels in patients between the ages 6 and 18 years, followed for asthma, and the relation between vitamin D levels and asthma control and severity. Materials and Methods. Patients with asthma and healthy volunteers between the ages 6 and 18 years were enrolled into the study as patient and control groups, respectively. Patient demographic information and clinical findings were recorded; a respiratory function test was performed. Body mass index (BMI), 25(OH) D,calcium, phosphorus, alkaline phosphatase, total IgE and eosinophil levels were determined for all patients. Asthma severity and control conditions were established based on GINA (Global Initiative for Asthma) criteria. Results. Seventy two patients with asthma and 66 healthy children were included. Compared to the control group, decreased serum vitamin D levels were detected in patient group. Thirty eight (52.8%) patients in asthma patient group had vitamin D defficiency; in this group, asthma control was poor and asthma severity was significantly higher. No significant correlation was found between vitamin D levels and gender, obesity, respiratory functions, skin test, serum eosinophil and total IgE levels. Conclusion. The frequency of vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Lower levels of vitamin D are associated with poor asthma control and increased asthma severity.

Effects of 25 hydroxy vitamin D levels on the severity and asthma control in school age asthma patients. / Efectos de la concentración de 25-hidroxi vitamina D sobre la gravedad y el control del asma en pacientes asmáticos en edad escolar.

BACKGROUND: The objective was to determine vitamin D levels in patients between the ages 6 and 18 years, followed for asthma, and the relation between vitamin D levels and asthma control and severity. MATERIALS AND METHODS: Patients with asthma and healthy volunteers between the ages 6 and 18 years were enrolled into the study as patient and control groups, respectively. Patient demographic information and clinical findings were recorded; a respiratory function test was performed. Body mass index (BMI), 25(OH) D,calcium, phosphorus, alkaline phosphatase, total IgE and eosinophil levels were determined for all patients. Asthma severity and control conditions were established based on GINA (Global Initiative for Asthma) criteria. RESULTS: Seventy two patients with asthma and 66 healthy children were included. Compared to the control group, decreased serum vitamin D levels were detected in patient group. Thirty eight (52.8%) patients in asthma patient group had vitamin D defficiency; in this group, asthma control was poor and asthma severity was significantly higher. No significant correlation was found between vitamin D levels and gender, obesity, respiratory functions, skin test, serum eosinophil and total IgE levels. CONCLUSION: The frequency of vitamin D deficiency and insufficiency was higher in children with asthma, compared to the controls. Lower levels of vitamin D are associated with poor asthma control and increased asthma severity.

OBJETIVO: Determinar la concentración de vitamina D en pacientes de entre 6 y 18 años de edad sometidos a un seguimiento por asma y la relación entre la concentración de vitamina D y el control y la gravedad del asma. MATERIALES Y MÉTODOS: Se inscribió en el estudio a pacientes con asma y voluntarios sanos de entre 6 y 18 años de edad, asignados al grupo de pacientes y al grupo de referencia, respectivamente. Se registraron las características demográficas y los hallazgos clínicos de los pacientes, y se les realizó una prueba funcional respiratoria. Se estimaron el índice de masa corporal (IMC) y la concentración de 25-hidroxi vitamina D (25(OH)D), calcio, fósforo, fosfatasa alcalina, inmunoglobulina E total y eosinófilos de todos los pacientes. La gravedad del asma y las condiciones de control se determinaron según los criterios de la Iniciativa Global para el Asma (Global Initiative for Asthma, GINA). RESULTADOS: Se incluyó a 72 pacientes con asma y a 66 niños sanos. En comparación con el grupo de referencia, en el grupo de pacientes se detectó una menor concentración de vitamina D. En 38 (52,8%) niños del grupo de pacientes con asma se observó deficiencia de vitamina D; en este grupo, el control del asma era deficiente y la gravedad, significativamente mayor. No se observó una correlación significativa entre la concentración de vitamina D y el sexo, la obesidad, las pruebas funcionales respiratorias, las pruebas cutáneas, la concentración sérica de eosinófilos e inmunoglobulina E (IgE) total. CONCLUSIÓN: La deficiencia y la insuficiencia de vitamina D fueron más frecuentes en los niños con asma, en comparación con los niños del grupo de referencia. Una menor concentración de vitamina D se asocia con un control deficiente del asma y una mayor gravedad de esta.

Training of trainers on epinephrine autoinjector use.

The majority of physicians do not know how to use epinephrine autoinjectors. This displays that current education of physicians on anaphylaxis is inadequate for a thorough practice. We hypothesize that a theoretical lecture together with a practical session on epinephrine autoinjector use will improve its proper use by physicians. Residents, specialists, and consultants from General Pediatrics excluding allergists and allergy fellows were included in this study. All physicians were given an eight-item questionnaire followed by a practical session scoring and timing ability to use epinephrine autoinjector trainer. This ensued with one-to-one hands-on training on correct autoinjector use. Finally, a joint theoretical lecture on anaphylaxis including re-demonstration of epinephrine autoinjector use was given. All physicians were scored a second time on use of epinephrine autoinjector 6 months later. One hundred fifty-one of 196 participants completed all steps of the study in four tertiary hospitals. Correct use of epinephrine autoinjector improved from 23.3% to 74.2%, mean score from 3.49 ± 1.14 to 4.66 ± 0.65, need for prospectus from 91.4% to 29.1%, and mean time to administer autoinjector from 28.01 ± 6.22 s to 19.62 ± 5.01 s (p < 0.001 for each). The rate of most common mistakes during autoinjector use decreased but the ranking did not change. An integrated theoretical and practical education increased correct of epinephrine autoinjector use by physicians. Ongoing mistakes despite this education may be related with its design.

Evaluation of new sensitizations in asthmatic children monosensitized to house dust mite by specific immunotherapy.

Specific immunotherapy (SIT) is one of the treatment modalities recomended for the management of asthma and allergic rhinitis by international guidelines. A potential benefit of immunotherapy (IT) is to prevent the development of sensitisation to new allergens. There is stil no conclusion on this subject. One hundred twenty-two children 8-18 years old with intermittent asthma, with or without allergic rhinitis, all of whom were monosensitised to house dust mite (HDM) were selected. Sixty two of these children accepted to receive SIT with HDM extract for 4 years and the remaining 60 did not accept SIT and were treated with asthma medications only. This second group of children served as the control group. At the end of the 4-year study period, 36 of the 53 patients (67.9%) in the SIT group showed no new sensitizations, compared to 38 of 52 (73.0%) in the control group (p = 0.141). The most frequent new sensitizations at the end of the study were pollens, grasses and olive polen, followed by animal dander, alternaria and cockroach. In conclusion, SIT may not prevent the onset of new sensitizations in asthmatic children monosensitized to house dust mites. Further investigation is required to clarify the immunologic mechanisms and other factors by which SIT reduces or not the development of new sensitizations in monosensitized children.