Triple inhaled drug protocol for the treatment of acute severe asthma.

STUDY OBJECTIVE: This study tests the hypothesis that the administration of multiple doses of inhaled albuterol (A), ipratropium bromide (IB), and flunisolide (F) provides an additional benefit to adults with acute severe asthma compared with the administration of A plus IB (A/IB) or A plus F (A/F). DESIGN: Randomized, double-blind, prospective trial. PATIENTS AND INTERVENTIONS: One hundred seventy-two patients who presented to an emergency department were assigned to receive A, IB, and F (ie, triple drug treatment [TDG]; 56 patients), A/IB (60 patients), or A/F (56 patients). All drugs were administered through a metered-dose inhaler and spacer at 10-min intervals for 3 h. RESULTS: Patients who received TDG had an overall 64% greater improvement (95% confidence interval [CI], 24 to 103%; p = 0.002) in FEV(1) (mean [+/- SD], 2.1 +/- 0.6 L) than those who received A/F (mean, 1.7 +/- 0.6 L), and a 41% greater improvement (95% CI, 1 to 80%; p = 0.04) than those who received A/IB (mean, 1.8 +/- 0.6 L). Differences between groups increased with time (p = 0.001). At 3 h, there was a trend toward a reduction in hospital admission rates (A/IB group, 25%; A/F group, 20%; and TDG group, 11%). The patients who were the most likely to benefit (ie, those with a greater improvement in pulmonary function and a significant reduction in the hospitalization rate) from TDG were those with more severe obstruction (ie, FEV(1), < 30% of predicted). The benefit of TDG was equally evident independent of the patient's previous use of corticosteroids. CONCLUSIONS: The data suggest that there was a therapeutic benefit from the addition of IB and F to A administered in high doses, particularly in those patients in whom the FEV(1) was < 30% of the predicted value.

[Adrenal function in topic corticotherapy]. / La función suprarrenal en la corticoterapia tópica.

It has been shown that corticosteroids for dermatological use produce an inhibition of the adrenal function, and it is considered that in our milieu these products are used without any precise indication. In this study, 29 ambulatory children from 3 to 15 years of age were selected, who were suffering from dermatoses with different degrees of extension, on whom urinary 17-ketosteroids, 17-ketogenicsteroids and serum cortisol were measured before and after non-occlusive treatment of two weeks, using 0.01 percent fluorocorticoids and controls after 24 hours and 8 days. A significant drop of the 17-keratogenicsteroids was found in patients studied at the end of the treatment, with immediate recovery. Additionally it was observed, in patients who had over 30 percent of skin area involved, that there was a decrease in serum cortisol, which persisted even 24 hours after discontinuing treatment, with normal levels in a measurement taken eight days later. It is therefore concluded that glucocorticoids applied topically are capable of inhibiting adrenal function.