Clinical evaluation and treatment of acute asthma exacerbations in children.

This update on treatment of asthma exacerbations in children is the result of an Italian Pediatric Society Task-force, made up of a panel of experts working in 2007-2008. The aim is to give clear indications on the use of the drugs most employed in children, grading the quality of evidence and the strength of recommendations. Suggestions on their limits due to unlicensed and off-label use are reported. The level of evidence and the strength of recommendations for different therapeutic approaches demonstrate that frequently the use of drugs in children is extrapolated from the experience in adults and that more studies are required to endorse the correct use of different drugs in asthmatic children.

Efficacy and duration of action of oral procaterol in asthmatic children after single administration of different dosages.

A double-blind crossover study was performed to evaluate the bronchodilating effect of different single doses of procaterol (less than 0.5 micrograms/kg, 1.5 micrograms/kg, and placebo) orally administered. Sixteen asthmatic children, age 6-12 years, participated in the trial. Pulmonary function, heart rate, blood pressure, and tremor were evaluated at 30, 60, 90, and 120 min and then hourly for 8 hours after administration. All three doses were therapeutically effective. The 1.5 micrograms/kg dose produced a more sustained bronchodilatation effect, but was also associated with an increase in the incidence of tremors. The 0.5 micrograms/kg dosage may, however, be a good starting dose because it assures a reasonable risk/benefit ratio.

Efficacy and safety of loratadine suspension in the treatment of children with allergic rhinitis.

The safety and efficacy of loratadine was compared with that of dexchlorpheniramine in children with allergic rhinitis. Twenty-one children received loratadine 0.11-0.24 mg/kg ideal body weight once daily and 19 dexchlorpheniramine 0.10-0.23 mg/kg every 8 h (0.30-0.69 mg/24 h) for 14 consecutive days. Both loratadine and dexchlorpheniramine were effective in reducing nasal and ocular symptoms in allergic children. Substantial improvement in allergy symptoms was observed at the first evaluation (day 3 of treatment) and was maintained for the study duration. No significant trend of abnormality in laboratory parameters was observed. Drowsiness was present only in the dexchlorpheniramine-treated group. Loratadine appears to be a simple, effective and safe therapy for seasonal allergic rhinitis.

Comparison of the protective effect and duration of action of orally administered clenbuterol and salbutamol on exercise-induced asthma in children.

Clenbuterol (C), a long-acting beta 2-selective bronchodilator was compared with salbutamol (S) in exercise-induced asthma (EIA) at two premedication time levels. Sixteen asthmatic children with EIA living at an altitude of 1,750 m were treated with C (0.001 mg/kg) and S (0.12 mg/kg), administered randomly in a double-blind cross-over study 90 and 300 minutes before exercise tests of running on a treadmill for 6 minutes. Pulmonary functions were evaluated prior to the administration of the drugs and immediately before, at the end of, and 2, 5, 10, 15, 20, and 25 minutes after exercise tests. In the preliminary screening exercise test the mean fall of FEV1 was 41.1%, but it was 21.0% and 27.1% after S and 21.9% and 19.9% after C administered 90 and 300 min prior to the test, respectively. Salbutamol administered 300 minutes before the test was statistically less effective than the same drug administered 90 minutes before the test or C administered 300 minutes before the test. Therefore, we can conclude that clenbuterol provides a more lasting protection than salbutamol in EIA.

Comparative study of two methods for spinhaler-specific bronchoprovocation challenges. II.

Two different methods of performing specific bronchial challenge using a micronized freeze-dried extract of D. pteronyssinus administered as a powder by a spinhaler have been evaluated in 11 children with chronic asthma and skin test RAST positive for house dust mite D. pteronyssinus. In the first method, "Cumulative Dose Method" (CDM), the test doses of antigen [0, 50, 100, 200, 400, 600, 800, and 1,000 Allergenic Units (A.U.)] were successively administered in 30-minute intervals. With the other method, "Daily Increasing Dose Method" (DIDM), a single antigen challenge (only one cup) was performed every day successively. The tests were considered positive when FEV1 values dropped below 20% of the value obtained immediately before the inhalation of the antigen. The early FEV1 fall was 36.6% +/- 10.8% with CDM and 29.1% +/- 11.5% with DIDM. There was a mean late fall of FEV1 52% +/- 17% and 35.3% +/- 12.2%, respectively, after a mean antigen administration of 270 +/- 149 A.U. with CDM and of 290 +/- 202 A.U. with DIDM. An increase in non-specific bronchial reactivity was observed after specific challenge performed with both methods. The CDM offers the advantage of obtaining information more quickly. The DIDM offers the advantage of administering a lower daily dose of antigen. Our results indicate that a modification of CDM with a shorter interval of administration may further improve this method of antigen administration.

[Pulmonary fibrosis in children: diagnosis and therapy]. / Fibrosi polmonari in età pediatrica: diagnosi e terapia.

Pulmonary fibrosis is a chronic disorder characterized by inflammation, injury and fibrosis of the alveolar structures and consequent loss of functional alveolar-capillary units. It involves a number of unresolved terminologic, pathogenetic, diagnostic and therapeutic controversies. The key to understanding the disease is the recognition that inflammation is the first event. The staging of the patients, important for correct therapy decision, is made using methods that specifically evaluate the inflammation such as open lung biopsy, bronchoalveolar lavage, and Gallium 67 scanning. The most rational therapeutic approach is to suppress the inflammation and to prevent further injury and scarring. The drugs of choice for treatment are corticosteroids (prednisone particularly). It is suggested to use large doses during the initial portion of the therapeutic trial followed by a tapering of the dose. If the patient does not respond to corticosteroids other immunosuppressive agents can be considered, particularly cyclophosphamide. The frequency and duration of response to these regimens remains to be defined.

Comparison of two new controlled-release theophylline formulations in the management of asthma in children and reliability of salivary theophylline concentration.

Two slow-release preparations of theophylline have been compared in an open crossover trial in the treatment of 20 asthmatic children. Theophylline concentrations were measured in both serum and saliva. Although the treatment preference of both patients and clinicians was for Somofillina Ritardo, there was no significant difference between the two treatments in respect to either serum and salivary concentrations. Nor did their mean bioavailabilities differ significantly. The results indicated that concentration in saliva was not a useful indicator of the serum concentration.