Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma.

OBJECTIVE: To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. METHODS: This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. RESULTS: A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. CONCLUSION: Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010.

Association between beta-2 adrenergic receptor variants and clinical outcomes in children and adolescents with acute asthma

ABSTRACT Objective To investigate whether different genotypes of p.Arg16Gly, p.Gln27Glu, p.Arg19Cys and p.Thr164Ile variants interfere in response to treatment in children and adolescents with moderate to severe acute asthma. Methods This sample comprised patients aged 2 to 17 years with a history of at least two wheezing episodes and current moderate to severe asthma exacerbation. All patients received multiple doses of albuterol and ipratropium bromide delivered via pressurized metered-dose inhaler with holding chamber and systemic corticosteroids. Hospital admission was defined as the primary outcome. Secondary outcomes were changes in forced expiratory volume in the first second after 1 hour of treatment, and for outpatients, length of stay in the emergency room. Variants were genotyped by sequencing. Results A total of 60 patients were evaluated. Hospital admission rates were significantly higher in carriers of the genotype AA relative to those with genotype AG or GG, within the p.Arg16Gly variant (p=0.03, test χ2, alpha=0.05). Secondary outcomes did not differ between genotypes. Conclusion Hospital admission rates were significantly higher among carriers of the genotype AA within the p.Arg16Gly variant. Trial registration: ClinicalTrials.gov: NCT01323010

Albuterol via metered-dose inhaler in children: Lower doses are effective, and higher doses are safe.

BACKGROUND: The ideal dosing of albuterol via metered-dose inhalers for acute childhood asthma is not well established. We hypothesized that greater doses of albuterol would result in less time in the hospital and lower admission rates. METHODS: This was a randomized controlled double-blind multicenter study, conducted in emergency rooms (ER). We included patients with 2-17 years old with moderate to severe acute asthma (Pediatric Respiratory Assessment Measure, PRAM, score ≥5). Dosages administered during the first hour included: 6 (up to 25 kg) or 12 puffs (>25 kg) in the control group and 9 (up to 15 kg), 12 (>15-20 kg), 15 (>20-25 kg), or 18 puffs (>25 kg) in the study group. Several efficacy (changes in PRAM score, pulse oximetry, and FEV1 , length of stay, and admission rates) and safety (albuterol plasma levels, heart rate, serum potassium, glucose and bicarbonate levels, EKG, and tremor rates) outcome measures were assessed. RESULTS: We included 119 patients with similar baseline conditions, and no significant differences were observed between groups in the length of stay (P = 0.48) or admission rate (P = 0.55). No significant differences were observed in FEV1 , PRAM score, and pulse oximetry changes after 1 hr and at discharge or admission. No significant differences were observed in safety outcomes between groups. CONCLUSIONS: Higher albuterol dosage regimens did not result in lower admission rate or shorter length of stay in the ER, but showed similar safety profile for children with moderate to severe acute asthma. Pediatr Pulmonol. 2016;51:1122-1130. © 2016 Wiley Periodicals, Inc.

Uso de inaladores dosimetrados em pacientes com asma: conhecimentos e efeitos de uma orientação teórico-prática para pediatras / Metered-dose inhaler for asthma patients: knowledge and effects of a theoretical and practical guidance for pediatricians

Objective: To evaluate the effect of a theoretical and practical guidance on knowledge of pediatricians regarding the use of metered dose inhalers with spacers. To identify major deficiencies, correct them and train these physicians on the correct use of the devices. Methods: Pediatricians who participated in a theoreticalpractical program focusing on the use of inhaler devices answered a questionnaire with five questions about the use of these devices before and after the program. A comparison of the scores obtained in the pre- and post-training tests was performed by Wilcoxon test for related samples, and a significance level of 0.05 was adopted. Results: Twenty pediatricians performed pre- and post-training tests. The performance of pediatricians in the post-training test was significantly better than baseline (p<0.001). Conclusion: A brief orientation program for pediatricians significantly improved their knowledge on the use of metered-dose inhalers with spacers, which may translate into an improvement in quality and quantity of prescriptions of these devices in clinical practice. The questions with higher rates of errors in the pre-training test were the questions about the waiting time between two sprays in successive applications and about the correct way to attach the inhaler to the spacer, both with high levels of success in the post-training test.

Objetivo: Avaliar o efeito de uma orientação teórico-prática sobre o conhecimento de pediatras a respeito do uso de inaladores dosimetrados com espaçadores. Detectar as principais deficiências, corrigi-las e capacitar esses médicos para a correta utilizaçãodesses inaladores. Métodos: Pediatras que participaram de um curso teórico-prático a respeito do uso de dispositivos inalatórios responderam a um questionário com cinco perguntas sobre o uso desses dispositivos antes e após o curso. A comparação entre asnotas obtidas no pré e no pós-teste foi feita por meio do teste de Wilcoxon para amostras relacionadas, sendo adotado um nível de significância de 0,05. Resultados: Vinte pediatras realizaram o pré e o pós-teste. O desempenho dos médicos no pós-teste foi significativamente melhor que o inicial (p<0,001). Conclusão: Um breve programa de orientação a pediatras melhorou de forma significativa o conhecimento desses médicos a respeito do uso de inaladores dosimetrados com espaçadores, fato que pode se traduzir em uma melhora na qualidade e na quantidade de prescrições desses dispositivos na prática clínica. As questões com maiores índices de erros no pré-teste foram a relativa ao tempo necessário entre dois jatos em aplicações sucessivas e a que diz respeito à maneira correta de se acoplar o inalador ao espaçador, todas com altos níveis de acertos no pós-teste.

Metered-dose inhaler for asthma patients: knowledge and effects of a theoretical and practical guidance for pediatricians.

OBJECTIVE: To evaluate the effect of a theoretical and practical guidance on knowledge of pediatricians regarding the use of metered dose inhalers with spacers. To identify major deficiencies, correct them and train these physicians on the correct use of the devices. METHODS: Pediatricians who participated in a theoretical-practical program focusing on the use of inhaler devices answered a questionnaire with five questions about the use of these devices before and after the program. A comparison of the scores obtained in the pre- and post-training tests was performed by Wilcoxon test for related samples, and a significance level of 0.05 was adopted. RESULTS: Twenty pediatricians performed pre- and post-training tests. The performance of pediatricians in the post-training test was significantly better than baseline (p<0.001). CONCLUSION: A brief orientation program for pediatricians significantly improved their knowledge on the use of metered-dose inhalers with spacers, which may translate into an improvement in quality and quantity of prescriptions of these devices in clinical practice. The questions with higher rates of errors in the pre-training test were the questions about the waiting time between two sprays in successive applications and about the correct way to attach the inhaler to the spacer, both with high levels of success in the post-training test.

Advances in inhalation therapy in pediatrics.

OBJECTIVES: To review the most relevant articles regarding the technical aspects of inhalation therapy, inhalers currently available, and especially major advances in inhalation therapy in pediatrics. SOURCES: Articles of MEDLINE database from 1983 were reviewed, in addition to book chapters, and the most important studies were selected according to the criteria established for this article. SUMMARY OF THE FINDINGS: Conventional nebulizers have a number of inconveniences, and breath-enhanced and breath-actuated inhalers are more attractive options. Among dry powder inhalers, we highlight those using passive and active powder dispersion mechanisms, which provide higher rates of drug deposition in the lung. Among pressurized metered-dose inhalers, we highlight breath-actuated, breath-coordinated, and velocity-modifying inhalers. These inhalers should be used preferably together with spacers, since the use of spacers produces a twofold increase in pulmonary drug deposition. CONCLUSIONS: For children younger than 8 years, pressurized metered-dose inhalers with spacers are the most appropriate devices, since they provide a practical approach associated with greater lung deposition. In children older than 8 years who can generate high inspiratory flow rates, dry powder devices are best suited.

Avanços na inaloterapia em pediatria / Advances in inhalation therapy in pediatrics

OBJETIVOS: Revisar os artigos mais relevantes a respeito dos aspectos técnicos da terapêutica inalatória, dos inaladores disponíveis e principalmente dos principais avanços obtidos na inaloterapia em pediatria. FONTES DOS DADOS: Foram revisados os artigos contidos na base de dados MEDLINE a partir de 1983, além de capítulos de livros, e selecionados os de maior importância de acordo com os critérios estabelecidos para este artigo. SÍNTESE DOS DADOS: Os nebulizadores convencionais apresentam uma série de inconveniências, sendo que inaladores com desempenho melhorado pela respiração e os ativados pela respiração são opções mais atrativas. Dentre os inaladores de pó seco, destacam-se os que utilizam mecanismos passivos e ativos de dispersão de pó, que propiciam maiores taxas de deposição pulmonar das drogas. Entre os inaladores pressurizados dosimetrados destacam-se os ativados pela respiração, os coordenados pela respiração e os modificadores de velocidade. Devem ser usados preferencialmente em conjunto com espaçadores, pois a utilização deste aumenta em até duas vezes a deposição pulmonar das drogas. CONCLUSÕES: Para menores de 8 anos, os inaladores pressurizados dosimetrados com espaçadores são os mais adequados, dada a sua praticidade associada à elevada deposição pulmonar que proporcionam. Nos maiores de 8 anos capazes de gerar altos fluxos inspiratórios, os dispositivos de pó são os mais indicados.

OBJECTIVES: To review the most relevant articles regarding the technical aspects of inhalation therapy, inhalers currently available, and especially major advances in inhalation therapy in pediatrics. SOURCES: Articles of MEDLINE database from 1983 were reviewed, in addition to book chapters, and the most important studies were selected according to the criteria established for this article. SUMMARY OF THE FINDINGS: Conventional nebulizers have a number of inconveniences, and breath-enhanced and breath-actuated inhalers are more attractive options. Among dry powder inhalers, we highlight those using passive and active powder dispersion mechanisms, which provide higher rates of drug deposition in the lung. Among pressurized metered-dose inhalers, we highlight breath-actuated, breath-coordinated, and velocity-modifying inhalers. These inhalers should be used preferably together with spacers, since the use of spacers produces a twofold increase in pulmonary drug deposition. CONCLUSIONS: For children younger than 8 years, pressurized metered-dose inhalers with spacers are the most appropriate devices, since they provide a practical approach associated with greater lung deposition. In children older than 8 years who can generate high inspiratory flow rates, dry powder devices are best suited.

[Evaluation of the knowledge of health professionals at a pediatric hospital regarding the use of metered-dose inhalers]. / Avaliação do conhecimento sobre o uso de inaladores dosimetrados entre profissionais de saúde de um hospital pediátrico.

OBJECTIVE: To evaluate health professionals working at a tertiary pediatric hospital in terms of their knowledge regarding the practical use of metered-dose inhalers. METHODS: Practical and written tests on the use of metered-dose inhalers were applied to physicians, physical therapists, nurses and nursing assistants. A score from 0 to 10 was assigned to each evaluation, and median scores were calculated for each professional category. Questions with higher and lower correct values were identified, and a descriptive comparison was made regarding the performance of the various professional categories. Statistical analysis was performed using the Kruskal-Wallis method for comparison of medians. A sequential logistic multiple regression analysis was also performed. RESULTS: A total of 30 resident physicians or interns in the pediatrics department, 23 attending physicians, 29 physical therapists, 33 nurses and 31 nursing assistants were evaluated. Resident physicians, physical therapists and attending physicians performed significantly better than did nurses and nursing assistants. Only resident physicians had a median score greater than 6. CONCLUSIONS: The health professionals evaluated, particularly the nurses and nursing assistants, who are directly involved in the practical use of metered-dose inhalers, possess insufficient knowledge regarding the use of such inhalers.

Avaliação do conhecimento sobre o uso de inaladores dosimetrados entre profissionais de saúde de um hospital pediátrico / Evaluation of the knowledge of health professionals at a pediatric hospital regarding the use of metered-dose inhalers

OBJETIVO: Avaliar os conhecimentos sobre o uso e manejo de inaladores pressurizados dosimetrados entre profissionais de um hospital pediátrico terciário. MÉTODOS: Foram realizadas avaliações sobre o conhecimento do uso de inaladores pressurizados dosimetrados através de questionários teóricos e práticos, com médicos, fisioterapeutas, enfermeiras e auxiliares de enfermagem, atribuindo-se uma nota de 0 a 10 para cada avaliação. Calcularam-se as medianas das notas obtidas pelos profissionais de cada categoria, as questões com maiores e menores índices de erros, e foi feita a comparação descritiva do desempenho das diversas categorias profissionais. A análise estatística foi feita através do método de Kruskal-Wallis de comparação de medianas. Também foi realizada a análise através de regressão logística múltipla seqüencial. RESULTADOS: Foram avaliados 30 médicos residentes ou estagiários de pediatria, 23 médicos assistentes, 29 fisioterapeutas, 33 enfermeiras e 31 auxiliares de enfermagem. Os médicos residentes, fisioterapeutas e médicos assistentes obtiveram desempenho significativamente superior aos dos enfermeiros e auxiliares de enfermagem. Apenas os médicos residentes obtiveram mediana superior a 6. CONCLUSÕES: O conhecimento a respeito do uso de inaladores dosimetrados entre os profissionais de saúde da instituição é insatisfatório, principalmente entre enfermeiros e auxiliares de enfermagem, diretamente envolvidos na aplicação prática dos inaladores dosimetrados.

OBJECTIVE: To evaluate health professionals working at a tertiary pediatric hospital in terms of their knowledge regarding the practical use of metered-dose inhalers. METHODS: Practical and written tests on the use of metered-dose inhalers were applied to physicians, physical therapists, nurses and nursing assistants. A score from 0 to 10 was assigned to each evaluation, and median scores were calculated for each professional category. Questions with higher and lower correct values were identified, and a descriptive comparison was made regarding the performance of the various professional categories. Statistical analysis was performed using the Kruskal-Wallis method for comparison of medians. A sequential logistic multiple regression analysis was also performed. RESULTS: A total of 30 resident physicians or interns in the pediatrics department, 23 attending physicians, 29 physical therapists, 33 nurses and 31 nursing assistants were evaluated. Resident physicians, physical therapists and attending physicians performed significantly better than did nurses and nursing assistants. Only resident physicians had a median score greater than 6. CONCLUSIONS: The health professionals evaluated, particularly the nurses and nursing assistants, who are directly involved in the practical use of metered-dose inhalers, possess insufficient knowledge regarding the use of such inhalers.

Tomografia computadorizada de alta resolução (TCAR) no diagnóstico radiológico e seguimento da displasia broncopulmonar: relato de casos / High-resolution computed tomography (HRCT) in the radiological diagnosis and follow-up of bronchopulmonary dysplasia: case reports

Objetivo: avaliar a utilizacao da tomografia computadorizada de alto resolucao (TCAR) em pacientes com displasia broncopulmonar, para diferencia-la...