Exercise-induced bronchoconstriction in school-aged children who had chronic lung disease in infancy.

OBJECTIVES: To assess for exercise-induced bronchoconstriction in 8- to 12-year-old children who had chronic lung disease (CLD) in infancy, and to evaluate the response of bronchoconstriction to bronchodilation with albuterol in comparison with preterm and term controls. STUDY DESIGN: Ninety-two children, including 29 with CLD, 33 born preterm at ≤32 weeks' gestation, and 30 born at term, underwent lung spirometry before and after cycle ergometry testing and after postexercise bronchodilation with albuterol. RESULTS: Doctor-diagnosed asthma and exercise-induced wheeze were reported more frequently in the CLD group than in the preterm and term groups, but only 10% were receiving a bronchodilator. There were no differences among the groups in peak minute ventilation, oxygen uptake, or carbon dioxide output at maximum exercise. After maximal exercise, predicted forced expiratory volume in 1 second (FEV1) decreased from a mean baseline value of 81.9% (95% CI, 76.6-87.0%) to 70.8% (95% CI, 65.5-76.1%) after exercise in the CLD group, from 92.0% (95% CI, 87.2-96.8%) to 84.3% (95% CI, 79.1-89.4%) in the preterm group, and from 97.5% (95% CI, 92.5-102.6%) to 90.3% (95% CI, 85.1-95.5%) in the term group. After albuterol administration, FEV1 increased to 86.8% (95% CI, 81.7-92.0%) in the CLD group, 92.1% (95% CI, 87.3-96.9%) in the preterm group, and 97.1% (95% CI, 92.0-102.3%) in the term group. The decrease in predicted FEV1 after exercise and increase in predicted FEV1 after bronchodilator use were greatest in the CLD group (-11.0% [95% CI, -18.4 to -3.6%] and 16.0% [95% CI, 8.6-23.4%], respectively; P < .005 for both), with differences of <8% in the 2 control groups. CONCLUSION: School-age children who had CLD in infancy had significant exercise-induced bronchoconstriction that responded significantly to bronchodilation. Reversible exercise-induced bronchoconstriction is common in children who experienced CLD in infancy and should be actively assessed for and treated.

Montelukast / Montelukast

Forma farmacéutica: tableta. Denominación común internacional: montelukast sódico.Composición: cada tableta contiene 10 mg de montelukast sódico, lactosa.Categoría farmacológica: antagonista de los leucotrienos (categorías farmacológicas).Farmacocinética: la concentración plasmática máxima se alcanza entre 2-4 horas después de su administración por vía oral con una biodisponibilidad del 64 por ciento. La absorción no se ve modificada por la ingestión de los alimentos. La unión a proteínas plasmáticas es del 99 por ciento .Se metaboliza de forma extensa en el hígado por las isoenzimas CYP3A4, CYP2A6 y CYP2C9 del citocromo P450. La semivida de eliminación del montelukast es de 2,7 a 5,5 horas, siendo eliminado, conjuntamente con sus metabolitos casi exclusivamente por vía biliar a través de las heces. Su metabolismo disminuye y su semivida de eliminación aumenta en presencia de disfunción hepática moderada. La farmacocinética es similar en pacientes jóvenes o ancianos y no es afectada por la insuficiencia renal.Indicaciones: asma persistente leve a moderada en pacientes no controlados adecuadamente con corticoides inhalados y beta-2 de acción corta a demanda. Profilaxis de asma cuyo componente principal es la broncoconstricción inducida por el ejercicio. Alivio sintomático de la rinitis alérgica estacional en pacientes asmáticos.Contraindicaciones: hipersensibilidad al montelukast.Uso en poblaciones especiales: ver información adicional en precauciones. Niño: se desconoce la eficacia y seguridad en esta población. LM: evitar, datos no disponibles. E: categoría de riesgo B. DH: usar con cautela.Precauciones: no es efectivo en el ataque agudo de....(AU)

Montelukast / Montelukast

Forma farmacéutica: tableta. Denominación común internacional: montelukast sódico.Composición: cada tableta contiene 10 mg de montelukast sódico, lactosa.Categoría farmacológica: antagonista de los leucotrienos (categorías farmacológicas).Farmacocinética: la concentración plasmática máxima se alcanza entre 2-4 horas después de su administración por vía oral con una biodisponibilidad del 64 por ciento. La absorción no se ve modificada por la ingestión de los alimentos. La unión a proteínas plasmáticas es del 99 por ciento .Se metaboliza de forma extensa en el hígado por las isoenzimas CYP3A4, CYP2A6 y CYP2C9 del citocromo P450. La semivida de eliminación del montelukast es de 2,7 a 5,5 horas, siendo eliminado, conjuntamente con sus metabolitos casi exclusivamente por vía biliar a través de las heces. Su metabolismo disminuye y su semivida de eliminación aumenta en presencia de disfunción hepática moderada. La farmacocinética es similar en pacientes jóvenes o ancianos y no es afectada por la insuficiencia renal.Indicaciones: asma persistente leve a moderada en pacientes no controlados adecuadamente con corticoides inhalados y beta-2 de acción corta a demanda. Profilaxis de asma cuyo componente principal es la broncoconstricción inducida por el ejercicio. Alivio sintomático de la rinitis alérgica estacional en pacientes asmáticos.Contraindicaciones: hipersensibilidad al montelukast.Uso en poblaciones especiales: ver información adicional en precauciones. Niño: se desconoce la eficacia y seguridad en esta población. LM: evitar, datos no disponibles. E: categoría de riesgo B. DH: usar con cautela.Precauciones: no es efectivo en el ataque agudo de....

Effects of ipratropium on exercise-induced bronchospasm.

Exercise-induced bronchospasm (EIB) is the transient narrowing of the airways that follows vigorous exercise. Ipratropium bromide may be used to prevent EIB, but its effect varies among individuals. We hypothesized that time of administration of ipratropium interferes with its action. This was a prospective, double-blind, cross-over study carried out to evaluate the bronchoprotective and bronchodilatory effect of ipratropium at different times of day. The study consisted of 4 exercise challenge tests (2 at 7 am and 2 at 6 pm). In the morning, one of the tests was performed after placebo administration and the other one after ipratropium (80 microg) and the two tests (placebo and ipratropium) were repeated in the evening. Twenty-one patients with severe or moderate asthma and previous confirmation of EIB were enrolled in this prospective trial. The bronchodilatory effect of ipratropium was 0.25+/-0.21 L or 13.11+/-10.99% (p=0.001 compared to baseline values) in the morning, and 0.14+/-0.25 L or 7.25+/-11.37% (p>0.05) in the evening. In the morning, EIB was 0.58+/-0.29 L on the placebo day and 0.38+/-0.22 L on the treatment day (p=0.01). In the evening, EIB was 0.62+/-0.28 L on the placebo day and 0.51+/-0.35 L on the treatment day (p>0.05). We suggest that the use of ipratropium for the treatment of asthma and EIB should take into consideration the time of administration.

Exercise training on disease control and quality of life in asthmatic children.

PURPOSE: Aerobic training has been shown to be effective in improving cardiopulmonary fitness in asthmatic children. However, the actual impact of physical training on clinical indicators of disease control remains controversial. METHODS: Thirty-eight children with moderate to severe persistent asthma were randomly assigned to control (N=17) and training (N=21) groups. Spirometry, exercise challenge, and maximum incremental cardiopulmonary exercise tests were performed 16 wk apart. Daily doses of inhaled steroids and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) scores were also recorded. RESULTS: Physical training was associated with significant improvements in physiological variables at peak and submaximal exercise (P<0.05); in contrast, no significant changes were found in controls. Severity of exercise-induced bronchoconstriction (EIB) and postexercise breathlessness were significantly lessened in trained patients; improvement in fitness and EIB, however, were not linearly related (P>0.05). In addition, PAQLQ scores improved only in trained children (P<0.01). Daily doses of inhaled steroids were reduced in trained patients (52%), but they remained unchanged or increased in controls (70.6%) (P=0.07). CONCLUSION: Supervised exercise training might be associated with beneficial effects on disease control and quality of life in asthmatic children. These data suggest an adjunct role of physical conditioning on clinical management of patients with more advanced disease.

Antileukotrienes in the treatment of asthma and allergic rhinitis.

OBJECTIVES: To compare leukotriene antagonists (LTA) to other groups of drugs used in asthma and allergic rhinitis treatment. SOURCES: MEDLINE, LILACS and Cochrane Library. KEYWORDS: leukotrienes, antileukotrienes, asthma treatment, allergic rhinitis treatment, asthma and allergic rhinitis. An attempt was made to group the main studies and reviews about this topic. SUMMARY OF THE FINDINGS: LTA are more efficient than placebo and enhance the effects of inhaled corticosteroids. The association of inhaled corticosteroids with long-acting Beta2 agonists is more efficient than the association of inhaled corticosteroids + LTA. Although use of LTA in acute asthma attacks and allergic rhinitis seems reasonable, more studies are needed to confirm this benefit. LTA reduce hospitalization time and the number of wheezing attacks in infants with acute viral bronchiolitis caused by respiratory syncytial virus, as well as recurrent wheezing after acute viral bronchiolitis. LTA are less efficient than intranasal corticosteroids for allergic rhinitis management. LTA are efficient in exercise-induced asthma, although they are not the first-line treatment. CONCLUSION: Controlled and randomized studies show that inhaled corticosteroids are the drugs of choice to treat persistent asthma and allergic rhinitis. There is not enough evidence to recommend the use of LTA as first-line drug (monotherapy) in children with asthma (level I). For children who cannot use inhaled corticosteroids, LTA may be a good alternative (level II).

[Exercise-induced asthma as perceived by pediatric patients and their parents]. / Asma inducida por ejercicio: Diferencias en la percepciónde síntomas entre pacientes pediátricos y sus padres.

BACKGROUND: Exercise is a frequent trigger of symptoms in asthmatic children and it worsens their quality of life. AIM: To compare the perception about exercise among asthmatic pediatric patients and their parents. MATERIAL AND METHODS: Asthmatic patients with symptoms related to exercise, were tested with an exercise challenge test following the Tal protocol. Before testing, a questionnaire about symptoms triggered by exercise was answered by children and their parents. The data was analyzed with a Kappa correlation test. RESULTS: Seventy five patients, aged 6 to 15 years, were studied. Forty one percent exercised less than one hour per week. Although 64% reported to experience respiratory difficulty and 80% cough during exertion, 87% were willing to perform more exercise. Forty percent of all patients had a positive challenge test for exercise-induced asthma. Correlation between patient's and parent's answers about the effect of physical activity exercise was low, with a kappa of 0.53. There was no correlation between exercise test and the answers to the questionnaire. CONCLUSIONS: Children with asthma frequently have exercise-associated symptoms and parental perception about this problem is very low.

Antileukotrienes in the treatment of asthma and allergic rhinitis

OBJETIVO: Comparar os antagonistas de leucotrienos (ARLT) aos outros grupos de medicamentos utilizados para tratar a asma e a rinite alérgica. FONTES DOS DADOS: MEDLINE, LILACS e Biblioteca Cochrane. Palavras chaves: leucotrienos, antileucotrienos, tratamento da asma, tratamento da rinite alérgica, asma e rinite alérgica. Procurou-se agrupar os principais trabalhos e revisões sobre o assunto. SíNTESE DOS DADOS: Os ARLT são mais eficazes do que placebo e potencializam os efeitos dos corticosteróides inalados. A associação de corticosteróides inalados com agentes beta2 agonistas de longa duração (LABA) é mais eficaz do que a associação de cortiscoteróides inalados + ARLT. Embora pareça racional o uso de ARLT na crise aguda de asma e rinite alérgica, mais estudos são necessários para comprovar esse benefício. Os ARLT promovem redução no tempo de hospitalização e no número de crises de sibilância em lactentes com bronquiolite viral aguda pelo vírus respiratório sincicial e na sibilância recorrente após bronquiolite viral aguda. Os ARLT são menos eficazes que os corticosteróides intranasais no manejo da rinite alérgica. Os ARLT são eficazes na asma induzida por exercício (AIE), embora não constituam a primeira linha de tratamento. CONCLUSÃO: Estudos controlados e randomizados mostram que os corticosteróides inalados são as drogas de escolha para o tratamento da asma persistente e rinite alérgica. :Não existem evidências suficientes para recomendar o uso de ARLT como medicamento de primeira linha (monoterapia) em crianças com asma (nível I). Nas crianças que não podem usar corticosteróides inalados, os ARLT podem ser uma alternativa (nível II).

OBJECTIVE: To compare leukotriene antagonists (LTA) to other groups of drugs used in asthma and allergic rhinitis treatment. SOURCES: MEDLINE, LILACS and Cochrane Library. Keywords: leukotrienes, antileukotrienes, asthma treatment, allergic rhinitis treatment, asthma and allergic rhinitis. An attempt was made to group the main studies and reviews about this topic. SUMMARY OF THE FINDINGS: LTA are more efficient than placebo and enhance the effects of inhaled corticosteroids. The association of inhaled corticosteroids with long-acting beta2-agonists is more efficient than the association of inhaled corticosteroids + LTA. Although use of LTA in acute asthma attacks and allergic rhinitis seems reasonable, more studies are needed to confirm this benefit. LTA reduce hospitalization time and the number of wheezing attacks in infants with acute viral bronchiolitis caused by respiratory syncytial virus, as well as recurrent wheezing after acute viral bronchiolitis. LTA are less efficient than intranasal corticosteroids for allergic rhinitis management. LTA are efficient in exercise-induced asthma, although they are not the first-line treatment. CONCLUSIONS: Controlled and randomized studies show that inhaled corticosteroids are the drugs of choice to treat persistent asthma and allergic rhinitis. There is not enough evidence to recommend the use of LTA as first-line drug (monotherapy) in children with asthma (level I). For children who cannot use inhaled corticosteroids, LTA may be a good alternative (level II).

Asma inducida por ejercicio: Diferencias en la percepciónde síntomas entre pacientes pediátricos y sus padres / Exercise-induced asthma as perceived by pediatric patients and their parents

Background: Exercise is a frequent trigger of symptoms in asthmatic children and it worsens their quality of life. Aim: To compare the perception about exercise among asthmatic pediatric patients and their parents. Material and methods: Asthmatic patients with symptoms related to exercise, were tested with an exercise challenge test following the Tal protocol. Before testing, a questionnaire about symptoms triggered by exercise was answered by children and their parents. The data was analyzed with a Kappa correlation test. Results: Seventy five patients, aged 6 to 15 years, were studied. Forty one percent exercised less than one hour per week. Although 64% reported to experience respiratory difficulty and 80% cough during exertion, 87% were willing to perform more exercise. Forty percent of all patients had a positive challenge test for exercise-induced asthma. Correlation between patient's and parent's answers about the effect of physical activity exercise was low, with a kappa of 0.53. There was no correlation between exercise test and the answers to the questionnaire. Conclusions: Children with asthma frequently have exercise-associated symptoms and parental perception about this problem is very low.

[Frequency of exercise-induced asthma in a group of children and adolescents with mild asthma attending a summer camp]. / Frecuencia de asma inducida por ejercicio en un grupo de niños y adolescentes con asma leve que acudieron a un campamento de verano.

BACKGROUND: Exercise-induced asthma is a transitory bronchospasm, which occurs after 6 to 8 minutes of continuous exercise. Diagnosis is done by a suggestive clinical history and by 15 to 20% post-challenge fall in FEV1. It happens in about 6 to 13% of general population, 90% of asthmatic individuals and 40% of individuals with allergic rhinitis. OBJECTIVE: To know the frequency of asthma induced by exercise in a group of asthmatic children and teenagers who went to a summer camp. MATERIAL AND METHODS: A cross-sectional, descriptive and observational study, which included 33 patients suffering from intermittent mild asthma, was based on espirometric measurements made before and after 8 minutes of continuous exercise (running). None of them had previous diagnosis of exercise-induced asthma. FEV1 greater than or equal to 15% was considered exercise-induced asthma. The test was performed at a room temperature of 73F and humidity of 40%. All patients were asymptomatic before the study and were given short-acting inhaled beta2-agonists as rescue medication, which was not administered during the 12 previous hours to the test. Data analysis was made by means of descriptive statistic. RESULTS: Thirty-three children aged 8-16 years with diagnosis of asthma were studied, with an average age of 12.5 years; 42.4% were female and 57.5% male. Of the 33 patients, 6 had (18.2%) a 15% fall in FEV1 after exercise; 50% of these patients showed exercise-induced mild asthma, 33% moderate and 17% severe. At the end of the test, in six patients (100%) FEV1 increased by 15%, five minutes after the administration of a beta2-agonist. CONCLUSIONS: Exercise-induced asthma is frequent among asthmatic pediatric patients, occurring in 18.8% of this study. Likelihood of having exercise-induced asthma must be deliberately investigated in all asthmatic patients, in order to establish an opportune diagnosis of this condition and provide recommendations of preventing therapy.

[Calisthenics as a preventive measure against the decrease in maximum expiratory flow in asthmatic patients before and after a soccer game]. / Calistenia como medida preventiva de la caída del flujo espiratorio máximo en pacientes asmáticos antes y después de un juego de futbol.

BACKGROUND: Exercise-induced asthma is a syndrome characterized by dyspnea, thoracic pain, cough, sibilant rales and diminished physical performance. It appears into the first 30 minutes after the beginning of physical activity. OBJECTIVE: To evaluate calisthenic effect on maximal expiratory flow rate in asthmatic patients. MATERIAL AND METHODS: A prospective, observational and descriptive study was done through a soccer game. Male and female asthmatic patients from 6 to 16 years old with intermittent and mild asthma were included. Maximal expiratory flow rate was measured before the beginning of soccer game, and then, at the end of the first and second sets. Statistical analysis was made through the media values comparison and t Student test. RESULTS: 60 patients were included. They were 11.3 +/- 2.4 mean aged. 45% had diagnosis of mild asthma, 36.6% mild asthma and allergic rhinitis and 6.6% persistent asthma. Average of basal maximal expiratory flow rate was 275 +/- 90 L/s, and no significant changes were observed in 52 patients: mean maximal expiratory flow rate at the end of first and second sets was 275 +/- 86 L/s and 273 +/- 96 L/s, respectively. Maximal expiratory flow rate diminished at 77 +/- 3.8% and 83 +/- 9.5% in the other eight patients at the end of the first and second sets, respectively. CONCLUSIONS: Calisthenic made before physical activity prevents maximal expiratory flow rate diminishment.

[Measurement of cytokines in patients with exercise-induced asthma treated with anti-leukotrienes]. / Determinación de citocinas en pacientes con asma inducida por el ejercicio y tratada con un antileucotrieno.

BACKGROUND: Exercise-induced asthma is defined as the transient broncho-spasm, that occurs after 3 to 8 minutes of continuous exercise; one of two mechanisms are implicated: the first is given by a hyper-osmolar environment interchange with the warm respiratory air and the water loss, the second due to reactive hyperemia or bronchial blood vessels edema. OBJECTIVES: To determine the effectiveness and safety of Zafirlukast treatment in exercise induce asthma, and in mild and moderated persistent bronchial asthma. Evaluate the security with laboratory test IL-2, IL-4, INFg, and CD69, to determinate TH1 and Th2 cells, laboratory and thorax x-ray determinations before and after zafirlukast treatment in exercise induce asthma, plus the functional respiratory test, and assert the clinical and adverse reaction with Zafirlukast. MATERIAL AND METHODS: A open, prospective, longitudinal study. Challenge test on a treadmill for 8 minutes. Twenty patients from the Allergy Service at Lic. Adolfo López Mateos Hospital, ISSSTE, in México City, fifteen female and five males. Aged 15 to 35 years. There was a control group of ten healthy subjects with similar age and sex. The drug Zafirlukast was administered 20 mg twice a day for eight weeks, with patient's informed and signed consent. Laboratory test: Blood Cell count, transaminases, bilirubins A, G, M and E immunoglobulins thorax X-ray, electrocardiogram, functional respiratory test before and after treatment. RESULTS: Zafirlukast blocked exercise induced asthma in the early and late phases. There was a statistically significant improvement of a VEF-1 after exercise with a p > 0.001; furthermore, there was significant improvement in the mid-spiratory speed before the exercise with a p > 0.05. The mid-spiratory speed after the exercise, improved (p > 0.01). There were no collateral reactions, such as Churg-Strauss, only transitory headache in six and nauseas in two. There were no statistically significant changes in the cytokines assessment. CONCLUSIONS: There were no statistically significant changes in the cytokines assessments, in four cases the IL-4 decreased after the treatment. The anti-leukotriene improved the bronchospastic answer during the early and late phases, reducing the FEV-1, decreasing the recovering phase.

O formoterol no tratamento da asma / Formoterol in the management of asthma

O formoterol é um agente beta-2-agonista de longa duraçäo, utilizado no tratamento da asma persistente, moderada ou grave, e administrado por via inalatória. Tem inicio rápido de açäo broncodilatadora que perdura por até 12 horas. Por conta disso, alguns pesquisadores o têm prescrito como medicaçäo de alívio para a exarcebaçäo aguda de asma. Administrado previamente a exercício intenso é capaz de bloquear o broncoespasmo induzido por exercício. Açäo antiinflamatória tem sido questionada por alguns pesquisadores, sobretudo durante o uso prolongado. Apesar disso, documenta-se diminuiçäo do seu efeito broncoprotetor durante broncoprovocaçäo com metacolina, bem como na broncodilataçäo adicional por beta-2-agonista de curta duraçäo, após uso por tempo prolongado. Em associaçäo a corticosteróides inalados, tem permitido melhor controle da asma mesmo com reduçäo das dores de corticosteróides inalados, o que justifica, durante uso prolongado, a sua associaçäo com esses agentes.(au)

[Experience with montelukast, a leukotriene receptor antagonist, in pediatric patients with asthma]. / Experiencia con montelukast, un antagonista de los receptores de leucotrienos, en pacientes pediátricos con asma.

BACKGROUND: Montelukast is a specific antagonist of leukotrienes' receptors and constitutes a therapeutic option in controlling asthma. OBJECTIVES: To evaluate efficacy of montelukast in patients with persistent light asthma, persistent moderate asthma and exercise-induced asthma; to try to reduce or to eliminate doses of inhaled steroid; to reduce the use of short-action beta agonists and to assess its tolerability in pediatric patients. MATERIAL AND METHOD: 40 patients were studied, 17 female, with an age range from 4 to 11 years and a mean of 7 years. Stratification was made by GINA-established parameters. RESULTS: Steroid dose could be reduced in 88%, with definitive suspension in 66% of patients. Moreover, an improvement in reducing asthma stratification and the use of rescue drugs were registered. 62% of patients with exercise-induced asthma improved and there was a good tolerance with the same side effects.

Asma inducida por ejercicio en niños / Exercise induced asthma in children

En el presente reporte se aborda el tema de la respuesta broncoconstrictora que se produce en los niños asmáticos luego de realizar ejercicio físico de cierta intensidad y duración. Se analizan los elementos etiopatogénicos reconocidos, en donde persiste como hecho central el nivel de hiperventilación alcanzado durante el ejercicio. Hasta hace poco tiempo la discusión se focalizó en la pérdida de agua y el enfriamiento del árbol bronquial producido por la hiperventilación, y en los distintos mediadores secretados producto de estos cambios locales en la vía aérea respiratoria. Actualmente el interés en los cambios vasculares ocasionados por el ejercicio en la vía aérea de sujetos hiperreactivos ocupa un lugar preponderante en la discusión de los hechos patogénicos del evento obstructivo. El conocimiento etiopatogénico del asma inducida por ejercicio (AIE), permite definir estrategias farmacológicas y no farmacológicas que son discutidas en este trabajo. Se analizan también los aspectos propios del esfuerzo físico como tipo, duración, intensidad de la actividad física o deportiva y su relación con el AIE

The leukotriene D4-receptor antagonist zafirlukast attenuates exercise-induced bronchoconstriction in children.

OBJECTIVE: To determine the effects of zafirlukast on exercise-induced bronchoconstriction in children. STUDY DESIGN: Exercise challenges were done 4 hours after single oral doses of zafirlukast or placebo were administered in asthmatic children (6 to 14 years) treated with beta 2-agonists alone. Subjects randomized to treatment had a >/=20% decrease in forced expiratory volume in 1 second (FEV1 ) after a screening challenge. In a randomized, double-blind, 3-way, crossover design, group 1 (n = 20) received placebo and 5 and 20 mg zafirlukast, and group 2 (n = 19) received placebo and 10 and 40 mg zafirlukast. Maximal percentage fall in FEV1, area under the curve, and time to recovery of FEV1 to within 5% of baseline after the challenge were compared with analysis of variance. RESULTS: Mean values for maximal fall in FEV1 ranged from -8.7% +/- 1.7% to -11.1% +/- 1.9% after zafirlukast compared with -17.1% +/- 1.8% and -16.3% +/- 1.9% after placebo. Differences from placebo for fall in FEV1 and area under the curve were significant (P

Comparative efficacy of inhaled furosemide and disodium cromoglycate in the treatment of exercise-induced asthma in children.

BACKGROUND: Inhaled furosemide has been shown, in patients with asthma, to have prophylactic properties similar to those of disodium cromoglycate. OBJECTIVE: The aim of this study was to evaluate the protective effect of these drugs in the treatment of exercise-induced asthma. METHODS: Fifteen children with exercise-induced asthma (mean age, 10.8 years) underwent exercise challenge after a single dose of nebulized placebo, furosemide (20 mg/m7 body area), or disodium cromoglycate (20 mg), 2 days apart, in a single-blind crossover trial. RESULTS: Both furosemide and disodium cromoglycate exerted significant protection against the bronchial response to exercise challenge, with a mean maximum percentage falls in FEV1 of 4.66% and 7.22%, respectively (p < 0.05). On the placebo day, the mean maximum percentage fall in FEV1 was 34.50% (p < 0.05). CONCLUSION: The results of this study suggest that furosemide and disodium cromoglycate provide comparable efficacy in preventing exercise-induced asthma in children, with no side effects.

Salmeterol. Estructura, función e indicaciones en pediatría / Salmeterol. Structure, function and indications in pediatrics

El salmeterol es un agonista beta-adrenérgico específico de acción prolongada. Su uso en pacientes pediátricos fue autorizado en los Estados Unidos de Norteamérica en 1993, pero la experiencia clínica aún es poca. Se revisa el mecanismo de acción, los efectos colaterales y las indicaciones para el uso de este medicamento en pediatría. Su eliminación es retardada debido a que se adhiere a un nicho especial llamado exositio. Se encaja y se desencaja de forma alternante en el nicho estimulador, causando una estimulación no continua del receptor. Por esto no se han visto ni taquifilaxia, ni hiposensibilidad, ni disminución en la función pulmonar con el uso prolongado del medicamento hasta el momento. En pediatría se indica para el asma nocturna, asma por ejercicio y para pacientes con mal control del asma crónico, siempre y cuando ya estén recibiendo anti-inflamatorios inhalados en dosis altas y no tengan mejoría

Prevención del asma inducido por ejercicio por terbutalina via turbuhaler / The protective effect of terbutaline inhaled via turbuhaler in excercise-induced asthma

El objetivo fue examinar el efecto preventivo de la terbutalina vía turbahaler en niños con asma inducido por ejercicio (AIE). Se estudiaron 20 casos (7-13 años), 12 varones y 8 mujeres, a quienes se les efectuó: una espirometría basal usando un espirómetro Flowmate 2500, test de provocación en cinta ergométrica Zuccolo Mod 315 llegando al 85 por ciento de su capacidad cardíaca durante 6, espirometria a los 7 y 30 post ejercicio. Durante la misma semana fue realizado el mismo estudio 15 posterior a la inhalación de 0,5 mg de terbutalina vía turbuhaler y el test con placebo a 12 pacientes. Fueron comparados los valores originales post ejercicio, y los encontrados posterior al uso de la terbutalina. Se encontraron 19 casos (95 por ciento) con Protección total (disminución < 5 por ciento del FEV1), 1 caso (5 por ciento) Protección parcial (disminución < del 10 por ciento FEV1) y sin encontrarse efectos significativos con placebos. La severidad del broncoespasmo en AIE fue significativamente reducida mediante el uso de terbutalina 15 previo al ejercicio y no observándose efectos adversos. La terbutalina vía turbuhaler es una droga B2 potente, y quizás su efecto mayor radica en el mejor depósito de la droga a nivel pulmonar, muy útil y práctico para casos de asma inducido por ejercicio, puesto que puede mejorar la calidad de vida de los asmáticos. (AU)