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1.
Rev Fac Cien Med Univ Nac Cordoba ; 76(4): 222-226, 2019 11 27.
Artigo em Espanhol | MEDLINE | ID: mdl-31833745

RESUMO

Introduction: Asthma is related to caries but the risk factors are not completely determined. Therefore, the objective of the study was to determine the risk of dental caries in pediatric asthmatic patients in inhalation treatment with salbutamol and budesonide who went to the National Hospital Arzobispo Loayza. Methods: Case-control study that consisted of 184 pediatric patients, between 5 and 12 years old, who attended the pneumology and pediatric dentistry service of the National Hospital Arzobispo Loayza during the years 2016-2017. The group of cases (n = 92) was composed of patients with moderate asthma medicated with inhaled salbutamol and budesonide, while the control group (n = 92) was composed of healthy patients. The risk of dental caries was evaluated with the dietary record, oral hygiene index and number of carious lesions. Results: The risk according to the type of cariogenic diet was moderate in both groups (p = 0.768). The oral hygiene index in the control group was regular in 63% (n = 58) and in the case group, bad in 60.9% (n = 56); p=0.001. The number of carious lesions in the control group was moderate in 50% (n = 46) and in the case group, high in 47.8% (n = 44); p = 0.001. Therefore, the risk of dental caries in the case group was high in 50% (n = 46) and in the control group it was moderate in 72.8% (n = 67); p = 0.001. Conclusion: The risk of dental caries in asthmatic patients on inhaled therapy with salbutamol and budesonide is significantly higher than that of healthy patients.


Assuntos
Albuterol/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/tratamento farmacológico , Budesonida/efeitos adversos , Cárie Dentária/induzido quimicamente , Administração por Inalação , Albuterol/administração & dosagem , Antiasmáticos/administração & dosagem , Budesonida/administração & dosagem , Estudos de Casos e Controles , Criança , Pré-Escolar , Cárie Dentária/epidemiologia , Feminino , Humanos , Incidência , Masculino , Higiene Bucal , Peru/epidemiologia , Projetos Piloto , Fatores de Risco
3.
Int J Pharm ; 566: 157-172, 2019 Jul 20.
Artigo em Inglês | MEDLINE | ID: mdl-31129343

RESUMO

PURPOSE: In the present work, a comparison between MDI and DPI for evaluating performance of the devices were carried out by experimentally investigating the deposition parameters through a realistic airway replica. METHODS: Computed tomography (CT) images of the respiratory airway of a healthy subject were used to develop the realistic model. The airway replica was included extrathoracic, trachea, and tracheobronchial tree up to fourth generations which was fabricated by rapid prototyping. Afterward, in vitro experiments were performed to validate the airway model by comparing the total deposition (G0 to G3) of present replica with available data in the literature. Drug deposition (Salbutamol) in the model was measured by determining concentration of the segments sample by High Performance Liquid Chromatography (HPLC) assay. RESULTS: Deposition parameters were used for investigating the deposition patterns of the inhaled particles. Results showed that inertial impaction is the dominant mechanism in the most regions of the replica. It was found that the MDI delivered more drug to the tracheobronchial tree compared to the DPI for three different flow rate. CONCLUSION: The developed realistic respiratory airways model provided an opportunity to more accurately evaluate the performance of drug delivery devices and studying mechanisms of the drug deposition.


Assuntos
Albuterol/administração & dosagem , Broncodilatadores/administração & dosagem , Inaladores de Pó Seco , Inaladores Dosimetrados , Modelos Biológicos , Sistema Respiratório/metabolismo , Aerossóis , Humanos
4.
N Engl J Med ; 380(21): 2020-2030, 2019 05 23.
Artigo em Inglês | MEDLINE | ID: mdl-31112386

RESUMO

BACKGROUND: In double-blind, placebo-controlled trials, budesonide-formoterol used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting ß2-agonist (SABA); the risk was similar to that of budesonide maintenance therapy plus as-needed SABA. The availability of data from clinical trials designed to better reflect clinical practice would be beneficial. METHODS: We conducted a 52-week, randomized, open-label, parallel-group, controlled trial involving adults with mild asthma. Patients were randomly assigned to one of three treatment groups: albuterol (100 µg, two inhalations from a pressurized metered-dose inhaler as needed for asthma symptoms) (albuterol group); budesonide (200 µg, one inhalation through a Turbuhaler twice daily) plus as-needed albuterol (budesonide maintenance group); or budesonide-formoterol (200 µg of budesonide and 6 µg of formoterol, one inhalation through a Turbuhaler as needed) (budesonide-formoterol group). Electronic monitoring of inhalers was used to measure medication use. The primary outcome was the annualized rate of asthma exacerbations. RESULTS: The analysis included 668 of 675 patients who underwent randomization. The annualized exacerbation rate in the budesonide-formoterol group was lower than that in the albuterol group (absolute rate, 0.195 vs. 0.400; relative rate, 0.49; 95% confidence interval [CI], 0.33 to 0.72; P<0.001) and did not differ significantly from the rate in the budesonide maintenance group (absolute rate, 0.195 in the budesonide-formoterol group vs. 0.175 in the budesonide maintenance group; relative rate, 1.12; 95% CI, 0.70 to 1.79; P = 0.65). The number of severe exacerbations was lower in the budesonide-formoterol group than in both the albuterol group (9 vs. 23; relative risk, 0.40; 95% CI, 0.18 to 0.86) and the budesonide maintenance group (9 vs. 21; relative risk, 0.44; 95% CI, 0.20 to 0.96). The mean (±SD) dose of inhaled budesonide was 107±109 µg per day in the budesonide-formoterol group and 222±113 µg per day in the budesonide maintenance group. The incidence and type of adverse events reported were consistent with those in previous trials and with reports in clinical use. CONCLUSIONS: In an open-label trial involving adults with mild asthma, budesonide-formoterol used as needed was superior to albuterol used as needed for the prevention of asthma exacerbations. (Funded by AstraZeneca and the Health Research Council of New Zealand; Novel START Australian New Zealand Clinical Trials Registry number, ACTRN12615000999538.).


Assuntos
Albuterol/administração & dosagem , Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Budesonida/administração & dosagem , Fumarato de Formoterol/administração & dosagem , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Adulto , Idoso , Albuterol/efeitos adversos , Broncodilatadores/efeitos adversos , Budesonida/efeitos adversos , Quimioterapia Combinada , Feminino , Fumarato de Formoterol/efeitos adversos , Humanos , Masculino , Inaladores Dosimetrados , Pessoa de Meia-Idade
5.
Ther Adv Respir Dis ; 13: 1753466619841274, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31002021

RESUMO

BACKGROUND: Omalizumab may modulate airway remodeling in severe asthma. Using forced expiratory volume in 1 second (FEV1) as a surrogate of airway remodeling, we aimed to investigate if an omalizumab add-on in severe allergic asthma may lead to a persistent reversal of airway obstruction and to evaluate the potential biomarkers of airway obstruction reversibility. METHODS: Data were collected before (T0) and after omalizumab add-on for 1 year (T1, 32 patients), 2 years (T2, 26 patients) and 4 years (T4, 13 patients). All patients had baseline FEV1 below 80 % predicted (60.5 ± 12.5 %). After omalizumab, 18 patients showed FEV1 normalization (reversible airway obstruction; RAO+) already at T1 (88.7 ± 14.9 %, p < 0.0001) that persisted up to T4 (83.2 ± 7.9, p < 0.01), while 14 patients (RAO-) had FEV1 persistently decreased, from T1 (65.2 ± 8.4%, p < 0.05) up to T4 (61.4 ± 6.2%, not significant). Both groups had significant improvement of symptoms and exacerbations after omalizumab at T1, which persisted up to T4. The comparison between pretreatment characteristics of the two groups showed that RAO+ patients, had higher values of circulating eosinophils, exhaled nitric oxide (FENO), prevalence of rhinitis and nasal polyps, need of oral corticosteroids, shorter asthma duration, higher FEV1 and response to albuterol test. The optimal cut-off points predicting FEV1 normalization after omalizumab add-on were 30.5 ppb for FENO and 305 cells/µl for eosinophils. CONCLUSIONS: This study suggests that omalizumab add-on contributes to the persistent reversal of airway obstruction in a consistent number of patients with severe allergic asthma, and this beneficial effect is predicted by elevated pretreatment FENO and circulating eosinophils.


Assuntos
Obstrução das Vias Respiratórias/tratamento farmacológico , Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Omalizumab/administração & dosagem , Adulto , Idoso , Remodelação das Vias Aéreas/efeitos dos fármacos , Albuterol/administração & dosagem , Albuterol/farmacologia , Asma/fisiopatologia , Eosinófilos/metabolismo , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Óxido Nítrico/metabolismo , Estudos Retrospectivos , Índice de Gravidade de Doença
6.
Pharm Res ; 36(6): 80, 2019 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-30968221

RESUMO

PURPOSE: The performance of carrier-based dry powder inhaler (DPI) formulations can be critically impacted by interfacial interactions driven by tribo-electrification. Therefore, the aim of the present work was to understand how distinct API particle characteristics affect the charging behaviour of blends intended for DPI delivery. METHODS: Salbutamol sulphate (SBS) particles engineered via spray-drying and jet milling were used as model APIs. D-mannitol was selected as a model carrier. The materials were characterized concerning their different particle properties and their charge was analysed alone and in blends before and after flow over a stainless-steel pipe. RESULTS: The spray-dried SBS (amorphous and spherical) charged positively and to a higher extent than jet milled SBS (crystalline and acicular) that charged negatively and to a lower extent. D-mannitol charged positively and to a higher extent than the APIs. All drug-excipient blends charged negatively and differences were found between the spray-dried and jet milled SBS blends at 2% and 5% drug loads. CONCLUSIONS: It was demonstrated how distinct solid-states, particle shape, size and morphology as well as different water contents of the different materials can affect tribo-charging. For their binary blends, the amount and nature of fines seem to govern inter-particle contacts critically impacting charge evolution.


Assuntos
Albuterol/administração & dosagem , Manitol/química , Administração por Inalação , Química Farmacêutica/métodos , Portadores de Fármacos/química , Inaladores de Pó Seco , Excipientes/química , Humanos , Tamanho da Partícula , Pós/química , Propriedades de Superfície
7.
Evid. actual. práct. ambul ; 22(1): e001077, abr. 2019. tab.
Artigo em Espanhol | LILACS | ID: biblio-1015125

RESUMO

La bronquiolitis es una infección respiratoria aguda baja de causa viral, de aparición invernal, que es común en bebés de 0a 12 meses de edad. Conduce a que las vías respiratorias pequeñas se inflamen y se llenen de desechos, obstruyéndose.El bebé tiene una tos fuerte, secreción nasal, generalmente fiebre y puede presentar sibilancias dificultad respiratoria ydesaturación de oxígeno. Tras la presentación de un caso en la guardia se generó una controversia científica sobre lautilidad de los broncodilatadores en pacientes con bronquiolitis. Luego de realizar una búsqueda bibliográfica y seleccionarla evidencia más reciente y de mejor calidad, se concluye que la evidencia no apoya el uso de broncodilatadores enpacientes con bronquiolitis.(AU)


Bronchiolitis is a low acute respiratory lower respiratory tract infection of viral origin, winter appearance, which is commonin babies from 0 to 12 months of age. It causes the small airways in the lungs to become inflamed and fill with debris. Theinfant has a harsh cough, runny nose, usually fever and may have wheezing, respiratory distress and oxygen desaturation.After the presentation of a case in the emergency department, a scientific controversy was generated about the usefulnessof bronchodilators in patients with bronchiolitis. After conducting a literature search and selecting the most recent and bestquality evidence, it is concluded that evidence does not support the use of bronchodilators in patients with bronchioliTIS.(AU)


Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Broncodilatadores/administração & dosagem , Bronquiolite/tratamento farmacológico , Epinefrina/administração & dosagem , Albuterol/administração & dosagem , Infecções Respiratórias/tratamento farmacológico , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Bronquiolite/diagnóstico , Epinefrina/efeitos adversos , Sons Respiratórios/diagnóstico , Tosse/prevenção & controle , Albuterol/efeitos adversos , Albuterol/uso terapêutico , Febre/prevenção & controle
8.
Allergol Int ; 68(3): 335-341, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30846304

RESUMO

BACKGROUND: Although the guidelines in most countries do not recommend continuous inhalation of l-isoproterenol to treat pediatric patients with acute severe exacerbation of asthma, lower dose of l-isoproterenol has been widely used in Japan. To determine whether the efficacy of low-dose l-isoproterenol was superior to that of salbutamol, we conducted a double-blind, randomized controlled trial. METHODS: Hospitalized patients aged 1-17 years were eligible if they had severe asthma exacerbation defined by the modified pulmonary index score (MPIS). Patients were randomly assigned (1:1) to receive inhalation of l-isoproterenol (10 µg/kg/h) or salbutamol (500 µg/kg/h) for 12 hours via a large-volume nebulizer with oxygen. The primary outcome was the change in MPIS from baseline to 3 hours after starting inhalation. Trial registration number UMIN000001991. RESULTS: From December 2009 to October 2013, 83 patients (42 in the l-isoproterenol group and 41 in the salbutamol group) were enrolled into the study. Of these, one patient in the l-isoproterenol group did not receive the study drug and was excluded from the analysis. Compared with salbutamol, l-isoproterenol reduced MPIS more rapidly. Mean (SD) changes in MPIS at 3 hours were -2.9 (2.5) in the l-isoproterenol group and -0.9 (2.3) in the salbutamol group (difference -2.0, 95% confidence interval -3.1 to -0.9; P < 0.001). Adverse events occurred in 1 (2%) and 11 (27%) patients in the l-isoproterenol and salbutamol groups, respectively (P = 0.003). Hypokalemia and tachycardia occurred only in the salbutamol group. CONCLUSIONS: Low-dose l-isoproterenol has a more rapid effect with fewer adverse events than salbutamol.


Assuntos
Albuterol/uso terapêutico , Asma/tratamento farmacológico , Asma/fisiopatologia , Broncodilatadores/uso terapêutico , Isoproterenol/uso terapêutico , Administração por Inalação , Albuterol/administração & dosagem , Albuterol/efeitos adversos , Broncodilatadores/administração & dosagem , Broncodilatadores/efeitos adversos , Criança , Pré-Escolar , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Lactente , Isoproterenol/administração & dosagem , Isoproterenol/efeitos adversos , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Masculino , Resultado do Tratamento
9.
J Chin Med Assoc ; 82(1): 55-59, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30839405

RESUMO

BACKGROUND: Hyperkalemia is a risky and potentially life-threatening condition in pre-term infants. Glucose-insulin infusion has been considered a major therapeutic way for non-oligouric hyperkalemia but affects the stability of blood sugar level. We aimed to evaluate the effectiveness of salbutamol nebulization compared to glucose-insulin infusion for the treatment of non-oliguric hyperkalemia in premature infants. METHODS: Forty premature infants (gestation age ≤36 weeks) with non-oliguric hyperkalemia (central serum potassium level greater than 6.0 mmol/L) within 72 h of birth were enrolled in this study. These infants were randomly assigned into two groups. One group received a regular insulin bolus with glucose infusion (Group A; n = 20), and the other received salbutamol (Ventolin) by nebulization (Group B; n = 20). Potassium level, blood sugar, heart rate, and blood pressure were recorded for each group before treatment and at 3, 12, 24, 48, and 72 h post-treatment. RESULTS: The serum potassium levels were reduced after treatment in both groups. No significant changes in heart rate or blood pressure were observed in either group. The fluctuation in glucose levels was gentler in the salbutamol-treated group than in the glucose-insulin infusion group. CONCLUSION: Salbutamol nebulization is not only as effective as glucose-insulin infusion for treating non-oliguric hyperkalemia in premature infants but can avoid potential side effects such as vigorous blood glucose fluctuations.


Assuntos
Albuterol/administração & dosagem , Glicemia/análise , Hiperpotassemia/tratamento farmacológico , Pressão Sanguínea/efeitos dos fármacos , Método Duplo-Cego , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hiperpotassemia/sangue , Hiperpotassemia/fisiopatologia , Recém-Nascido , Recém-Nascido Prematuro , Nebulizadores e Vaporizadores , Estudos Prospectivos
10.
J Vet Intern Med ; 33(2): 976-980, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30707780

RESUMO

BACKGROUND: Bronchoalveolar lavage (BAL) is a method for the recovery of respiratory secretion from the lower airways. OBJECTIVES: To investigate if the administration of a single dose of a bronchodilatator in horses with a suspected or confirmed severe equine asthma could improve recovery of bronchoalveolar lavage fluid (BALF). ANIMALS: Twenty-eight horses with severe equine asthma. METHODS: Horses were divided into 2 groups: group "treated" was given salbutamol before endoscopic examination and BALF collection, whereas group "not treated" was not given. BAL was performed with BAL-catheter by instilling 350 mL of sterile saline. Amount of recovered fluid was recorded. Statistical analysis was performed with a two-tailed Student's t test. RESULTS: The average fluid recovery in the horses treated with salbutamol was 52% ± 15% (mean +/- SD), compared with 38% ± 13% for the group of horses not treated with salbutamol (P = 0.013). CONCLUSIONS AND CLINICAL IMPORTANCE: Clinicians should consider administration of salbutamol before performing BAL on horses with asthma.


Assuntos
Albuterol/administração & dosagem , Asma/veterinária , Lavagem Broncoalveolar/veterinária , Broncodilatadores/administração & dosagem , Doenças dos Cavalos/diagnóstico , Animais , Asma/diagnóstico , Asma/tratamento farmacológico , Lavagem Broncoalveolar/métodos , Líquido da Lavagem Broncoalveolar , Endoscopia/veterinária , Feminino , Cavalos , Masculino
11.
Int J Pharm ; 560: 35-46, 2019 Apr 05.
Artigo em Inglês | MEDLINE | ID: mdl-30664994

RESUMO

The evaluation of particle size recommended in the pharmacopeias requires a constant flow rate, and the method for pediatric inhaled drugs is the same as for adult drugs. In this study, the aerosol concentration and particle size distribution (PSD) were measured under a realistic breathing pattern and constant flow. Two types of nebulizer (i.e., breath-enhanced nebulizer and vibrating-mesh nebulizer) and two formulations (i.e., budesonide suspension and albuterol solution) were chosen for comparison. The aerosol concentration under the realistic pattern was not constant, which was different from the result at constant flow. The changing trend of aerosol concentration varied with the operation process of each device. The aerosol concentration profile was similar between budesonide suspension and albuterol solution. As to the PSD, as inspiratory flow increased, the X50 (50% undersize) increased with all nebulizers but Omron microAir NE-U22 nebulizer. There was good agreement between X50 obtained under the realistic inhalation patterns and their equivalent average flow rates by Bland-Altman analysis, although the X50 obtained under the realistic inhalation pattern was greater than value at constant flow. The agreement of the two breath-enhanced jet nebulizers was better than that of the vibrating-mesh nebulizers. The X50 of budesonide was not equal to that of albuterol when using the same nebulizer. Interestingly, a significant difference was observed in the X50 and Span when comparing the results of PSD under adult and child breathing patterns. Furthermore, all vibrating-mesh nebulizers produced aerosol droplets having larger mean diameter and narrower size distribution than those of the air-jet nebulizers. We conclude that it will be more conducive to the evaluation of particle size to use a laser diffractometer under a realistic pattern and make up for the shortcomings of cascade impactors. The effects of flow pattern, nebulizer and formulation should be taken into account in the evaluation of the qualities of nebulizer products in pharmaceutical practice.


Assuntos
Albuterol/administração & dosagem , Broncodilatadores/administração & dosagem , Budesonida/administração & dosagem , Nebulizadores e Vaporizadores , Administração por Inalação , Adulto , Aerossóis , Albuterol/química , Broncodilatadores/química , Budesonida/química , Criança , Desenho de Equipamento , Humanos , Lasers , Tamanho da Partícula , Vibração
13.
An. pediatr. (2003. Ed. impr.) ; 90(1): 19-25, ene. 2019. tab
Artigo em Espanhol | IBECS | ID: ibc-177172

RESUMO

Introducción y objetivo: Aunque las guías basadas en la evidencia científica sobre bronquiolitis aguda recomiendan únicamente el tratamiento de soporte, se continúa documentando el uso de tratamientos innecesarios. El objetivo de este estudio fue analizar el impacto de una iniciativa de mejora de la calidad para reducir el sobreuso de tratamientos innecesarios en lactantes con bronquiolitis en atención primaria. Método: Para determinar el número de tratamientos innecesarios, fueron revisados los registros correspondientes a niños menores de 2 años de edad diagnosticados de bronquiolitis en dos áreas de atención primaria, durante dos epidemias de bronquiolitis (octubre-marzo de 2015-2016 (periodo preintervención) y de 2016-2017 (periodo postintervención)). Entre estas dos epidemias fue distribuido un protocolo de manejo basado en la evidencia científica y se desarrollaron sesiones interactivas con descripción de datos sobre la utilización de fármacos en los centros implicados. Los resultados fueron la tasa de niños que recibieron salbutamol, corticoides o antibióticos. Resultados: Se registraron un total de 1.277 episodios de bronquiolitis aguda, atendidos en 20 centros de salud, durante las dos epidemias (619 en el periodo preintervención y 658 en el periodo postintervención). Globalmente, el uso de cualquier medicación se redujo desde un 72,5% (IC 95%: 68,8-75,9) hasta un 52,1% (IC 95%: 48,3-55,9) (p < 0,01): salbutamol de un 56,0% (IC 95%: 52,1-59,9) a un 38,3% (IC 95%: 34,6-42,0) (p < 0,01), corticoides de un 23,7% (IC 95%: 20,5-27,2) a un 12,9% (IC 95%: 10,5-15,7) (p < 0,01) y antibióticos de un 36,1% (IC 95%: 32,5-40,0) a un 29,6% (IC 95%: 26,2-33,2) (p < 0,05). El número de medicaciones por paciente disminuyó de una media de 1,81 (DE: 0,86) a 1,62 (DE: 0,81) (p < 0,01). Conclusiones: En el presente estudio, se redujo de forma significativa el uso de tratamientos innecesarios para la bronquiolitis aguda en atención primaria. Esta iniciativa de mejora de la calidad puede ser aplicada en los centros sanitarios donde se atienden la mayoría de los niños con bronquiolitis aguda en los países occidentales


Introduction and objective: Although evidence-based guidelines for acute bronchiolitis recommend primarily supportive care unnecessary treatments remain well documented. The objective of this study was to analyse a quality improvement initiative to reduce overuse of unnecessary treatments in infants with acute bronchiolitis in primary care settings. Method: To determine the number of unnecessary treatments we reviewed the charts corresponding to infants aged <24 months of age diagnosed with acute bronchiolitis in two Primary Care areas during two bronchiolitis seasons [October-Mars of 2015-2016 (pre-intervention period) and 2016-2017 (post-intervention period)]. Between those seasons we distributed an evidence-based management protocol and developed interactive sessions with on-line data collection and feed-back. Outcomes were the rate of infants receiving salbutamol, steroids or antibiotics. Results: Twenty outpatient clinics contributed with 1,277 chart reviews (619 in the pre-intervention period and 658 in the post-intervention period). Overall, the use of any medication was reduced from 72.5% (95% CI, 68.8-75.9) to 52.1% (95% CI, 48.3-55.9) (p < 0.01): salbutamol from 56.0% (95% CI, 52.1-59.9) to 38.3% (95% CI, 34.6-42.0) (p < 0.01), corticosteroids from 23.7% (95% CI, 20.5-27.2) to 12.9% (95% CI, 10.5-15.7) (p < 0.01) and antibiotics from 36.1% (95% CI; 32.5-40.0) to 29.6% (95% CI; 26.2-33.2) (p < 0.05). The number of medications per patient decreased from a mean of 1.81 (SD: 0.86) to 1.62 (SD: 0.81) (p < 0.01). Conclusions: We significantly decreased the use of unnecessary treatments in infants with acute bronchiolitis. This quality improvement initiative may be applied to the settings where the majority of infants with acute bronchiolitis are attended in western countries


Assuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Bronquiolite/tratamento farmacológico , Atenção Primária à Saúde , Sobremedicalização , Albuterol/administração & dosagem , Corticosteroides/administração & dosagem , Antibacterianos/administração & dosagem
14.
Pediatrics ; 143(1)2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30518671

RESUMO

OBJECTIVES: The American Academy of Pediatrics' bronchiolitis guidelines recommend against albuterol and corticosteroids for treating and chest radiographs (CRs) for diagnosing infants with bronchiolitis. However, high rates of nonadherence have been documented. Our objective was to improve guideline adherence in infants with bronchiolitis. METHODS: This quality improvement study was conducted in 1 urban academic pediatric primary care clinic caring for predominately minority and publicly insured children. We tested provider guideline education, display of guidelines in patient care areas, and monthly e-mails to all providers documenting deviation rates, with individual e-mails to providers who deviated. P-charts and interrupted time series analysis were used to estimate the effect of the intervention. RESULTS: There were 380 children <2 years of age with a diagnosis of bronchiolitis in the 16 nonsummer months preintervention and 417 in the 15 postintervention months. Rates of prescribed and administered albuterol declined from 45.7% in the baseline period to 13.7% in the intervention period and CR use dropped from a mean of 10.1% to 3.4%, both demonstrating special cause variation. Steroid use did not change significantly. In interrupted time series analyses, the intervention was associated with a significant decrease in albuterol use (P < .001) but not in CR or steroid use. Emergency department visits declined slightly but admissions for bronchiolitis were stable. CONCLUSIONS: Traditional quality improvement efforts coupled with social psychology techniques resulted in improved guideline adherence in outpatient bronchiolitis management. Additional study will help identify which techniques are most effective for increasing guideline adherence in cases of low-value care.


Assuntos
Albuterol/administração & dosagem , Bronquiolite/tratamento farmacológico , Bronquiolite/psicologia , Broncodilatadores/administração & dosagem , Pessoal de Saúde/psicologia , Adesão à Medicação/psicologia , Pré-Escolar , Feminino , Fidelidade a Diretrizes , Pessoal de Saúde/educação , Humanos , Lactente , Recém-Nascido , Masculino , Psicologia Social
15.
Minerva Pediatr ; 71(2): 103-109, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26365818

RESUMO

BACKGROUND: Forced expiratory flow between 25% and 75% of vital capacity (FEF25-75%), a spirometric measure of small airways, may predict the presence of airway responsiveness both in asthmatics and in allergic rhinitis (AR). We aimed to search the correlation between FEF25-75% and standard measures of spirometry (forced expiratory volume in the first second [FEV1%] and FEV1/FVC [forced vital capacity]) in different clinical conditions, that is in children with asthma, in children with asthma and AR, in children with AR and in healthy children. METHODS: Children with asthma (N.=116), asthma plus AR (N.=25), AR (N.=75) and healthy controls (N.=52) were evaluated. Clinical examinations, spirometry and bronchodilation tests were performed. RESULTS: In asthmatics there was a strong correlation between FEF25-75% and FEV1% (r=0.596, P<0.001); and between FEF25-75% and FEV1/FVC (r=0.740, P<0.001). In AR patients correlation between FEF25-75% and FEV1% (r=0.367, P=0.001); and between FEF25-75% and FEV1/FVC (r=0.534, P<0.001) were less prominent compared to asthmatics but they were still significant and strong. In children with both AR and asthma correlation between FEF25-75% and FEV1% (r=0.633, P=0.001) and between FEF25-75% and FEV1/FVC (r=0.539, P=0.005) were again significant. Pre-test FEV1% and FEF25-75% in AR patients were lower than that of the control subjects. After the bronchodilation, percentage change in the FEV1 in AR patients were significantly higher than the control subjects (P=0.010). AR patients showed significant increases in FEV1%, (P<0.001), FEF25-75%, (P<0.001) and (P=0.001) after the bronchodilation test. Within the AR patients, only 12/75 (16.0%) showed bronchodilation with salbutamol. Among the ones with a FEF25-75% <65%, FEV1% was normal in 6/43 (14%) patients in asthmatics, and FEV1% was normal in 3/9 (33%) patients in asthma +AR patients. CONCLUSIONS: Besides the FEV1% and FEV1/FVC, the FEF25-75% may be a useful and early spirometric parameter to evaluate the children with asthma and or AR.


Assuntos
Asma/diagnóstico , Broncodilatadores/administração & dosagem , Rinite Alérgica/diagnóstico , Espirometria/métodos , Adolescente , Albuterol/administração & dosagem , Asma/fisiopatologia , Estudos de Casos e Controles , Criança , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Fluxo Máximo Médio Expiratório , Rinite Alérgica/fisiopatologia , Capacidade Vital
16.
J Pharm Pharmacol ; 71(3): 293-305, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30485903

RESUMO

OBJECTIVES: To investigate the effects of formulation composition on the physico-chemical and drug release properties of mucoadhesive buccal films prepared by melt extrusion technology, using a response surface methodology. METHODS: Salbutamol sulphate, an antiasthmatic drug was used for this study. Klucel hydroxypropylcellulose (HPC) EF (film-forming polymer), Benecel hydroxypropylmethylcellulose (HPMC) K-15M (drug release retardant) and polyethylene glycol (PEG) 4500 (plasticiser) were the three independent factors utilised for the study. The responses were fitted to a full quadratic model and P-values for each of the factors were used to determine their significance on the film characteristics. KEY FINDINGS: Films were successfully extruded using the corotating twin-screw extruder. The torque during extrusion was found to be significantly affected by all the three factors and no interaction between factors was observed. A significant interaction was observed between HPC and PEG 4500 for stiffness of films. For disintegration time and swelling index, a significant interaction was found between HPC and HPMC. The in vitro % drug release was directly correlated with HPMC content and not with other factors and varied from 69-89% at 4 h. CONCLUSIONS: The influence of extrusion process and formulation parameters on salbutamol sulphate films was elucidated, indicating the use of melt extrusion as a feasible method for film preparation.


Assuntos
Adesivos/administração & dosagem , Adesivos/química , Mucosa Bucal/efeitos dos fármacos , Administração Bucal , Albuterol/administração & dosagem , Albuterol/química , Antiasmáticos/administração & dosagem , Antiasmáticos/química , Celulose/análogos & derivados , Celulose/química , Química Farmacêutica/métodos , Sistemas de Liberação de Medicamentos/métodos , Liberação Controlada de Fármacos/efeitos dos fármacos , Temperatura Alta , Derivados da Hipromelose/química , Plastificantes/química , Polietilenoglicóis/química , Polímeros/química , Tecnologia Farmacêutica/métodos , Resistência à Tração/efeitos dos fármacos
17.
J Pediatr ; 204: 245-249.e2, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30392872

RESUMO

OBJECTIVE: To compare the efficacy of a breath-enhanced and a conventional jet nebulizer in the treatment of children with moderate to severe acute asthma. STUDY DESIGN: We enrolled subjects between 6 and 18 years of age presenting to the emergency department (ED) with acute asthma and an initial forced expiratory volume in 1 second (FEV1) <70% of predicted. We excluded patients with chronic disease, who required immediate resuscitation, or failed spirometry. Subjects were randomized to breath-enhanced or conventional jet delivery of a 5-mg albuterol treatment. Our primary outcome was change in FEV1, and secondary outcomes included change in clinical asthma scores, ED length of stay, disposition, and side effects. Student t test and multivariable linear regression were used to evaluate the primary outcome. RESULTS: In total, 497 patients were assessed for eligibility with 118 enrolled and 107 subjects available for analysis of the primary outcome. Improvement in FEV1 was significantly greater with conventional jet nebulizer (mean ΔFEV1 +13.8% vs +9.1%, P = .04). This difference remained significant after adjustment for baseline differences. Subgroup analysis of 57 subjects with spirometry meeting American Thoracic Society/European Respiratory Society guidelines yielded similar results (mean ΔFEV1 +14.5% vs +8.5%, P=.03). There were no significant differences in clinical asthma scores, ED length of stay, disposition, or side effects. CONCLUSIONS: Albuterol delivered via conventional jet nebulizer resulted in significantly greater improvement in FEV1 than albuterol delivered by breath-enhanced nebulizer, without significant differences in clinical measures. Conventional jet nebulizers may deliver albuterol to children with acute asthma more effectively than breath-enhanced nebulizers. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02566902.


Assuntos
Albuterol/administração & dosagem , Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Nebulizadores e Vaporizadores/estatística & dados numéricos , Adolescente , Albuterol/efeitos adversos , Broncodilatadores/efeitos adversos , Criança , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Espirometria/métodos
18.
J Liposome Res ; 29(4): 332-342, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30296863

RESUMO

The motive behind present work was to discover a solution for overcoming the problems allied with a deprived oral bioavailability of salbutamol sulfate (SS) due to its first pass hepatic metabolism, shorter half-life, and systemic toxicity at high doses. Pulmonary delivery provides an alternative route of administration to avoid hepatic metabolism of SS, moreover facilitated diffusion and prolonged retention can be achieved by incorporation into liposomes. Liposomes were prepared by thin film hydration technique using 32 full factorial design and formulation was optimized based on the vesicle size and percent drug entrapment (PDE) of liposomes. Optimized liposomal formulation exhibited an average size of about 167.2 ± 0.170 nm, with 80.68 ± 0.74% drug entrapment, and 9.74 ± 1.10 mV zeta potential. The liposomal dispersion was then spray dried and further characterized for in-vitro aerosol performance using Andersen Cascade Impactor. Optimized liposomal formulation revealed prolonged in-vitro drug release of more than 90% up to 14 h following Higuchi's controlled release model. Thus, the proposed new-fangled liposomal formulation would be a propitious alternative to conventional therapy for efficient and methodical treatment of asthma and alike respiratory ailments.


Assuntos
Albuterol/química , Asma/tratamento farmacológico , Preparações de Ação Retardada/química , Lipossomos/química , Pulmão/metabolismo , Nanopartículas/química , Administração por Inalação , Aerossóis/química , Albuterol/administração & dosagem , Albuterol/uso terapêutico , Composição de Medicamentos/métodos , Liberação Controlada de Fármacos , Estabilidade de Medicamentos , Humanos , Tamanho da Partícula
19.
Int J Cardiol ; 274: 100-105, 2019 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-30001944

RESUMO

BACKGROUND: The long-term outlook after surgical closure of ventricular septal defect (VSD) has traditionally been considered benign. However, there is an increasing awareness of not only late cardiac dysfunction, but also pulmonary abnormalities. The primary aim of this study was to describe pulmonary function in adults with a surgically repaired VSD, and secondarily to determine the effects of salbutamol on the potential abnormalities. METHODS: All patients (operated for a VSD in early childhood) and controls (age- and gender-matched) underwent static and dynamic spirometry, impulse oscillometry, multiple breath washout, diffusion capacity for carbon monoxide, and cardiopulmonary exercise testing. In a double-blinded, cross-over study, participants were randomized to inhalation of either 900 µg of salbutamol or placebo. The primary outcome was forced expiratory volume in 1 s. RESULTS: In total, 30 participants with a surgically closed VSD and 30 healthy controls were included. The VSD participants had a lower forced expiratory volume in 1 s (99 ±â€¯13% vs. 111 ±â€¯13%), p < 0.001, impaired forced vital capacity, (106 ±â€¯12% vs. 118 ±â€¯13%), p < 0.001, and lower peak expiratory flow, (95 ±â€¯18% vs. 118 ±â€¯19%), p < 0.001, than the control group. Also, the VSD group had a lower alveolar volume than the control group, (92 ±â€¯10% vs. 101 ±â€¯11%), p < 0.001, but there were no differences in the remaining pulmonary function parameters. Salbutamol reduced airway resistances in both groups, but exercise performance was not improved by salbutamol, however. CONCLUSIONS: Adults who have undergone surgical closure of a VSD in early childhood have reduced pulmonary function compared with controls, which is unaffected by inhalation of salbutamol.


Assuntos
Resistência das Vias Respiratórias/fisiologia , Albuterol/administração & dosagem , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Tolerância ao Exercício/fisiologia , Comunicação Interventricular/cirurgia , Complicações Pós-Operatórias/etiologia , Ventilação Pulmonar/fisiologia , Administração por Inalação , Adulto , Broncodilatadores/administração & dosagem , Estudos Cross-Over , Progressão da Doença , Método Duplo-Cego , Teste de Esforço , Feminino , Seguimentos , Volume Expiratório Forçado , Comunicação Interventricular/fisiopatologia , Humanos , Masculino , Complicações Pós-Operatórias/tratamento farmacológico , Complicações Pós-Operatórias/fisiopatologia , Testes de Função Respiratória , Adulto Jovem
20.
Pediatr Emerg Care ; 35(3): 209-215, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-28926508

RESUMO

OBJECTIVE: To assess the variation between racial/ethnic groups in emergency department (ED) treatment of asthma for pediatric patients. METHODS: This study was a cross-sectional analysis of pediatric (2-18 years) asthma visits among 6 EDs in the Upper Midwest between June 2011 and May 2012. We used mixed-effects logistic regression to assess the odds of receiving steroids, radiology tests, and returning to the ED within 30 days. We conducted a subanalysis of asthma visits where patients received at least 1 albuterol treatment in the ED. RESULTS: The sample included 2909 asthma visits by 1755 patients who were discharged home from the ED. After adjusting for demographics, insurance type, and triage score, African American (adjusted odds ratio [aOR], 1.78; 95% confidence interval [CI], 1.40-2.26) and Hispanic (aOR, 1.64; 95% CI, 1.22-2.22) patients had higher odds of receiving steroids compared with whites. African Americans (aOR, 0.58; 95% CI, 0.46-0.74) also had lower odds of radiological testing compared with whites. Asians had the lowest odds of 30-day ED revisits (aOR, 0.26; 95% CI, 0.08-0.84), with no other significant differences detected between racial/ethnic groups. Subgroup analyses of asthma patients who received albuterol revealed similar results, with American Indians showing lower odds of radiological testing as well (aOR, 0.47; 95% CI, 0.22-1.01). CONCLUSIONS: In this study, children from racial/ethnic minority groups had higher odds of steroid administration and lower odds of radiological testing compared with white children. The underlying reasons for these differences are likely multifactorial, including varying levels of disease severity, health literacy, and access to care.


Assuntos
Asma/terapia , Serviços Médicos de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adolescente , Albuterol/administração & dosagem , Asma/etnologia , Broncodilatadores/administração & dosagem , Criança , Pré-Escolar , Estudos Transversais , Grupos Étnicos , Feminino , Glucocorticoides/administração & dosagem , Humanos , Masculino , Readmissão do Paciente , Estados Unidos
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