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1.
Medicine (Baltimore) ; 99(4): e18657, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31977855

RESUMO

BACKGROUND: To systematically evaluate the clinical efficacy of salbutamol treatment in infants with bronchiolitis. METHODS: A systematic review and meta-analysis of randomized controlled trials (RCTs) investigating the use of salbutamol in infants with bronchiolitis was performed. The Cochrane Risk of Bias Assessment Tool was used to evaluate the quality of RCTs. Data were extracted and meta-analyzed using STATA version 12.0 (StataCorp, College Station, TX). RESULTS: Thirteen RCTs, including a total of 977 participants, were assessed in the present meta-analysis. Results indicated that salbutamol therapy for bronchiolitis in infants led to an increase in respiratory rate (weighted mean difference [WMD] 2.26 [95% confidence interval {CI} 0.36-4.16]) and higher heart rate (WMD 12.15 [95% CI 9.24-15.07]). However, as a selective ß2-agonist, salbutamol did not improve the clinical severity score of infants with bronchiolitis (WMD -0.11 [95% CI -0.26 to 0.03]), length of hospital stay (WMD 0.12 [95% CI -0.32 to 0.56]), or oxygen saturation (WMD 0.20 [95% CI -0.35 to 0.75]). CONCLUSION: Based on the results of this systematic review, the use of salbutamol had no effect on bronchiolitis in children <24 months of age. Moreover, the treatment can also lead to side effects, such as high heart rate. As such, salbutamol should not be recommended for treatment of bronchiolitis in infants.


Assuntos
Albuterol/uso terapêutico , Bronquiolite/tratamento farmacológico , Broncodilatadores/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Humanos , Lactente , Tempo de Internação , Oxigênio/sangue , Ensaios Clínicos Controlados Aleatórios como Assunto , Taxa Respiratória/efeitos dos fármacos , Índice de Gravidade de Doença
3.
Prensa méd. argent ; 105(8): 448-455, sept 2019. graf, tab
Artigo em Inglês | LILACS, BINACIS | ID: biblio-1023262

RESUMO

EIB (Exercise-Induced Bronchoconstriction) describes the narrowing that accurs in the airway follow a short period of exercise. EIB is found in 8-10% of normal children population as occult bronchospasm during or after physical activities. The mecanisms of EIB are related to rapid ventilation and mouth brathing which cause beat and water loss during breathing leading to bronchoconstriction. Peak Expiratory Flow Rate (PEFR) measured pre and post-exercise in students aged 12-16 years in girl intrmediate school. Any female shows PEFR values reduction 15% after 6 minutes continuous free running considered as asthmatic patient, this give an incidence rate of asthmatic patient of 9% in female students in this age. Treatment of EIB, Zafirlukast treatment gives (85.7%) protection rate. While salbutamol inhalation gives a protection rate 88%. Only 66.6% of girls with EIB give an improvement in PEFR values after sodium cromoglycate treatment. A regular measurement of PEFR in school students appears to be a good indicator of EIB, while inhalation of salbutaol 15 minutes before exercise give a good protection against EIB attacks at least for 4 hours (AU)


Assuntos
Humanos , Feminino , Adolescente , Asma Induzida por Exercício/terapia , Terapêutica , Cromolina Sódica/uso terapêutico , Antagonistas de Leucotrienos/uso terapêutico , Albuterol/uso terapêutico
4.
Rev Fac Cien Med Univ Nac Cordoba ; 76(3): 164-169, 2019 08 29.
Artigo em Espanhol | MEDLINE | ID: mdl-31465184

RESUMO

Background: The link between upper and lower airways is recognized clinically as a "unique airway". Subclinical spirometric abnormalities have been observed in patients with rhinitis without asthma, which could be proportional to rhinitis severity. Objectives: To investigate possible subclinical alterations in lung function and bronchodilator reversibility in children and adolescents with allergic (AR) and non-allergic rhinitis (NAR) without asthma, according to the clinical grade of rhinitis classified by ARIA (Allergic Rhinitis and Its Impact on Asthma). Methods: In a cross-sectional analytical study, we included patients aged 5 to 18 years with symptoms of AR and NAR without asthma. Spirometry was performed by flow-volume curve and we analyzed the abnormalities in respiratory function and bronchodilator response in relation to clinical grade of rhinitis by ARIA using an adjusted logistic model. Results: We studied 193 patients; 42 (21.7%) had some spirometric abnormalities. Patients with moderate-severe persistent rhinitis had greater impairment of lung function compared to the other grades of rhinitis (p=0.009). This defect was associated with both frequency (p=0.03) and severity of rhinitis (p=0.04) but not with atopic status (p=0.28). A positive bronchodilator response was more frequent in grades moderate-severe of rhinitis than in mild forms (p=0.04). Conclusion: Abnormalities of lung function was more prevalent in moderate-severe persistent rhinitis and was associated with the frequency and severity of rhinitis but not to atopic status. The bronchodilator reversibility was observed in patients with intermittent and persistent moderate-severe rhinitis.


Assuntos
Albuterol/uso terapêutico , Broncodilatadores/uso terapêutico , Pulmão/fisiopatologia , Rinite/complicações , Rinite/tratamento farmacológico , Adolescente , Alérgenos/administração & dosagem , Alérgenos/classificação , Argentina , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Pulmão/efeitos dos fármacos , Masculino , Rinite/diagnóstico , Rinite Alérgica/complicações , Rinite Alérgica/diagnóstico , Rinite Alérgica/tratamento farmacológico , Índice de Gravidade de Doença , Testes Cutâneos , Espirometria
5.
Ital J Pediatr ; 45(1): 82, 2019 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-31307512

RESUMO

Lung function impairment is common in Congenital Diaphragmatic Hernia (CDH) survivors. The aim of this study was to evaluate, in children who underwent CDH surgical repair, mid and long-term consequences on respiratory impedance, investigating the impact of CDH on both resistance and reactance parameters, as well as bronchodilator response.Forced Oscillation Technique (FOT) parameters were collected from 12 patients (2-11 years). Resistance and reactance values at 8 Hz (Rrs8, Xrs8) and the area under the reactance curve (AX) were measured pre and post-salbutamol. Quantitative variables were compared using Mann-Whitney U test. Differences of categorical variables were evaluated using Fisher exact test. Statistically significant differences between measured and predicted values for Rrs8 (p = 0.04), Xrs8 (p = 0.02) and AX (p = 0.01) were found. When stratifying for age, significant difference between measured and predicted values was observed only in children < 5 years (n = 6) (Rrs8 p = 0.03, Xrs8 p = 0.001, AX p = 0.007). With respect to children 5 years (n = 6), the younger ones showed higher z-scores in Rrs8 (p = 0.015), Xrs8 (p = 0.002) and AX (p = 0.002) values. Since the z-score difference was greater than 0.5, it was considered a difference clinically relevant. No differences in bronchodilator response were recorded.In children with CDH an impairment of respiratory impedance measured by FOT is observed only in children aged less than 5 years.


Assuntos
Resistência das Vias Respiratórias , Hérnias Diafragmáticas Congênitas/complicações , Hérnias Diafragmáticas Congênitas/cirurgia , Albuterol/uso terapêutico , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Itália , Masculino , Testes de Função Respiratória
6.
Turk J Med Sci ; 49(4): 1008-1013, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31269786

RESUMO

Background/aim: The aim of this study was to compare the effect of salbutamol delivered to children by jet nebulizer (JN) and mesh nebulizer (MN). Materials and methods: Children admitted with acute asthma were treated with 3 doses of nebulized salbutamol, 1 given by MN. The patients' vital signs, lung function measurements, modified pulmonary index score (MPIS), and whole body plethysmography (WBP) measurements were evaluated before and 20 min after each dose of salbutamol. Results: Thirty-onechildren [9.5 (6.4­17.2) years, 67.7% male, 32.3% female] with mild (67.7%) and moderate (32.3%) asthma attacks were included in the study. The improvements with MN were comparable with JN in terms of changes in pretreatment and posttreatment forced expiratory volume in the first second (FEV1) (2.57 ± 4.57, 3.65 ± 5.44; P = 0.44), forced vital capacity (FVC) (2.52 ± 5.29, 4.17 ± 7.54; P = 0.28), heart rate (7.33 ± 10.21, 4.14 ± 9.32; P = 0.24), peripheral capillary oxygen saturation (SpO2) (0.38 ± 0.23, 0.43 ± 0.15; P = 0.83), and modified pulmonary index score (MPIS) (−6.30 ± 22.70, −8.77 ± 25.46; P = 0.70). The pre- and posttreatment values of total lung capacity (TLC), residual volume (RV), specific conductance (sGaw), and RV/TLC were similar for the JN and MN groups. Adverse effects were not different: however, complaints of palpitation were significantly higher in the posttreatment MN group than the pretreatment MN group (32.3% vs 9.7%, respectively, P = 0.016). Conclusion: These findings support the previous evidence found in studies of adults that MN is as effective as and as safe as JN in the treatment of acute asthma in children


Assuntos
Asma/terapia , Broncodilatadores/administração & dosagem , Nebulizadores e Vaporizadores , Administração por Inalação , Adolescente , Albuterol/administração & dosagem , Albuterol/uso terapêutico , Asma/diagnóstico , Asma/fisiopatologia , Broncodilatadores/uso terapêutico , Criança , Feminino , Volume Expiratório Forçado/fisiologia , Humanos , Masculino , Pletismografia Total , Espirometria , Capacidade Vital/fisiologia
8.
JAMA Pediatr ; 173(6): 527-533, 2019 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-31009034

RESUMO

Importance: Tonsillectomy is a common pediatric procedure for the treatment of sleep-disordered breathing and chronic tonsillitis. Up to half of children having this procedure experience a perioperative respiratory adverse event. Objective: To determine whether inhaled albuterol sulfate (salbutamol sulfate) premedication decreases the risk of perioperative respiratory adverse events in children undergoing anesthesia for tonsillectomy. Design, Setting, and Participants: A randomized, triple-blind, placebo-controlled trial (the Reducing Anesthetic Complications in Children Undergoing Tonsillectomies [REACT] trial) was conducted at Perth Children's Hospital (formerly Princess Margaret Hospital for Children), the only tertiary pediatric hospital in Western Australia. Participants included 484 children aged 0 to 8 years who were undergoing anesthesia for tonsillectomy. The study was conducted between July 15, 2014, and May 18, 2017. Interventions: Participants were randomized to receive either albuterol (2 actuations, 200 µg) or placebo before their surgery. Main Outcomes and Measures: Occurrence of perioperative respiratory adverse events (bronchospasm, laryngospasm, airway obstruction, desaturation, coughing, and stridor) until discharge from the postanesthesia care unit. Results: Of 484 randomized children (median [range] age, 5.6 [1.6-8.9] years; 285 [58.9%] boys), 479 data sets were available for intention-to-treat analysis. Perioperative respiratory adverse events occurred in 67 of 241 children (27.8%) receiving albuterol and 114 of 238 children (47.9%) receiving placebo. After adjusting for age, type of airway device, and severity of obstructive sleep apnea in a binary logistic regression model, the likelihood of perioperative respiratory adverse events remained significantly higher in the placebo group compared with the albuterol group (odds ratio, 2.8; 95% CI, 1.9-4.2; P < .001). Significant differences were seen in children receiving placebo vs albuterol in laryngospasm (28 [11.8%] vs 12 [5.0%]; P = .009), coughing (79 [33.2%] vs 27 [11.2%]; P < .001), and oxygen desaturation (54 [22.7%] vs 36 [14.9%]; P = .03). Conclusions and Relevance: Albuterol premedication administered before tonsillectomy under general anesthesia in young children resulted in a clinically significant reduction in rates of perioperative respiratory adverse events compared with the rates in children who received placebo. Premedication with albuterol should be considered for children undergoing tonsillectomy. Trial Registration: Australian New Zealand Clinical Trials Registry identifier: ACTRN12614000739617.


Assuntos
Albuterol/uso terapêutico , Broncodilatadores/uso terapêutico , Complicações Intraoperatórias/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Cuidados Pré-Operatórios/métodos , Doenças Respiratórias/prevenção & controle , Tonsilectomia/efeitos adversos , Criança , Pré-Escolar , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Lactente , Recém-Nascido , Complicações Intraoperatórias/epidemiologia , Masculino , Complicações Pós-Operatórias/epidemiologia , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/etiologia , Resultado do Tratamento
9.
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
10.
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
11.
Pediatr Pulmonol ; 54(5): 531-536, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30719873

RESUMO

INTRODUCTION: Spacer devices optimize delivery of aerosol therapies and maximize therapeutic efficacy. We assessed the impact of spacer device on the prevalence and magnitude of bronchodilator response (BDR) in children with asthma. METHODS: Children with physician confirmed asthma and parentally reported symptoms in the last 12 months were recruited for this study. Each participant completed two separate visits (5-10 days apart) with spirometry performed at baseline and following cumulative doses of salbutamol (200, 400, 800, and 200 µg) delivered by either a small volume disposable spacer or a large volume multi-use spacer. Spacer type was alternated for each participant during each visit. The primary outcome was the effect of spacer type on bronchodilator responsiveness. The secondary outcome was to assess the relationships between spacer device, salbutamol dose and the proportion of children with a clinically relevant BDR. RESULTS: Thirty-two children (mean age 11.8 years) completed both visits. Change in lung function following bronchodilators was increased using the large volume spacer, for relative but not absolute increase in FEV1 [mean difference (95% confidence intervals): 1.28% (0.02, 2.54; P = 0.047) and 0.013 L (-0.01, 0.04; P = 0.288)], respectively. There was no observed difference in FVC by spacer type. Overall, 59% (n = 19) of children exhibited a clinically relevant BDR at 400 µg of salbutamol for any spacer and was independent of spacer type. CONCLUSION: Spacer device was not associated with clinically important differences in lung function following bronchodilator inhalation in children with asthma. At a recommended dose of 400 µg, some children with asthma may have their bronchodilator responsiveness misclassified.


Assuntos
Albuterol/administração & dosagem , Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Inaladores Dosimetrados , Administração por Inalação , Adolescente , Albuterol/uso terapêutico , Asma/fisiopatologia , Broncodilatadores/uso terapêutico , Criança , Estudos Cross-Over , Feminino , Volume Expiratório Forçado , Humanos , Masculino , Nebulizadores e Vaporizadores , Testes de Função Respiratória , Espirometria
12.
Ann Allergy Asthma Immunol ; 122(4): 381-386, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30742915

RESUMO

BACKGROUND: Intensive care unit (ICU) admission is a risk factor for fatal asthma. Little is known about risk factors for pediatric ICU admissions for asthma. OBJECTIVE: To examine characteristics of underserved minority children with prior ICU admissions for asthma. METHODS: Baseline survey data, salivary cotinine levels, and allergen specific IgE serologic test results were obtained from children with uncontrolled asthma enrolled in a randomized clinical trial of a behavioral education environmental control intervention. Characteristics of children with and without prior ICU admission were compared using χ2 and t tests. Logistic regression assessed significance of higher odds of prior ICU admission comparing factor-level categories. RESULTS: Patients included 222 primarily African American (93.7%), male (56%), Medicaid-insured (92.8%) children with a mean (SD) age of 6.4 (2.7) years with uncontrolled asthma. Most (57.9%) had detectable cotinine levels, 82.6% were sensitized to more than 1 environmental allergen, and 27.9% had prior ICU admissions. Prior ICU patients were more likely to be very poor (<$10,000 per year) and sensitized to more than 1 allergen tested (most importantly mouse) (P < .05). Allergen sensitization in the groups did not differ for cockroach, cat, dog, Alternaria, Aspergillus, dust mite, grass, or tree. Although more ICU patients received combination controller therapy, they also overused albuterol. Only 27.4% of ICU patients received specialty care in the previous 2 years, which was not significantly different from non-ICU patients. CONCLUSION: Children with high mortality risk, including history of ICU admission, were twice as likely to live in extreme poverty, have atopy (particularly mouse allergen), use combination controller therapy, and overuse albuterol. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01981564.


Assuntos
Asma/prevenção & controle , Exposição Ambiental/prevenção & controle , Hospitalização/estatística & dados numéricos , Hipersensibilidade Imediata/prevenção & controle , Unidades de Terapia Intensiva Pediátrica/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Adulto , Albuterol/uso terapêutico , Alérgenos/imunologia , Antiasmáticos/uso terapêutico , Asma/sangue , Asma/terapia , Cuidadores/psicologia , Criança , Pré-Escolar , Cotinina/análise , Feminino , Humanos , Hipersensibilidade Imediata/sangue , Hipersensibilidade Imediata/terapia , Imunoglobulina E/sangue , Masculino , Saliva/química , Adulto Jovem
13.
Food Funct ; 10(2): 903-911, 2019 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-30694283

RESUMO

Pericarpium Citri Reticulatae (PCR, Citrus reticulata 'Chachi', Guangchenpi in Chinese) is one of the most famous Chinese citrus herbal medicines. The in vivo anti-asthmatic activity of 'Chachi' PCR was investigated using a histamine-induced experimental asthma model in Guinea pigs. Two alkaloid-type compounds, synephrine and stachydrine, were analyzed and identified in the 'Chachi' PCR alkaloid fraction. The alkaloid fraction and synephrine protected Guinea pigs against histamine-induced experimental asthma in a dose-dependent manner. The respective application of high, middle, and low doses of the 'Chachi' PCR alkaloid fraction significantly increased specific airway resistance by 284%, 328%, and 355%, and decreased dynamic compliance by 57%, 67%, and 75%. A similar change was observed for synephrine. The expression of eosinophils in bronchoalveolar lavage fluid (BALF) and serum IgE, IL-4, and IL-5 levels in histamine-induced experimental asthmatic Guinea pigs were significantly downregulated by the 'Chachi' PCR alkaloid fraction and synephrine compared to the control group, whereas stachydrine did not impart a statistically significant effect on the expression of tested inflammatory cells (leucocytes, eosinophils, neutrophils, and lymphocytes), immunoglobulin (IgE), or cytokines (IL-4 and IL-5). Pathological changes in lung tissues in each treatment group included the infiltration of inflammatory cells around the bronchia.


Assuntos
Alcaloides/uso terapêutico , Asma/induzido quimicamente , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Extratos Vegetais/uso terapêutico , Albuterol/uso terapêutico , Alcaloides/química , Animais , Antiasmáticos , Broncodilatadores/administração & dosagem , Citrus , Feminino , Cobaias , Extratos Vegetais/química , Distribuição Aleatória
15.
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
16.
Toxicol Lett ; 303: 9-15, 2019 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-30572106

RESUMO

Sulfur mustard (SM) was responsible for more than 80% of all documented chemical casualties during the Great War. Recent literature on clinic picture of SM exposure remained so limited with the sporadic cases who were accidentally exposed to SM especially either in Western Europe or China. We reported a Syrian family of four who became victims of chemical terrorism due to SM exposure and we described the detailed clinical course of the family including the medical history, initial symptomatology, clinical examination, hematological data, and initial treatment in the first 48 hours after exposure at Kilis State Hospital, Turkey. The principles of our therapeutic approaches were designed according to the total affected body surface area, severity of cutaneous and respiratory lesions, and existing hematological disorders. SM is still considered as a critical vesicant agent and a current threat because of its ease of synthesis. Chemical terrorist attacks of non-state actors or terrorist organizations with "home-made" SM is likely such a threat which is targeting health systems of developed and developing countries. Except sarin attacks in Japan, the literature depends on real incidents of chemical terrorism is so rare and for this reason we have gaps and challanges in the prepardness of medical response system against chemical terrorism. Medical management could be performed adequetly only if the response system is well planned, well equipped, and well prepared for overburdened medical facilities filled with SM contaminated casualties after a chemical terrorist attack.


Assuntos
Terrorismo Químico , Gás de Mostarda/toxicidade , Acetaminofen/uso terapêutico , Acetilcisteína/uso terapêutico , Administração Cutânea , Administração por Inalação , Adulto , Albuterol/uso terapêutico , Grupo com Ancestrais do Continente Asiático , Pré-Escolar , Ciclopentolato/uso terapêutico , Feminino , Gentamicinas/uso terapêutico , Humanos , Recém-Nascido , Lidocaína/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Sulfadiazina de Prata/uso terapêutico , Pele/efeitos dos fármacos , Pele/patologia , Síria , Terrorismo , Turquia
18.
Allergol. immunopatol ; 46(6): 585-593, nov.-dic. 2018. graf, ilus, tab
Artigo em Inglês | IBECS | ID: ibc-177899

RESUMO

Background: One of the loop diuretics, furosemide, was found useful in bronchial asthma. It enhanced anti-asthmatic effects of albuterol. The underlying mechanism is still unclear. Objective: This study was planned to investigate whether the enhancing effect of furosemide for albuterol in ovalbumin-induced asthmatic BALB/c mice is diuretic-related or not. Methods: Two sets of experiments were performed. In the first, effects of inhaled subdiuretic doses of furosemide and bumetanide (another loop diuretic) were compared. Treatments (mg/mL) were given as 15 minute-inhalation before final ovalbumin provocation as follows: albuterol (2.5), furosemide (0.08), bumetanide (0.005), (albuterol + furosemide, 2.5 + 0.08), and (albuterol+bumetanide, 2.5 + 0.005). Airway hyperreactivity (AHR) to inhaled methacholine, levels of IL-6, TNF-alfa, and differential white blood cells in bronchoalveolar lavage fluid (BALF), and lung histopathology were evaluated. In the second set, effects of oral diuretic doses (mg/kg) of furosemide (10) and bumetanide (0.25) were given before final ovalbumin provocation. Urine volume and asthma parameters were measured. Results: Ovalbumin-asthmatic mice showed significant increases in AHR, levels of IL-6, TNF-alfa, and inflammatory cells in BALF, and lung inflammatory cell infiltration. Inhaled furosemide significantly decreased these changes while inhaled bumetanide failed. Albuterol and albuterol + bumetanide significantly decreased these changes more than furosemide while albuterol + furosemide produced the most significant decreases. Both oral furosemide and bumetanide exerted equivalent diuretic effects but failed to improve asthma. Conclusions: Inhaled subdiuretic dose of furosemide enhanced effects of albuterol more in ovalbumin-asthmatic mice rather than bumetanide, while oral diuretic doses of both drugs failed to improve asthma, indicating that this enhancing effect is not diuretic-related


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Assuntos
Humanos , Animais , Feminino , Camundongos , Albuterol/uso terapêutico , Asma/tratamento farmacológico , Bumetanida/uso terapêutico , Furosemida/uso terapêutico , Alérgenos/imunologia , Sinergismo Farmacológico , Quimioterapia Combinada , Interleucina-6/metabolismo , Pulmão/patologia , Camundongos Endogâmicos BALB C , Ovalbumina/imunologia , Fator de Necrose Tumoral alfa/metabolismo
19.
Biomedica ; 38(3): 303-307, 2018 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-30335235

RESUMO

Salbutamol is a ß2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the ß2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos , Albuterol/efeitos adversos , Mioclonia/induzido quimicamente , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Albuterol/uso terapêutico , Terapia Combinada , Sinergismo Farmacológico , Quimioterapia Combinada , Emergências , Evolução Fatal , Fenoterol/efeitos adversos , Fenoterol/uso terapêutico , Humanos , Ipratrópio/uso terapêutico , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Oxigenoterapia , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/terapia , Transtornos Relacionados ao Uso de Substâncias/complicações
20.
Am J Health Syst Pharm ; 75(22): 1791-1797, 2018 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-30282664

RESUMO

PURPOSE: The results of a study to determine if rates of poor response differ in patients receiving continuous nebulized albuterol (CNA) therapy with or without the preservative benzalkonium chloride are presented. METHODS: A retrospective analysis of the records of all patients who received CNA therapy at a large academic medical center from July 2015 to January 2016 was conducted. Data from patient evaluations performed before and after a change to benzalkonium chloride-containing albuterol were collected. The primary outcome was the rate of poor patient response, defined as a composite endpoint. Secondary outcomes included duration of therapy, dosing requirements, and duration of supplemental oxygen therapy. RESULTS: There was no significant difference in rates of poor response between patients exposed (n = 80) and patients not exposed (n = 48) to benzalkonium chloride (16% and 17%, respectively; p = 0.95). The cohort not exposed to benzalkonium chloride had a median CNA duration of 7.0 hours, as compared with 10.5 hours for the cohort exposed to benzalkonium chloride, but this difference was not significant (p = 0.19). There were no significant differences between the benzalkonium chloride-exposed and nonexposed cohorts in the maximum dosing requirement (12.6 mg/hr versus 12.8 mg/hr, p = 0.89) or median duration of supplemental oxygen use (27.5 hours versus 16.5 hours, p = 0.77). CONCLUSION: A study of hospitalized patients receiving CNA detected no significant difference in the frequency of poor response to therapy between groups receiving benzalkonium chloride-free versus benzalkonium chloride-containing albuterol products.


Assuntos
Albuterol/efeitos adversos , Compostos de Benzalcônio/efeitos adversos , Broncodilatadores/efeitos adversos , Conservantes Farmacêuticos/efeitos adversos , Administração por Inalação , Adolescente , Albuterol/administração & dosagem , Albuterol/uso terapêutico , Compostos de Benzalcônio/administração & dosagem , Compostos de Benzalcônio/uso terapêutico , Broncodilatadores/administração & dosagem , Broncodilatadores/uso terapêutico , Criança , Feminino , Humanos , Masculino , Nebulizadores e Vaporizadores , Conservantes Farmacêuticos/administração & dosagem , Conservantes Farmacêuticos/uso terapêutico , Estudos Retrospectivos , Estado Asmático/tratamento farmacológico , Resultado do Tratamento
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