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1.
J Zoo Wildl Med ; 50(4): 1012-1015, 2020 Jan 09.
Artigo em Inglês | MEDLINE | ID: mdl-31926539

RESUMO

Adenoviruses have been reported to affect a broad range of host species, tend to be species specific, and often affect the respiratory system. This report describes the isolation of an adenovirus from deep nasal swabs of two wild North American porcupines (Erethizon dorsatum) with respiratory diseases that presented to a wildlife hospital. Partial sequences of the deoxyribonucleic acid polymerase gene of the isolated virus were identical to skunk adenovirus (SkAdV-1), also known as pygmy marmoset adenovirus. Both porcupines survived and were released back to the wild after successful medical treatment and rehabilitation. The significance of the adenovirus isolated from these porcupines is unknown; however, this is the first report of an adenovirus in porcupines, and the first report of SkAdV-1 in a rodent.


Assuntos
Infecções por Adenoviridae/veterinária , Adenoviridae/classificação , Porcos-Espinhos , Infecções Respiratórias/veterinária , Adenoviridae/isolamento & purificação , Infecções por Adenoviridae/tratamento farmacológico , Infecções por Adenoviridae/virologia , Animais , Antibacterianos/uso terapêutico , Azitromicina/uso terapêutico , Broncodilatadores/uso terapêutico , Enrofloxacina/uso terapêutico , Masculino , Infecções Respiratórias/tratamento farmacológico , Infecções Respiratórias/virologia , Terbutalina/uso terapêutico
2.
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.
Zhonghua Jie He He Hu Xi Za Zhi ; 42(11): 838-844, 2019 Nov 12.
Artigo em Chinês | MEDLINE | ID: mdl-31694094

RESUMO

Objective: To compare the efficacy and safety profiles of tiotropium/olodaterol with the mono-components in Chinese and total study population from TONADO trial. Methods: In the replicate, double-blind, parallel-group, active-controlled, randomized, 52-week, Phase Ⅲ TONADO studies (TONADO 1+2), patients received tiotropium/olodaterol, tiotropium, or olodaterol via the Respimat(®) Inhaler (Boehringer Ingelheim, Germany). Primary end points were forced expiratory volume in 1 second (FEV(1)) area under the curve from 0 to 3 hours (AUC(0-3h)) response and trough FEV(1) response, and St George's respiratory questionnaire (SGRQ) total score at 24 weeks. Adverse events were also collected. This subgroup analysis only focused on the efficacy and safety of the drug at the approved dose in China. Results: 548 Chinese patients were randomized, aged 41 to 82 years [mean age, (63±8) years] and most were male (526, 96%), 111 received tiotropium/olodaterol 5/5 µg, and 127 received tiotropium 5 µg and 95 received olodaterol 5 µg. The baseline characteristics of these groups were similar. After 24 weeks, treatment with tiotropium/olodaterol 5/5 µg, tiotropium 5 µg and olodaterol 5 µg resulted in an adjusted mean FEV(1) AUC(0-3h) response of 0.240, 0.157 and 0.079 L, and trough FEV(1) response of 0.117, 0.068 and-0.001 L, respectively. Tiotropium/olodaterol 5/5 µg significantly improved SGRQ scores in Chinese patients compared with olodaterol 5 µg (32.729 and 37.202, respectively). Generally, the safety profile of tiotropium/olodaterol was comparable with mono-components in 52 weeks. Conclusion: Compared with tiotropium or olodaterol, tiotropium/olodaterol in Chinese patients provided significant improvement in lung function and quality of life, and the safety profiles were similar.


Assuntos
Benzoxazinas/administração & dosagem , Broncodilatadores/administração & dosagem , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Qualidade de Vida , Brometo de Tiotrópio/administração & dosagem , Administração por Inalação , Agonistas de Receptores Adrenérgicos beta 2 , Adulto , Idoso , Idoso de 80 Anos ou mais , Benzoxazinas/uso terapêutico , Broncodilatadores/uso terapêutico , China/epidemiologia , Método Duplo-Cego , Volume Expiratório Forçado , Humanos , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/etnologia , Doença Pulmonar Obstrutiva Crônica/psicologia , Brometo de Tiotrópio/uso terapêutico , Resultado do Tratamento
4.
Ther Umsch ; 76(6): 301-310, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762413

RESUMO

Development of inhaled therapies for COPD and asthma Abstract. Inhaled therapies still represent one of the most important pillars of the COPD and asthma treatments. In recent years, the importance of inhaled corticosteroids in the treatment of COPD changed again and again and currently it seems that they are gaining more importance again. In the future, inhaled therapies will increasingly focus on biomarkers. New to the market are the "triple therapies as a fixed combination", whose success will be evident in the next few years. Despite the great variety of new agents, new combinations and new inhalation systems, it is important to keep a good overview and to focus on the individual benefit of the patients. The goal is to find the products that are suitable for the individual patient in a dosage form that is ideal for him. A correct inhalation technique and a good medication adherence to the prescribed treatment plan is crucial for the success of an inhaled therapy.


Assuntos
Asma , Broncodilatadores/administração & dosagem , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Feminino , Humanos , Masculino , Adesão à Medicação , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
5.
Ther Umsch ; 76(6): 311-316, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31762414

RESUMO

The data situation for the use of ICS in asthma is clear. In the case of COPD, on the other hand, where in recent years the pendulum has moved away from ICS towards a dual therapy based on LABA / LAMA, the discussion is open again thanks to new work. However, it would certainly be wrong to recommend ICS as a meaningful therapy for all COPD patients at this point in time, since therapy with ICS is associated with side effects, in particular an increase in the risk of developing pneumonia or osteoporosis. However, there is no doubt that patients with asthma COPD overlap require ICS therapy.


Assuntos
Corticosteroides/uso terapêutico , Agonistas de Receptores Adrenérgicos beta 2 , Asma , Broncodilatadores/uso terapêutico , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Asma/tratamento farmacológico , Quimioterapia Combinada , Humanos , Antagonistas Muscarínicos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
6.
FP Essent ; 486: 26-32, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31710455

RESUMO

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease characterized by cough, dyspnea, and sputum production caused by inhalation of harmful chemicals, such as tobacco smoke. COPD should be suspected in patients with a significant smoking history, shortness of breath, and sputum production. The diagnosis is made by spirometry. A forced expiratory volume in the first second of expiration to forced vital capacity (FEV1/FVC) ratio of less than 0.7 after bronchodilator administration confirms the diagnosis. Therapy for patients with stable COPD should include a bronchodilator, either a long-acting beta2-agonist (LABA) or a long-acting muscarinic antagonist (LAMA). For patients who continue to experience dyspnea with a single bronchodilator, dual therapy with a LABA and LAMA is appropriate. For patients with continued exacerbations, inhaled corticosteroids can be added to LABA-LAMA therapy. Acute exacerbations are characterized by a worsening of symptoms that requires additional therapy. Short-acting beta2-agonists with or without short-acting muscarinic antagonists are the basic therapy for acute exacerbations of COPD. Systemic glucocorticoids have been shown to shorten exacerbations and improve lung function. Antibiotics have been shown to reduce rates of treatment failure and sputum purulence. Noninvasive mechanical ventilation is preferred for patients with respiratory failure.


Assuntos
Agonistas de Receptores Adrenérgicos beta 2 , Broncodilatadores , Antagonistas Muscarínicos , Doença Pulmonar Obstrutiva Crônica , Administração por Inalação , Corticosteroides , Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Broncodilatadores/uso terapêutico , Volume Expiratório Forçado , Humanos , Antagonistas Muscarínicos/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
7.
Evid. actual. práct. ambul ; 22(3): e002021, nov. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1047108

RESUMO

Una joven de 23 años con asma leve intermitente se presenta a la consulta médica. Se plantea cuál es la mejor alternativa para su tratamiento: el uso de broncodilatadores de acción corta a demanda (SABA, por sus iniciales en inglés) o de broncodilatadores de acción rápida en asociación con corticoides inhalatorios (ICS/FABA, por sus iniciales en inglés) a demanda. Tras revisar la bibliografía se encontraron una revisión sistemática y dos ensayos clínicos que indican que los ICS/FABA serían superiores a los SABA; sin embargo este efecto fue solamente estudiado en casos de asma persistente.Es importante discutir estos hallazgos con los pacientes, junto a sus implicancias económicas, incorporando sus valores y preferencias a la hora de tomar una decisión terapéutica. (AU)


A 23-year-old woman with mild intermittent asthma comes to the doctor's office. The best alternative for treatment is considered: the use of short-acting bronchodilators on demand (SABA) or fast-acting bronchodilators in association with inhaled corticosteroids (ICS/FABA) on demand. After a literature search, a systematic review and two clinical trials werefound, which indicate that the ICS/FABA would be superior to the SABA; however, this effect was only studied in cases of persistent asthma. It is important to discuss these findings with the patients, alongside with their economic implications,incorporating their values and preferences when making a therapeutic decision.


Assuntos
Humanos , Feminino , Lactente , Adulto , Adulto Jovem , Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Asma/diagnóstico , Asma/etiologia , Asma/epidemiologia , Sinais e Sintomas Respiratórios , Fatores Socioeconômicos , Broncodilatadores/administração & dosagem , Bronquiolite , Sons Respiratórios , Corticosteroides/uso terapêutico , Tosse , Tomada de Decisões , Dispneia , Adesão à Medicação
8.
J Biochem Mol Toxicol ; 33(12): e22407, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31581362

RESUMO

In this study, we investigated the effects of certain respiratory drugs, which are mainly used on human serum paraoxonase-1 (hPON1; EC 3.1.8.1). hPON1 was purified from human serum, with 354.91 fold and 45% yield by using two simple step procedures including, first, ammonium sulfate precipitation, then, Sepharose-4B-l-tyrosine-1-naphthylamine hydrophobic interaction chromatography. SDS-polyacrylamide gel electrophoresis showed a single protein band belonging to hPON1 with 43 kDa. All the pharmaceutical compounds inhibited the PON1 enzyme highly at the micromolar level. The obtained IC50 values for nine different pharmaceutics ranged from 0.219 µM (salbutamol sulfate) to 67.205 µM (montelukast sodium). So, all drugs could be considered as potent hPON1 inhibitors. Ki values and inhibition types were determined by Lineweaver-Burk graphs. While varenicline tartrate and moxifloxacin hydrochloride inhibited the enzyme in a noncompetitive manner, others inhibited it in a mixed manner.


Assuntos
Arildialquilfosfatase/química , Arildialquilfosfatase/isolamento & purificação , Broncodilatadores/química , Inibidores Enzimáticos/química , Soro/enzimologia , Arildialquilfosfatase/antagonistas & inibidores , Broncodilatadores/efeitos adversos , Broncodilatadores/uso terapêutico , Cromatografia em Gel/métodos , Eletroforese em Gel de Poliacrilamida , Inibidores Enzimáticos/efeitos adversos , Inibidores Enzimáticos/uso terapêutico , Humanos , Interações Hidrofóbicas e Hidrofílicas , Infecções Respiratórias/tratamento farmacológico
10.
J Vet Sci ; 20(5): e57, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31565900

RESUMO

Theophylline acts as a bronchodilator and has an anti-inflammatory effect. In addition, theophylline can be applied in patients where there are concerns regarding the side-effects of corticosteroids. This retrospective case series evaluated theophylline-based therapy in tracheal collapse (TC) canine patients. Forty-seven dogs with TC that received theophylline-based therapy during 2013-2017 were investigated. A fluoroscopic examination was performed to diagnose and grade TC. Theophylline was prescribed (7.5-30 mg/kg PO q12h) and the theophylline serum concentrations were measured. Coughing was assessed using a coughing scoring scale. The mean coughing score decreased after the theophylline-based therapy compared with that observed before treatment. Clinical improvements were observed in 46/47 patients (97.9%). As the intrathoracic TC grading increased, the final theophylline dosage also increased (p value 0.019). The symptom-free period (SFP) with therapy was 189.7 ± 194.45 days (range, 0-720 days) and there was no statistically significant correlation between the SFP and age, sex, or TC grade on fluoroscopy. Although theophylline has generally been used as a third-line treatment, it was used as the main treatment in this study and most patients showed improvements. Dogs have a wider therapeutic index of serum concentrations than humans, and any undesirable effects were easily overcome. With further research, this therapy may prove to be a useful approach, but its safety for long-term use in the treatment of canine TC patients needs to be established.


Assuntos
Broncodilatadores/uso terapêutico , Doenças do Cão/tratamento farmacológico , Teofilina/uso terapêutico , Estenose Traqueal/veterinária , Animais , Doenças do Cão/etiologia , Cães , Feminino , Fluoroscopia/veterinária , Masculino , Estudos Retrospectivos , Estenose Traqueal/tratamento farmacológico , Estenose Traqueal/etiologia
11.
Eur. respir. j ; 54(3)Sept. 2019.
Artigo em Inglês | BIGG | ID: biblio-1026259

RESUMO

This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and were discharged from the hospital, or who were older than 36 weeks of postmenstrual age. The guideline was based on pre-defined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature, and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the Task Force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding day care attendance. With regards to treatment, we suggest to use bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function, no treatment with inhaled or systemic corticosteroids, natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period, and to treat with supplemental oxygen with a saturation target range of 90­95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.


Assuntos
Humanos , Masculino , Feminino , Criança , Broncodilatadores/uso terapêutico , Displasia Broncopulmonar/complicações , Displasia Broncopulmonar/diagnóstico , Displasia Broncopulmonar/terapia , Administração dos Cuidados ao Paciente/métodos , Nascimento Prematuro/enfermagem
12.
Medicine (Baltimore) ; 98(33): e16637, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415357

RESUMO

BACKGROUND: The goal of the current meta-analysis and systematic review was to explore the efficacy of tiotropium in treating patients with moderate-to-severe asthma on the basis of qualified randomized controlled trials (RCTs). METHODS: The following online electronic databases, such as Cochrane, PubMed, and Embase database were screened to identify qualified studies updated to January 2019 through the use of index words. Several literatures that were relevant to the present analysis were also included. To further analyze the main outcomes, we utilized the odds rations (OR), and mean difference (MD) along with its 95% confidence interval (95% CI). RESULTS: A total of 14 RCTs with 4998 patients in the tiotropium group and 5074 patients in the control group were included in the present study. On the basis of the pooled results, tiotropium was significantly associated with improved morning PEF (SMD: 3.29, 95%CI: 2.03-4.55), evening PEF (SMD: 3.36, 95%CI: 2.24-4.48), peak FEV (SMD: 2.67, 95%CI: 1.47-3.88), and trough FEV (SMD: 1.90, 95%CI: 0.87-2.92) vs the control group. Nevertheless, no significant difference was observed in peak FVC (SMD: 0.77, 95%CI: -0.21-1.76), trough FVC (SMD: 0.67, 95%CI: -0.18-1.53), AE (RR: 0.98, 95%CI: 0.94-1.02) and serious AE (RR: 1.08, 95%CI: 0.77-1.52) between the 2 groups. CONCLUSIONS: In this review, we summarized the significant effect of tiotropium for the treatment of moderate-to-severe asthma, mainly in increasing morning PEF, evening PEF, peak FEV and trough FEV based on high-quality RCTs. Nevertheless, no significant difference in peak FVC, trough FVC, AE and serious AE was found between the 2 groups. A close comparison of the 2 groups revealed that more high-quality larger-sample RCTs are needed to gather more strong evidence on the therapeutic efficacy and safety of tiotropium for clinical practice.


Assuntos
Asma/tratamento farmacológico , Broncodilatadores/uso terapêutico , Brometo de Tiotrópio/uso terapêutico , Adulto , Asma/patologia , Criança , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Masculino , Pessoa de Meia-Idade , Pico do Fluxo Expiratório/efeitos dos fármacos , Ensaios Clínicos Controlados Aleatórios como Assunto , Índice de Gravidade de Doença , Capacidade Vital/efeitos dos fármacos
13.
Ned Tijdschr Geneeskd ; 1632019 08 22.
Artigo em Holandês | MEDLINE | ID: mdl-31449362

RESUMO

Several toxic substances, inhaled or swallowed, can cause similar respiratory symptoms. We present two young patients with respiratory symptoms, one after inhaling chlorine gas and the other after ingesting lamp oil. Pathophysiology and clinical effects of these two substances differ. No specific antidotes exist for most toxic substances. Inhalation of respiratory irritants, such as chlorine gas, can lead to wheezing or bronchial obstruction, which can generally be handled by the family physician. In mild cases, administration of a bronchodilator is sufficient. Hydrocarbons such as lamp oil, however, can cause severe respiratory problems which develop over days, even when only small amounts are ingested. Hospitalization is therefore warranted in these cases, even when initial symptoms appear to be mild.


Assuntos
Obstrução das Vias Respiratórias/induzido quimicamente , Asfixia/induzido quimicamente , Cloro/toxicidade , Hidrocarbonetos/toxicidade , Administração por Inalação , Asfixia/terapia , Broncodilatadores/uso terapêutico , Deglutição/efeitos dos fármacos , Feminino , Humanos , Masculino
14.
Lancet ; 394(10202): 919-928, 2019 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-31451207

RESUMO

BACKGROUND: In adults with mild asthma, a combination of an inhaled corticosteroid with a fast-onset long-acting ß-agonist (LABA) used as reliever monotherapy reduces severe exacerbations compared with short-acting ß-agonist (SABA) reliever therapy. We investigated the efficacy of combination budesonide-formoterol reliever therapy compared with maintenance budesonide plus as-needed terbutaline. METHODS: We did a 52-week, open-label, parallel-group, multicentre, superiority, randomised controlled trial at 15 primary care or hospital-based clinical trials units and primary care practices in New Zealand. Participants were adults aged 18-75 years with a self-reported doctor's diagnosis of asthma who were using SABA for symptom relief with or without maintenance low to moderate doses of inhaled corticosteroids in the previous 12 weeks. We randomly assigned participants (1:1) to either reliever therapy with budesonide 200 µg-formoterol 6 µg Turbuhaler (one inhalation as needed for relief of symptoms) or maintenance budesonide 200 µg Turbuhaler (one inhalation twice daily) plus terbutaline 250 µg Turbuhaler (two inhalations as needed). Participants and investigators were not masked to group assignment; the statistician was masked for analysis of the primary outcome. Six study visits were scheduled: randomisation, and weeks 4, 16, 28, 40, and 52. The primary outcome was the number of severe exacerbations per patient per year analysed by intention to treat (severe exacerbations defined as use of systemic corticosteroids for at least 3 days because of asthma, or admission to hospital or an emergency department visit because of asthma requiring systemic corticosteroids). Safety analyses included all participants who had received at least one dose of study treatment. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12616000377437. FINDINGS: Between May 4, 2016, and Dec 22, 2017, we assigned 890 participants to treatment and included 885 eligible participants in the analysis: 437 assigned to budesonide-formoterol as needed and 448 to budesonide maintenance plus terbutaline as needed. Severe exacerbations per patient per year were lower with as-needed budesonide-formoterol than with maintenance budesonide plus terbutaline as needed (absolute rate per patient per year 0·119 vs 0·172; relative rate 0·69, 95% CI 0·48-1·00; p=0·049). Nasopharyngitis was the most common adverse event in both groups, occurring in 154 (35%) of 440 patients receiving as-needed budesonide-formoterol and 144 (32%) of 448 receiving maintenance budesonide plus terbutaline as needed. INTERPRETATION: In adults with mild to moderate asthma, budesonide-formoterol used as needed for symptom relief was more effective at preventing severe exacerbations than maintenance low-dose budesonide plus as-needed terbutaline. The findings support the 2019 Global Initiative for Asthma recommendation that inhaled corticosteroid-formoterol reliever therapy is an alternative regimen to daily low-dose inhaled corticosteroid for patients with mild asthma. FUNDING: Health Research Council of New Zealand.


Assuntos
Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Combinação Budesonida e Fumarato de Formoterol/uso terapêutico , Adolescente , Adulto , Idoso , Antiasmáticos/administração & dosagem , Broncodilatadores/administração & dosagem , Broncodilatadores/uso terapêutico , Budesonida/administração & dosagem , Budesonida/uso terapêutico , Combinação Budesonida e Fumarato de Formoterol/administração & dosagem , Esquema de Medicação , Estudos de Equivalência como Asunto , Feminino , Glucocorticoides/administração & dosagem , Glucocorticoides/uso terapêutico , Humanos , Masculino , Pessoa de Meia-Idade , Nebulizadores e Vaporizadores , Índice de Gravidade de Doença , Terbutalina/administração & dosagem , Terbutalina/uso terapêutico , Resultado do Tratamento , Adulto Jovem
15.
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
16.
Drugs ; 79(13): 1455-1466, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31468315

RESUMO

Glycopyrronium/formoterol (Bevespi Aerosphere®) is a fixed-dose combination of the long-acting muscarinic antagonist glycopyrronium bromide and the long-acting ß2-agonist formoterol fumarate delivered via a pressurized metered dose inhaler (pMDI) and formulated using co-suspension delivery technology. It is approved in the USA and EU for use as maintenance treatment in patients with chronic obstructive pulmonary disease (COPD) and in Japan to relieve symptoms in patients with COPD. In the PINNACLE trials in patients with moderate to very severe COPD, glycopyrronium/formoterol was associated with significantly greater improvements in lung function than its monocomponents and placebo at 24 weeks and its monocomponents and open-label tiotropium over 52 weeks. In the AERISTO trial, glycopyrronium/formoterol was non-inferior to umeclidinium/vilanterol dry powder inhaler for peak change in forced expiratory volume in 1 s (FEV1) within 2 h postdose, but not for the change in morning predose trough FEV1, over 24 weeks. Glycopyrronium/formoterol was generally well tolerated in patients with moderate to very severe COPD, with most adverse events (AEs) being of mild or moderate severity. Thus, glycopyrronium/formoterol pMDI formulated using co-suspension delivery technology is a useful new addition that extends treatment options for patients with COPD.


Assuntos
Adjuvantes Anestésicos/uso terapêutico , Broncodilatadores/uso terapêutico , Fumarato de Formoterol/uso terapêutico , Glicopirrolato/uso terapêutico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Animais , Ensaios Clínicos como Assunto , Humanos
17.
West J Emerg Med ; 20(4): 587-600, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31316698

RESUMO

Angioedema is defined by non-dependent, non-pitting edema that affects several different sites and is potentially life-threatening due to laryngeal edema. This narrative review provides emergency physicians with a focused overview of the evaluation and management of angioedema. Two primary forms include histamine-mediated and bradykinin-mediated angioedema. Histamine-mediated forms present similarly to anaphylaxis, while bradykinin-mediated angioedema presents with greater face and oropharyngeal involvement and higher risk of progression. Initial evaluation and management should focus on evaluation of the airway, followed by obtaining relevant historical features, including family history, medications, and prior episodes. Histamine-mediated angioedema should be treated with epinephrine intramuscularly, antihistaminergic medications, and steroids. These medications are not effective for bradykinin-mediated forms. Other medications include C1-INH protein replacement, kallikrein inhibitor, and bradykinin receptor antagonists. Evidence is controversial concerning the efficacy of these medications in an acute episode, and airway management is the most important intervention when indicated. Airway intervention may require fiberoptic or video laryngoscopy, with preparation for cricothyrotomy. Disposition is dependent on patient's airway and respiratory status, as well as the sites involved.


Assuntos
Angioedema/etiologia , Angioedema/terapia , Serviço Hospitalar de Emergência , Manuseio das Vias Aéreas , Algoritmos , Anti-Inflamatórios não Esteroides/uso terapêutico , Fatores de Coagulação Sanguínea/uso terapêutico , Bradicinina/análogos & derivados , Bradicinina/metabolismo , Bradicinina/uso terapêutico , Antagonistas de Receptor B2 da Bradicinina/uso terapêutico , Broncodilatadores/uso terapêutico , Epinefrina/uso terapêutico , Glucocorticoides/uso terapêutico , Histamina/metabolismo , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Peptídeos/uso terapêutico , Plasma , Urticária/etiologia
18.
BMC Pulm Med ; 19(1): 127, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299936

RESUMO

BACKGROUND: In patients with chronic obstructive pulmonary disease, all efforts should be made to prevent exacerbations because each event modifies the trajectory of the disease. Treatment recommendations are mostly built on results from randomized controlled trials (RCTs) whose methodology ensure internal validity. However, their relevance may be compromised by the lack of generalizability, due to poor representability of study populations compared to real-life patients. In order to delimit to whom the results of studies on current and future treatments apply, we sought to identify and characterize the fraction of COPD population that would be eligible for inclusion into RCTs aiming at decreasing exacerbation risk. METHODS: We used the Initiatives-BPCO database, a French cohort of 1309 real-life COPD patients monitored in academic centers. We identified industry-sponsored phase III and IV trials that enrolled more than 500 patients, lasted at least one year and used exacerbations related endpoints. Eligibility criteria were extracted from each trial and applied to the patients. RESULTS: The eligibility criteria of 16 RCTs were applied to the 1309 patients. The most discriminating eligibility criteria were FEV1, minimum exacerbation rate in the previous year and smoking history, responsible for the exclusion of 39.9, 36.7 and 16.8% of patients, respectively. Altogether, 2.3 to 46.7% of our patients would have satisfied all eligibility criteria. CONCLUSION: These analyses confirm that an important gap exists between real-life patients and clinical trials populations in COPD, which limits the relevance of results and therefore should be considered when grading levels of evidence and designing future studies.


Assuntos
Progressão da Doença , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto , Broncodilatadores/uso terapêutico , Difusão de Inovações , Medicina Baseada em Evidências , Volume Expiratório Forçado , Humanos , Seleção de Pacientes , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Qualidade de Vida , Reprodutibilidade dos Testes , Índice de Gravidade de Doença
19.
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
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