RESUMO
A novel series of zileuton-hydroxycinnamic acid hybrids were synthesized and screened as 5-lipoxygenase (5-LO) inhibitors in stimulated HEK293 cells and polymorphonuclear leukocytes (PMNL). Zileuton's (1) benzo[b]thiophene and hydroxyurea subunits combined with hydroxycinnamic acid esters' ester linkage and phenolic acid moieties were investigated. Compound 28, bearing zileuton's (1) benzo[b]thiophene and sinapic acid phenethyl ester's (2) α,ß-unsaturated phenolic acid moiety 28, was shown to be equipotent to zileuton (1), the only clinically approved 5-LO inhibitor, in stimulated HEK293 cells. Compound 28 was three times as active as zileuton (1) for the inhibition of 5-LO in PMNL. Compound 37, bearing the same sinapic acid (3,5-dimethoxy-4-hydroxy substitution) moiety as 28, combined with zileuton's (1) hydroxyurea subunit was inactive. This result shows that the zileuton's (1) benzo[b]thiophene moiety is essential for the inhibition of 5-LO product biosynthesis with our hydrids. Unlike zileuton (1), Compound 28 formed two π-π interactions with Phe177 and Phe421 as predicted when docked into 5-LO. Compound 28 was the only docked ligand that showed a π-π interaction with Phe177 which may play a part in product specificity as reported.
Assuntos
Ácidos Cumáricos/química , Hidroxiureia/análogos & derivados , Inibidores de Lipoxigenase/química , Inibidores de Lipoxigenase/farmacologia , Araquidonato 5-Lipoxigenase/química , Araquidonato 5-Lipoxigenase/metabolismo , Simulação por Computador , Avaliação Pré-Clínica de Medicamentos , Sequestradores de Radicais Livres/química , Sequestradores de Radicais Livres/farmacologia , Células HEK293 , Humanos , Hidroxiureia/química , Inibidores de Lipoxigenase/síntese química , Simulação de Acoplamento Molecular , Neutrófilos/efeitos dos fármacos , Neutrófilos/metabolismo , Relação Estrutura-AtividadeRESUMO
BACKGROUND: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis associated with asthma, anti-neutrophil cytoplasmic antibodies (ANCA) positivity, and tissue eosinophilia. OBJECTIVE: To describe the presenting clinical features, significant biochemical alterations, and also potential pathogenic factors in adult patients diagnosed in our Center over a period of >20 years. METHOD: A retrospective study of EGPA patients diagnosed from 1994 to 2019 at ASST Grande Ospedale Metropolitano Niguarda Ca' Granda, Milan (Italy), which was performed according to the 1990 American College of Rheumatology criteria and Chapel Hill Consensus Conference definition. A dataset was compiled, registering demographic and clinical features, biochemical analysis at onset, and also the therapies received 3 months prior to EGPA diagnose. Statistical analyses were subsequently conducted dividing patients in 2 groups based on ANCA positivity and comparing them. RESULTS: Two groups were clearly identified by ANCA serology and specific organ involvement in accordance with literature reports; however, our data underline for the first time the association between anti-leukotriene receptor antagonists (LTRAs) and ANCA positivity. The group of previously treated patients presents an OR of 6.42 to be ANCA positive. This finding could be attributed to an imbalanced stimulation of leukotriene receptors, inducing both mast cells activation and an increased neutrophil extracellular traps release from neutrophils. CONCLUSION: Despite the limitations of this retrospective study, the association between LTRAs and ANCA antibodies elucidates the mechanism by which innate immunity is directly involved in tolerance breakdown and autoantibodies production. Validation of our results with targeted studies could clarify the differences between ANCA-positive and ANCA-negative patients with important consequences on the use of some drug classes in the treatment of EGPA and asthmatic subjects.
Assuntos
Anticorpos Anticitoplasma de Neutrófilos/imunologia , Autoanticorpos/imunologia , Síndrome de Churg-Strauss/diagnóstico , Síndrome de Churg-Strauss/imunologia , Granulomatose com Poliangiite/diagnóstico , Granulomatose com Poliangiite/imunologia , Leucotrienos/imunologia , Adulto , Anticorpos Anticitoplasma de Neutrófilos/sangue , Autoanticorpos/sangue , Biomarcadores , Síndrome de Churg-Strauss/sangue , Feminino , Granulomatose com Poliangiite/sangue , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Fenótipo , Estudos Retrospectivos , Avaliação de SintomasRESUMO
BACKGROUND: Based on endoscopic examination, chronic rhinosinusitis (CRS) is divided into chronic inflammation with (CRSwNP) or without nasal polyps (CRSsNP). On the basis of the pathomechanism of inflammation, CRS is divided into endotypes. Eosinophilic CRSwNP with coexisting bronchial asthma and hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) is a real therapeutic challenge. AIM: Comparative analysis of the results of treatment of patients with CRSwNP, bronchial asthma, or hypersensitivity to NSAIDs (NSAID-exacerbated respiratory disease, NERD), using antileukotrienes (leukotriene receptor antagonists, LTRAs) or intranasal glucocorticoids or both drugs together after endoscopic sinus surgery (ESS). MATERIAL AND METHODS: 33 patients (11 male, 33%) with NERD divided into three groups treated with LTRAs or intranasal glucocorticoids or both drugs together were assessed in terms of general well-being, state of pathological changes, and olfactory disorders using the following tools: Sino-Nasal Outcome Test, Visual Analogue Scale, Brief Identification Smell Test, and Lund-Kennedy score before and at 12 months after surgery. CT assessments were made prior to surgery using the Lund-MacKay scale. RESULTS: Comparable efficacy of treatment with nasal steroids and antileukotrienes was found after 12 months of observation of patients. CONCLUSIONS: The results suggest comparable efficacy of treatment with nasal steroids and antileukotrienes in patients with NERD after ESS. Treatment with montelukast and mometasone has not been shown to be superior to both drugs administered separately.
Assuntos
Asma Induzida por Aspirina/tratamento farmacológico , Antagonistas de Leucotrienos/uso terapêutico , Pólipos Nasais/tratamento farmacológico , Seios Paranasais/efeitos dos fármacos , Rinite/tratamento farmacológico , Sinusite/tratamento farmacológico , Adulto , Idoso , Asma Induzida por Aspirina/complicações , Asma Induzida por Aspirina/cirurgia , Doença Crônica , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Pólipos Nasais/cirurgia , Seios Paranasais/cirurgia , Período Pós-Operatório , Rinite/cirurgia , Sinusite/cirurgia , Esteroides/uso terapêutico , Resultado do TratamentoRESUMO
OBJECTIVE: To determine the role of montelukast - a leukotriene receptor antagonist (LTRA) - in improving the quality of life (QOL) and asthma control of adult patients with mild to moderate persistent asthma. METHODS: Randomized, double-blind, placebo-controlled, non-crossover trial was conducted from March 2017 till November 2018 in three hospitals of Karachi and Hyderabad. Adults of age 15 years or more with mild to moderate persistent asthma. Treatment group was administered tablet montelukast 10mg once daily; the other group was given a similar looking placebo; as an adjuvant to the current medication. QOL was assessed with Asthma Quality of Life Questionnaire - Standard (AQLQ-S) before and after the treatment. Asthma control was monitored via Asthma Control Test (ACT). RESULTS: After 4 weeks, the mean ± SD of overall QOL on AQLQ-S improved from 3.74±0.88 to 5.06±0.89 for montelukast group and from 3.58±0.92 to 4.71±0.97 for placebo group (p=0.02). The improvement in sub-domains of symptoms, activity, and emotional functions was not significant; however, the sub-domain "environmental stimuli" significantly improved with 5.06±0.89 for montelukast group and 4.71±0.97 for placebo group (p=0.02). The mean ± SD of ACT, after four weeks, for montelukast group was 18.19±2.91 and for placebo group 17.28±3.36. Only on ACT, Montelukast did not show any statistically insignificant results. CONCLUSION: The role of montelukast in improving QOL of adult patients with mild to moderate persistent asthma is quite beneficial. It improves patient quality of life. It has the ease of once daily oral administration and also eradicates side effects associated with long-term adherence to steroids.
RESUMO
The paper discusses the classification and forms of allergic rhinitis with a special focus on seasonal allergic rhinitis (SAR). The general principles of SAR management are presented, including the role of nasal glucocorticoids, nasal and oral antihistamines, and antileukotrienes. Based on the latest guidelines, the current rules for the selection of drugs in the therapy of SAR are given, paying special attention to the initial treatment. The aim of the paper is to present updated guidelines for the pharmacological management of patients with seasonal allergic rhinitis.
RESUMO
We assessed the use of antileukotrienes for treating adenotonsillar hypertrophy. We reviewed the current literature on the anatomy of adenotonsillar tissue, adenotonsillar hypertrophy/hyperplasia (and the associated pathophysiology and symptoms), and the effects of antileukotrienes used to treat adenotonsillar hypertrophy. Leukotrienes (LTs) are inflammatory mediators produced by a number of cell types, including mast cells, eosinophils, basophils, macrophages, and monocytes. There are several types (e.g., LTA4, LTB4, LTC4, LTD4, and LTE4). By competitive binding to the cysLT1 receptor, LT-receptor antagonist drugs such as montelukast, zafirlukast, and pranlukast block the effects of cySHLTs, improving the symptoms of some chronic respiratory diseases. High numbers of LT receptors have been found in the tonsils of children with obstructive sleep apnea. Antileukotrienes reduce the apnea-hypopnea index and adenotonsillar inflammation. Antileukotrienes may be useful for children with adenotonsillar hypertrophy due to their anti-inflammatory effects, which help to reduce adenotonsillar inflammation.
Assuntos
Tonsila Faríngea/patologia , Antagonistas de Leucotrienos/uso terapêutico , Tonsila Palatina/patologia , Tonsila Faríngea/metabolismo , Humanos , Hipertrofia/tratamento farmacológico , Inflamação/tratamento farmacológico , Tonsila Palatina/metabolismo , Receptores de Leucotrienos/metabolismoRESUMO
BACKGROUND: Asthma control represents the main goal of asthma management and different strategies aim to avoid the long term downsides of inhaled corticosteroids. We investigated in real-life conditions the contribution of sublingual immunotherapy in achieving the control of birch-related mild persistent asthma compared to two usual step-up therapeutic options. METHODS: A three-year open randomised study included 84 asthmatics, uncontrolled during the previous birch pollen season, despite a treatment with budesonide 400µg/day. Patients randomly received budesonide 800µg/day, budesonide 1600µg/day, budesonide 400µg/day plus montelukast 10µg/day and budesonide 400µg/day plus carbamylated allergoid of betulaceae pre-coseasonally. Asthma Control test, combined allergy symptoms and medications score, albuterol consumption, lung function, nasal eosinophils and nasal steroids usage were assessed as changes from the first to last pollen season. RESULT: Seventy-six patients concluded the study. All options, except budesonide 800µg/day, produced an improvement of mean monthly Asthma Control test (p<0.05). Patients undergoing low-dose budesonide plus immunotherapy achieved, after three years, an appreciable control (ACT mean score 24). A significant improvement was seen in all groups for allergy symptoms plus medications and bronchial reactivity. Albuterol consumption and lung function improved in all but the first group. Only budesonide plus immunotherapy reduced nasal eosinophils and nasal steroids usage. Two mild self-resolving adverse events were reported. CONCLUSIONS: For patients with respiratory allergy due to birch pollen and mild persistent asthma, sublingual immunotherapy added to low-dose inhaled corticosteroids appears effective in maintaining long-term seasonal asthma control, representing a safe opportunity to reduce the cumulative amount of delivered corticosteroids.
Assuntos
Alérgenos/efeitos adversos , Antiasmáticos/uso terapêutico , Asma/terapia , Betula/efeitos adversos , Dessensibilização Imunológica/métodos , Pólen/efeitos adversos , Acetatos/uso terapêutico , Adolescente , Adulto , Idoso , Asma/etiologia , Budesonida/uso terapêutico , Terapia Combinada , Ciclopropanos , Esquema de Medicação , Quimioterapia Combinada , Humanos , Modelos Lineares , Pessoa de Meia-Idade , Quinolinas/uso terapêutico , Índice de Gravidade de Doença , Sulfetos , Resultado do Tratamento , Adulto JovemRESUMO
Acute coronary syndrome (ACS) is a set of signs and symptoms caused by a reduction of coronary blood flow with subsequent myocardial ischemia. ACS is associated with activation of the leukotriene (LT) pathway with subsequent releases of various LTs, including LTB4, LTC4, and LTD4, which cause inflammatory changes and induction of immunothrombosis. LTs through cysteine leukotriene (CysLT) induce activation of platelets and clotting factors with succeeding coronary thrombosis. CysLT receptor (CysLTR) antagonists such as montelukast (MK) may reduce the risk of the development of ACS and associated complications through suppression of the activation of platelet and clotting factors. Thus, this critical review aimed to elucidate the possible protective role of MK in the management of ACS. The LT pathway is implicated in the pathogenesis of atherosclerosis, cardiac hypertrophy, and heart failure. Inhibition of the LT pathway and CysL1TR by MK might be effective in preventing cardiovascular complications. MK could be an effective novel therapy in the management of ACS through inhibition of pro-inflammatory CysLT1R and modulation of inflammatory signaling pathways. MK can attenuate thrombotic events by inhibiting platelet activation and clotting factors that are activated during the development of ACS. In conclusion, MK could be an effective agent in reducing the severity of ACS and associated complications. Experimental, preclinical, and clinical studies are recommended to confirm the potential therapeutic of MK in the management of ACS.
RESUMO
OBJECTIVE: The aim of our study was to analyze the montelukast effectiveness in improving oculonasal symptoms, patient-reported outcomes (PROs), and eosinophilic biomarkers in patients with nonallergic rhinitis eosinophilic syndrome (NARES). METHODS: We enrolled prospectively 80 symptomatic patients treated with 10 mg once a day of montelukast in monotherapy for 2 months. All patients were investigated before and after treatment. Nasal symptoms (nasal obstruction, rhinorrhoea, sneezing, nasal itching), ocular symptoms (redness/puffiness, watery eyes), and other PROs (olfactory dysfunction, difficulty going to sleep, nighttime awakenings, and nasal congestion on awakening) were scored by visual analogic scale. The following clinical scores were assessed: Total Nasal Symptom Score (T4NSS), Total Ocular Symptom Score (T2OSS), Total Symptom Score of Patient-Reported Outcomes (TSS-PROs), and a Composite Symptoms Score (CSS). Patients were classified as responders when a reduction of at least 50% of the CSS was observed. Before and after treatment, the eosinophilic biomarkers in nasal lavage were analyzed: nasal eosinophilia (number of eosinophils per high power field), eotaxin-1 and eotaxin-2. RESULTS: After treatment, significant reductions were observed for all the symptom scores. Forty-two of 78 patients were considered responders. A significant reduction of eosinophils in nasal mucosa and of levels of eotaxin-1 and eotaxin-2 in nasal lavage were observed after treatment in responder patients. Patients with asthma had an increased probability to be responders. CONCLUSION: NARES patients may benefit from treatment with montelukast. In particular, the presence of concomitant asthma may be predictive of a greater efficacy. LEVEL OF EVIDENCE: 2 Laryngoscope, 129:551-557, 2019.
Assuntos
Acetatos/uso terapêutico , Oftalmopatias/tratamento farmacológico , Antagonistas de Leucotrienos/uso terapêutico , Doenças Nasais/tratamento farmacológico , Quinolinas/uso terapêutico , Acetatos/sangue , Adulto , Asma/sangue , Asma/complicações , Biomarcadores/sangue , Ciclopropanos , Eosinofilia/sangue , Eosinofilia/complicações , Oftalmopatias/etiologia , Feminino , Humanos , Antagonistas de Leucotrienos/sangue , Masculino , Doenças Nasais/etiologia , Estudos Prospectivos , Quinolinas/sangue , Rinite/sangue , Rinite/complicações , Sulfetos , SíndromeRESUMO
Asthma is a frequent disease, mainly characterized by airway inflammation, in which drug therapy is crucial in its management. The potential of pharmacogenomics testing in asthma therapy has been, to date, little explored. In this review, we discuss pharmacogenetic factors affecting asthma treatment, both related to drugs used as controller medications for regular maintenance, such as inhaled corticosteroids, anti-leukotriene agents, long-acting beta-agonists, and the new biologic agents used to treat severe persistent asthma. In addition, we discuss current pharmacogenomics knowledge for rescue medications provided to all patients for as-needed relief, such as short-acting beta-agonists. Evidence for genetic variations as a factor related to drugs response has been provided for the following genes and groups of drugs: Inhaled corticosteroids: FCER2; anti-leukotriene agents: ABCC1, and LTC4S; beta-agonists: ADRB2. However, the following genes require further studies confirming or rejecting association with the response to asthma therapy: ADCY9, ALOX5, ARG1, ARG2, CRHR1, CRHR2, CYP3A4, CYP3A5, CYSLTR1, CYSLTR2, GLCCI1, IL4RA, LTA4H, ORMDL3, SLCO2B1, SPATS2L, STIP1, T, TBX21, THRA, THRB, and VEGFA. Although only a minority of these genes are, at present, listed as associated with drugs used in asthma therapy, in the Clinical Pharmacogenomics Implementation Consortium gene-drug pair list, this review reveals that sufficient evidence to start testing the potential of clinical pharmacogenomics in asthma therapy already exists. This evidence supports the inclusion in pilot pharmacogenetics tests of at least four genes. Hopefully these tests, if proven useful, will increase the efficiency and the safety of asthma therapy.
RESUMO
BACKGROUND: Asthma represents a worldwide health problem with a strong morbidity and a major impact on the health care system. Multiple efforts have been made towards the development of new strategies for the prevention and treatment of this disorder. In the light of this the present review of the literature aimed at summarizing the latest advances in prevention and treatment of pediatric asthma with a focus on the most effective options of interventions during the first stages of life. METHODS: References were identified by searches of PubMed. Search terms used in the search were "pediatric asthma", "treatment" and "prevention". We included only meta-analysis, randomized controlled trials, reviews and systematic review articles pertaining to humans and subjects aged 0-18 years. All the interventions have been classified as "non-pharmacological" and "pharmacological". RESULTS: Non-pharmacological interventions have been focused in identifying the genetic and environmental factors underlying the pathogenesis of this disease, including the individual genetic susceptibility, the early allergic sensitization, the role of the environmental microbiome and the exposure to infections and to pollutants. Moreover, the optimization of the existing pharmacological strategies and the development of new treatment options have improved markedly the management of this disease, thereby reducing the health care costs and ameliorating the quality of life of patients. CONCLUSION: Childhood asthma prevention and treatment still represents a worldwide challenge. Future efforts should be aimed at identifying high risk target populations, minimizing the costs of each policy of intervention and increasing adherence to treatment strategies.
Assuntos
Asma/prevenção & controle , Asma/terapia , Adolescente , Anticorpos Monoclonais/uso terapêutico , Asma/etiologia , Criança , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Imunoterapia , Qualidade de Vida , Infecções Respiratórias/tratamento farmacológicoRESUMO
Bronchial asthma is an inflammatory condition. The inflammatory actions of leukotrienes (LT) B4, C4, D4, and E4 have been shown experimentally to play a role in inflammatory mechanisms, producing asthma. Antileukotrienes (ALT) or leukotrienes antagonists (LA) is a new class of anti-asthma drugs with anti-inflammatory role. LT modifiers from the groups of 5 lipoxygenase inhibitor and Cys LT1 receptor antagonists, are found useful in asthma therapy. LAs are of main use in young infants and toddler with recurrent wheezing, children with moderate to severe chronic asthma on steroid therapy and in allergic rhinitis. In chronic asthma they are required to be used for prolonged periods with other anti-asthma agents. Except for Montelukast and Zafirlukast, which can be used in children above two and six years of age respectively, the paediatric use of other agents is yet to be established. However, these agents are essentially safe. The cost of LAs is reasonably high. At present, with available evidence, these drugs are considered promising in management of asthma in children. However, there is need to do more long term clinical trials for ascertaining their effectivity in different types of asthma to compare their effects with long acting B2 agnoists and chromones, so as to optimally explore their utility.
RESUMO
Introducción: el asma bronquial es una enfermedad crónica, los antileucotrienos demuestran gran valor en el tratamiento y su control. Objetivo: evaluar el estado clínico-funcional de los niños tratados con Montelukast. Método: se realizó una investigación longitudinal prospectiva, donde se estudió un total de 37 niños asmáticos en el Policlínico Universitario Rubén Batista Rubio en el municipio Cacocum, provincia de Holguín, Cuba. Resultados: el volumen espiratorio forzado antes del uso de Montelukast, se expresó en +80%, en 21 niños (56,7%) y el 43,2%, 16 de los pacientes se encontraba entre 80-60%, después del medicamento, 32 pacientes (86,5%) se encontraban con un VEF1 +80%, también se observó que 25 pacientes el 92,6% de los que presentaban VEF1 en +80% nunca presentaron tos nocturna y el 93,3% nunca mostraron ni sibilancia al reírse, ni intolerancia a los ejercicios. El 35,14% presentaba otros tipos de atopia, el 51,4% estaban no controlados y el 48,6% parcialmente controlados, se observó que de los no controlados 10 el 27,1% padecían de otras atopias, luego del tratamiento con montelukast, 3 pacientes el 8,1% se encontraban no controlados, se valoró un riesgo relativo de 2,1 en relación con las atopias y el control de la enfermedad. Conclusiones: con la utilización del Montelukast disminuyeron significativamente la sibilancia al reírse, la tos nocturna y la intolerancia al ejercicio físico lográndose un mejor control clínico y aumento del VEF1. Mejoró el estado clínico-funcional de los pacientes asmáticos.
Introduction: bronchial asthma is a chronic disease; the antileukotrienes show a great value in the treatment and control of this disease. Objective: to evaluate the clinical functional stage of children treated with Montelukast. Methods: a retrospective and longitudinal study was done in 37 asthmatic children at Rubén Batista Rubio university polyclinic in Cacocum municipality of Holguín province. Results: forced expiratory volume before using Montelukast was expressed in + 80%, in 21 children (56.7%) and 43.2%, 16 of the patients were between 80-60%, after the drug, 32 patients (86.5% ) Had a FEV1 + 80%, the result also revealed that 25% of patients with FEV1 in 80% never had nocturnal cough, and 93.3% never presented with wheezing or intolerance exercises. 35.14% had other types of atopy, 51.4% were uncontrolled and 48.6% were partially controlled. Of the uncontrolled 10, 27.1% had other atopias, after treatment with montelukast, three patients 8.1%. Were uncontrolled, a relative risk of 2.1 was assessed in relation to atopy and control of the disease. Conclusions: with the use of Montelukast wheezing, nocturnal coughing, and physical exertion intolerance diminished significantly, getting to a better clinical control and the FEV1 increase. The clinical and functional state of asthmatic patients was improved.
RESUMO
Introducción: el asma bronquial es una enfermedad que se considera puede ser controlable, aunque no puede curarse, pero sus manifestaciones clínicas, que son las que afectan al paciente, pueden desaparecer o disminuir hasta lograr una vida normal, o casi normal, para este y sus familiares, con una serie de medidas medicamentosas y no medicamentosas. Objetivo: evaluar la eficacia del montelukast en el tratamiento de niños asmáticos persistentes. Métodos: se realizó un estudio en 65 niños asmáticos persistentes en el Hospital Pediátrico Universitario William Soler. Se evaluaron los síntomas, pruebas funcionales respiratorias, días perdidos en la escuela, y control de la enfermedad, inicialmente, y un año después de la introducción del montelukast. Se observó la posibilidad de efectos secundarios. Resultados: 55 pacientes (84,6 por ciento) tenían tos nocturna diaria antes del tratamiento. Al año, la tos nocturna diaria se observó solo en 9 (13,9 por ciento); 43 (66,1 por ciento) presentaban sibilancias al reírse, mientras que al año 1 (1,6 por ciento) mantenía sibilancias diarias con la risa; 41 (63,0 por ciento) tenían, inicialmente, afectación de la actividad física, mientras que al año 51 (78,4 por ciento) no tenían limitaciones. El 100 por ciento tenía ausencias escolares. Durante el año de tratamiento 34 (57,0 por ciento) no presentaron días perdidos; 42 (64,6 por ciento) tenian crisis diarias, sin embargo, al reevaluar, 38 (58,5 por ciento) no tuvieron crisis. Habían tenido ingresos hospitalarios 23 (35,4 por ciento), pero posteriormente solo 5 necesitaron hospitalización. Antes del tratamiento, 49 (75,0 por ciento) necesitaron tratamiento de rescate, en cambio, durante el año disminuyó a 27 (41,0 por ciento). 19 niños (38,0 por ciento) tenían inicialmente el volumen espiratorio forzado en 1 s menor del 80 por ciento, y ....
Introduction: bronchial asthma is a disease that may to be controlled, although is not curable, but its clinical manifestations affecting the patient may to disappear or to decrease until to achieve a normal or almost-normal life for patient and for its family with a series of drug and non-drug measures. Objective: to assess the effectiveness of montelukast in treatment pf children with persistent asthma. Methods: in 65 children presenting with persistent asthma seen in the William Soler University Children Hospital authors conducted a study. The symptoms, respiratory functional tests, days absent to school and disease control were initially assessed and one year after introduction of the montelukast. There was a possibility of secondary effects. Results: fifty five patients (84,6 percent) had daily nocturnal cough before treatment. One year after above mentioned cough was observed only in 9 (13,9 percent); 43 (66,1 percent) had sibilismus when laugh; 41 (63,0 percent) had initially affection of physical activity, whereas at one year 51 of them (78,4 percent) hadn't any limitation. The 100 percent had school absences. During the year of treatment 34 (57,0 percent) not showed such absences; 42 (64,6 percent) had daily crises, however, in re-evaluation, 38 (58,5 percent) hadn't crises. Twenty three were admitted in the hospital (35,4 percent) but later only 5 needed to be admitted. Before treatment, 49 (75,0 percent) need rescue treatment, on the other hand, during that year decreased to 27 (41,0 percent). A total of 19 children (38,0 percent) initially had a forced expiratory volume (FEV1) less than 80 percent and only 8 (16,0 percent) had it later. Before treatment the 100 percent of ...
RESUMO
La rinosinusitis crónica (RSC) es actualmente una de las patologías crónicas de mayor prevalencia en nuestra sociedad. Se distinguen dos formas clínicas: la RSC con pólipos (RSCCP) y la RSC sin pólipos (RSCSP). Es considerada, en términos generales, como una inflamación de la cavidad nasal y senos paranasales de una duración superior a 12 semanas. En la actualidad, los posibles mecanismos fisiopatológicos involucrados ubican al componente inflamatorio como entidad central en su etiología. La relación entre inflamación y poliposis nasal es aún objeto de gran debate. Existen distintos tratamientos médicos con evidencia científica de diferentes niveles de calidad, dentro de los cuales se encuentran antibióticos, corticoides, lavados nasales y antileucotrienos. El uso de macrólidos en bajas dosis y por períodos prolongados de tiempo surge como una eficaz alternativa tanto en el control de síntomas como de parßmetros objetivos, principalmente en pacientes con RSCSP. Este artículo efectúa una exposición respecto al tratamiento médico actualmente disponible, su eficacia y evidencia científica, tanto para la RSCP como para la RSCSP.
Chronic rhinosinusitis (CRS) is currently one of the most prevalent chronic pathologies in Chile. Two forms are distinguishable: Polyp CRS and non-polyp CRS. CRS is condidered, generally speaking, an inflammation of the nasal cavities and paranasal sinuses lasting longer than 12 weeks. Current possible physiopathological mechanisms involved establish inflammation as a central entity in CRS etiology. The relationship between inflammation and nasal polyposis is still a matter of great debate. Several treatment options are available, supported by heterogeneous scientific evidence; among these are antibiotics, corticoids, nasal rinses and antileucotriens. Prolonged treatment with low-dose macrolides treatment has become a good alternative, effectively controlling both symptoms and objective parameters, mainly in non-polyp CRS. This article reviews the CRS medical treatment currently available, its efficacy and the scientific evidence supporting it, both for the polyp and non-polyp types.