Inhalation In Children Research Articles

Experience of the use of tobramycin for inhalation in children with cystic fibrosis

научный биометрический журнал, который знакомит читателя с клиническими рекомендациями и особенностями применения лекарственных и вакцинных средств у детей, предоставляет исчерпывающую информацию о воздействии лекарственных средств на плод, о проводимых в

Tracheo-Bronchial Foreign Body Aspiration in Children: A One Year Descriptive Study

The aim of this work was to study the clinical presentation of tracheo-bronchial foreign body aspiration in children for its early diagnosis. This article attempts to address the potential hazards of foreign body inhalation in children and its subsequent management by rigid bronchoscopy. This study was conducted in Department of Otorhinolaryngology, K.L.E.S Dr. Prabhakar Kore Hospital, Belgaum, for a period of 1year. Children less than 16years of age with history suggestive or suspicious of foreign body aspiration were screened clinically and radiologically and those patients with high index of suspicion of foreign body were included in the study. All patients were subjected to rigid bronchoscopy under general anaesthesia and the results were analyzed. This study comprises of 29 patients with suspected foreign body aspiration. On rigid bronchoscopy, foreign body was found and successfully removed in 22 patients. Highest incidence was seen in boys between 1 and 2years age. History of foreign body aspiration was absent in most cases and children presented with combination of symptoms. Obstructive emphysema was commonest chest X-ray finding. There was no significant difference in the site of foreign body aspiration on the right and left bronchus and commonest foreign bodies were vegetative type. Complication rates in this study were low as compared to previous studies. Tracheo-bronchial foreign body aspiration is very common in children. Foreign body aspiration usually presents as an un-witnessed episode and a high index of suspicion by the surgeon, even in absence of a positive history is necessary to prevent morbidity and mortality due to delayed or misdiagnosis. Foreign body aspiration is an emergency and should be removed by rigid bronchoscopy at the earliest to prevent complications.

390 Efficacy and safety of colistin for inhalation in children 5 years old and younger with cystic fibrosis with Pseudomonas aeruginosa infection

390 Efficacy and safety of colistin for inhalation in children 5 years old and younger with cystic fibrosis with Pseudomonas aeruginosa infection

P01-287 - Relationship between, smell of cigarette smoking and inhalation for children under one year and the probability of cigarette smoking in adulthood

ObjectiveTo examine the relationship between, smell of cigarette smoking and inhalation for children under one year and the probability of cigarette smoking in adulthood.Materials and methodThis is a case control study in which two groups of subjects (smokers as case group and nonsmokers as observed group) are considered.Cigarette exposure experience under age of one has been questioned in both groups.FindingsThe results of the research show that 60.71% of smoker group had parents smoking in their infancy Period while this was 30.35% for nonsmokers, indicating a significant difference (P = 0.000,X2 = 63.91). Also, 58.82% of subjects in smoker group have smoking parents while 12% in nonsmoker group .19.64% have certain medical disease history compared with 5.35% in nonsmoker group which showed a significant difference.(P = 0.044,X2 = 4.00).DiscussionAs the results show it is Probable that unexpected inhalation of cigarette smoke induce a conditional learning for children in their infancy Period and in family environment under the influence of simultaneous kindness of both parents while inhalation smoking reminds them their parent’s kindness and favor. There is a good feeling for these Persons while they smoke and this increases the chance for them to be smoker.Although this study is limited, it may be can show the effect of parent’s smoking on the probability of smoking for children in their future life, to prevent which can decrease this probability.

Reduction of Nocturnal Awakenings With Mometasone Furoate Administered Via Dry Powder Inhaler in Children With Persistent Asthma Previously Receiving Other Inhaled Corticosteroids

RATIONALE: The incidence of asthma-related nocturnal awakenings is an important measure of asthma control. The effect of mometasone furoate administered via dry powder inhaler (MF-DPI) on nocturnal awakenings was investigated post hoc using data from three pediatric trials.

Easily missed? Foreign body inhalation in children

Clinical OtolaryngologyVolume 35, Issue 6 p. 494-495 Easily missed? Foreign body inhalation in children Kay Wang, Kay WangSearch for more papers by this authorAnthony Harnden, Anthony HarndenSearch for more papers by this authorAnne Thomson, Anne ThomsonSearch for more papers by this author Kay Wang, Kay WangSearch for more papers by this authorAnthony Harnden, Anthony HarndenSearch for more papers by this authorAnne Thomson, Anne ThomsonSearch for more papers by this author First published: 30 December 2010 https://doi.org/10.1111/j.1749-4486.2010.02210.xCitations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume35, Issue6December 2010Pages 494-495 RelatedInformation

Efficacy and safety of tobramycin and colistin for inhalation in children with cystic fibrosis from Moscow region

Efficacy and safety of tobramycin and colistin for inhalation in children with cystic fibrosis from Moscow region

Long-term safety of Mometasone Furoate administered via a dry powder inhaler in children: Results of an open-label study comparing Mometasone Furoate with Beclomethasone Dipropionate in children with persistent asthma

BackgroundTo assess the long-term pediatric safety of 2 doses of mometasone furoate administered via a dry powder inhaler (MF-DPI) for mild-to-moderate persistent asthma and compare them with that of beclomethasone dipropionate administered via a metered dose inhaler (BDP-MDI) in the treatment of persistent asthma. Both MF-DPI doses tested are twice the approved pediatric dosage of 100 μg once-daily (QD) for children aged 4–11 years.MethodsChildren (N = 233) aged 4–11 years were randomized to 52 weeks of treatment with MF-DPI 200 μg QD AM, MF-DPI 100 μg twice daily (BID), or BDP-MDI 168 μg BID. Patients had used inhaled corticosteroids (ICSs) daily for ≥ 30 days before the screening visit and were on stable ICS doses for ≥ 2 weeks before screening. The primary safety variable was the incidence of adverse events. Secondary safety variables were laboratory tests (including cortisol concentrations), vital signs, and physical examination.ResultsThe incidence of adverse events was similar in all 3 treatment groups. The most frequently reported adverse event was upper respiratory tract infection, reported by 47%–49% of the MF-DPI-treated patients and 51% of the BPD-treated patients. Most adverse events were considered unrelated to study drug. The most frequently reported related adverse events were headache (MF-DPI 200 μg QD AM, 8%; MF-DPI 100 μg BID, 4%; BDP-MDI 168 μg BID, 2%) and oral candidiasis (4% in each treatment group). No clinically relevant changes in laboratory values, including plasma cortisol, vital signs, or physical examinations were noted in any treatment group.ConclusionBoth MF-DPI doses were well tolerated, with no unusual or unexpected adverse events or safety concerns, and had a similar adverse event profile to that of BDP-MDI 168 μg BID.

Suspected Foreign Body Inhalation in Children: What Are the Indications for Bronchoscopy?

To define the criteria for bronchoscopy in children with suspected foreign body (FB) inhalation. Health history, physical examination, and radiologic examination were performed before bronchoscopy in all children referred for suspected FB inhalation between 2003 and 2005. A total of 142 children, ranging in age from 3 months to 14 years (median age, 20 months), were referred with a history of suspected FB inhalation. An FB was found in 42 children with abnormal physical and radiologic findings, in 17 children with abnormal physical or radiologic findings, and in 2 children with normal physical and radiologic finding but persistent cough. Bronchoscopy revealed no FB in the children with normal physical and radiologic examinations and no symptoms (n = 16). In children with a history of choking, bronchoscopy is mandatory in the presence of persistent symptoms, such as cough, dyspnea, and fever, or any abnormal physical or chest radiography findings. Bronchoscopy is not necessary in asymptomatic children with normal physical and radiographic examinations.

Children's inhalation exposure to methamidophos from sprayed potato fields in Washington State: Exploring the use of probabilistic modeling of meteorological data in exposure assessment

We examined the significance of meteorology and postspray volatilization of methamidophos (an organophosphorus insecticide) in assessing potential inhalation risk to children in an agricultural community. We combined fluxes from sources and dispersion modeling with a range of possible local meteorology to create output to study the variability in potential community exposure as a result of changing temperature, wind speeds and wind directions. This work is based on an aerial spray drift study where air sampling measurements of methamidophos were made before, during and after a spray event were used to examine acute inhalation risk for children living in an Eastern Washington State community in close proximity (between 15 and 200 m) to sprayed potato fields. We compared the measured average air concentrations of methamidophos in the community to a "no observed adverse effect level" for subchronic inhalation to characterize acute and subchronic inhalation risks. The baseline estimates of inhalation exposure were below Environment Protection Agency's (EPA) level of concern based on a target margin of exposure of 300. As meteorological conditions during and after spraying influence the amount of material moving into areas where children reside we used historical meteorological data to drive model simulations that predicted likely air residue concentrations under different wind and temperature conditions. We also added variability to the decay constant and initial emission fluxes to create a 2-D simulation of estimated air concentrations in the community near the fields. This work provides a methodological framework for the assessment of air concentrations of pesticides from agricultural sprays in the absence of extended measurements, although including variability from meteorological conditions. The deterministic as well as the probabilistic risk analyses in this study indicated that postspray volatilization in the specific spray situation analyzed (methamidophos applied on potato fields in Eastern Washington) did not pose acute or subchronic risks as defined by the EPA. However, this study did not consider any pathway of exposure other than inhalation (e.g. diet, dermal, etc.) and the risk assessment should be evaluated in that context.

Use of helium-oxygen mixtures in the treatment of croup: a systematic review

Objective:To determine the effect of helium-oxygen inhalation on relieving symptoms and distress in children with croup as measured by the croup score, and to identify areas of uncertainty for future...

Tracheobronchial anatomy and the distribution of inhaled foreign bodies in children

Foreign body inhalation is a common and life-threatening emergency, and is most prevalent in young children. The traditional view is that tracheobronchial anatomy determines that an inhaled foreign body is more likely to enter the right main bronchus. This view has been challenged in young children, in whom the distribution of inhaled objects is more evenly distributed between the bronchi. We, therefore, investigated tracheobronchial anatomy relevant to foreign body inhalation in children. One hundred and fifty-six normal pediatric chest radiographs were selected from a large electronic database. Eight groups of radiographs were identified: supine (n=76) and erect; males (n=84) and females; aged <3 years (median age 12 [0.5-29] months) and > or =3 years (median age 126 [48-180] months). Tracheobronchial widths and angles were determined using a standardized technique with good reproducibility. Overall, children had a proximal right main bronchus that was consistently steeper and slightly wider than the left (P<0.001), becoming more vertical in the erect position (P=0.0001). In most children, the carina was positioned to the left of the mid-trachea, but in 34% of cases (40% of infants), it was to the right of the mid-trachea. The effects of age and gender were otherwise minimal. On the basis of tracheobronchial anatomy, an inhaled foreign body is more likely to enter the right bronchial tree than the left in children of all ages. However, the variability in the position of the carina with respect to the mid-trachea may explain why this right-sided preference is less marked in children compared to adults.

Overview: Workshop on Children's Inhalation Dosimetry and Health Effects for Risk Assessment

Overview: Workshop on Children's Inhalation Dosimetry and Health Effects for Risk Assessment

Distributional Analyses for Children's Inhalation Risk Assessments

The discussion here is divided into three parts. First there is a generic introduction to variability and uncertainty and a discussion of some underappreciated features of these concepts that have nontrivial implications for structuring risk analyses. Next are some suggestions for a way forward to build a better quantitative understanding of relevant variability and uncertainty. The process involves building databases of putative analogous cases to represent the concerns that are now reflected in the various point-estimate “uncertainty factors” or “adjustment factors” in the formulas used to derive current reference doses and reference concentrations (RfDs and RfCs). The use of such databases is illustrated with some limited selections from our own databases where some preliminary comparisons between child and adult population variability in activity and respiratory response parameters are possible. A final section reflects on the current evolution of practice in estimating variability in risk assessments.

Potential New Approaches for Children's Inhalation Risk Assessment

The U.S. Environmental Protection Agency (EPA) practice of risk assessment is moving toward more thoroughly considering children's unique susceptibilities and exposure potential. Childhood is assessed as a sequence of life stages that reflects the fact that as humans develop, windows of susceptibility may appear that lead to enhanced sensitivity to exposure of environmental agents, while changes in behavior and physiology may increase exposure and dose. The U.S. EPA developed guidance in the past few years that addresses some aspects of increased susceptibility and exposure and dose. However, when it comes to considering inhalation exposure, dose, and risk, current U.S. EPA practice does not explicitly address children. The purpose here is to begin studying the adequacy of practice for children's health and to explore possible next steps in developing new methods to more accurately assess life-stage-specific differences. The existing guidelines and policies used to address potentially unique susceptibilities of children for inhaled environmental chemicals were considered, as well as what may be learned from examples of approaches that have been applied by state agencies (such as the California Environmental Protection Agency) or in the literature, to incorporate potentially unique susceptibilities and exposures to children. Finally, there is a discussion of possible approaches for considering inhalation exposure and susceptibility in U.S. EPA risk assessments.

Focusing on Children's Inhalation Dosimetry and Health Effects for Risk Assessment: An Introduction

Substantial effort has been invested in improving children's health risk assessment in recent years. However, the body of scientific evidence in support of children's health assessment is constantly advancing, indicating the need for continual updating of risk assessment methods. Children's inhalation dosimetry and child-specific adverse health effects are of particular concern for risk assessment. When focusing on this topic within children's health, key issues for consideration include (1) epidemiological evidence of adverse effects following children's exposure to air pollution, (2) ontogeny of the lungs and effects on dosimetry, (3) estimation and variability of children's inhalation rates, and (4) current risk assessment methodologies for addressing children. In this article, existing and emerging information relating to these key issues are introduced and discussed in an effort to better understand children's inhalation dosimetry and adverse health effects for risk assessment. While much useful evidence is currently available, additional research and methods are warranted for improved children's health risk assessment.

Assessing The Health Effects and Risks Associated with Children's Inhalation Exposures—Asthma and Allergy

Adults and children may have different reactions to inhalation exposures due to differences in target tissue doses following similar exposures, and/or different stages in lung growth and development. In the case of asthma and allergy both the developing immune system and initial encounters with common allergens contribute to this differential susceptibility. Asthma, the most common chronic childhood disease, has significant public health impacts and is characterized by chronic lung inflammation, reversible airflow obstruction, and immune sensitization to allergens. Animal studies described here suggest that air pollutants exacerbate asthma symptoms and may also play a role in disease induction. Changes characteristic of asthma were observed in rhesus monkeys sensitized to house dust mite antigen (HDMA) as infants and exposed repeatedly thereafter to ozone (O3) and HDMA. O3 exposure compromised airway growth and development and exacerbated the allergen response to favor intermittent airway obstruction and wheeze. In Brown Norway rats a variety of air pollutants enhanced sensitization to HDMA such that symptoms elicited in response to subsequent allergen challenge were more severe. Although useful for assessing air pollutants effects on initial sensitization, the rodent immune system is immature at birth relative to humans, making this model less useful for studying differential effects between adults and children. Because computational models available to address children's inhalation exposures are limited, default adjustments and their associated uncertainty will continue to be used in children's inhalation risk assessment. Because asthma is a complex (multiple genes, phenotypes, organ systems) disease, this area is ripe for systems biology approaches.

Fog-induced Cough with Impaired Respiratory Sensation in Congenital Central Hypoventilation Syndrome

Congenital central hypoventilation syndrome (CCHS) is a genetic disorder mainly characterized by failure of automatic control of breathing, causing alveolar hypoventilation. Little is known regarding cough in CCHS. Parental reports indicate that patients cough normally during airway infections; however, previous studies have demonstrated no cough response to fog inhalation. To evaluate the sensory and motor components of cough, respiratory sensations, and changes in ventilation evoked by fog inhalation in children with CCHS and in sex- and age-matched control subjects. Cough threshold was measured and cough intensity was indexed in terms of cough peak expiratory flow and integrated abdominal electromyographic activity. The pattern of breathing was recorded by inductive plethysmography. Respiratory sensations were also investigated. All control subjects and six of seven patients coughed in response to fog inhalation. The seventh coughed with citric acid aerosol inhalation. Cough threshold values were similar in control subjects (range, 0.40-2.22 ml/min) and patients (range, 0.40-3.26 ml/min). Mean values of cough peak expiratory flow and of integrated abdominal electromyographic activity-related variables during coughing were also similar and corresponded to 80% of those recorded during maximum voluntary cough. Cough appearance was preceded by respiratory sensations and increases (P < 0.01) in ventilation in the control subjects but not in the patients. Children with CCHS have normal cough threshold and motor responses to fog inhalation. However, the lack of respiratory sensations and the likely related ventilatory changes typically elicited by tussigenic fog concentrations suggest a neural sensory deficit that may increase the risk of respiratory disease in these patients.

Cost-effectiveness of salmeterol xinafoate/fluticasone propionate combination inhaler in chronic asthma

ABSTRACTObjective: To determine where in the treatment steps recommended by the British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) Asthma Guideline it is cost-effective to use salmeterol xinafoate/fluticasone propionate combination inhaler (SFC) (Seretide) compared with other inhaled corti­costeroid (ICS) containing regimens (with and without a long acting beta‑2 agonist (LABA)) for chronic asthma in adults and children.Research design and methods: Meta-analyses of percentage symptom-free days (%SFD) were used within a cost-effectiveness model. Time spent in two asthma control health states, ‘symptom-free’ and ‘with-symptoms’ was used as the measure of differential treatment effectiveness. SFC was compared with varying doses of fluticasone propionate (FP) and beclometasone dipropionate (BDP) with or without a separate salmeterol inhaler, and with the budeson­ide/formoterol combination inhaler (BUD/FORM) (Symbicort). Drug costs, non-drug costs and quality adjusted life years (QALY) were incorporated into the analyses. Results are presented as cost per QALY ratios and uncertainty explored using probabilistic sensitivity analysis.Results: Compared with an increased dose of FP in adults, SFC either ‘dominates’ (i.e. cheaper and more effective) FP or the cost per QALY is £6852. The cost per QALYs estimated in sensitivity analyses using BDP costs range from £5679 to £15 997. For children the cost per QALY for SFC 50 Evohaler* compared with an increased dose of FP is £15 739. SFC is similarly clinically effective in improving %SFDs compared with FP plus salmeterol delivered in separate inhalers (mean differences for each dose comparison of –3.9 (low) (with a 95% confidence interval (CI): –12.96; 5.16); 4.10 (medium) (95% CI: –3.01; 11.21); –0.4 (high) (95% CI: –8.88; 8.08)) and BUD/FORM (mean difference of 0.40 (95% CI –3.69; 4.49)) in adults, and a cheaper SFC option is available at all doses (annual cost savings range from £18–£427 per patient). SFC was similarly effective compared with FP plus salmeterol in separate inhalers in children under 12 and also resulted in annual cost savings of between £47 and £77. A number of other comparisons were also made and the results are available as electronic supplementary data.Conclusions: This is the first analysis to estimate the cost-effectiveness of SFC in chronic asthma compared with multiple comparators and based on a systematic identification of relevant trials and data on %SFDs. The findings suggest that for adults and children uncontrolled on BDP 400 μg/day or equivalent it is a cost-effective option to switch to SFC (at an equivalent ICS dose) compared with increasing the dose of ICS. For adults and children aged 12 years and over who have passed this point and are uncontrolled on BDP 800 μg/day or equivalent, switching to SFC remains a cost-effective approach. Where an adult or child requires an ICS and a LABA to be co-prescribed, SFC is a cost-effective option compared with FP or BDP plus salmeterol delivered in separate inhalers. In adults who require combination therapy, SFC is a cost-effective option compared with BUD/FORM.

Once versus twice daily budesonide metered-dose inhaler in children with mild to moderate asthma: effect on symptoms and bronchial responsiveness

Background Simplifying dosing regimens could improve both adherence and asthma-related morbidity. However, there is little information on the effectiveness of once-daily budesonide, administered through a metered dose inhaler (MDI) plus spacer, on asthma symptoms and pulmonary function in asthmatic children. Methods The aim of this study was to compare the effect of once-daily versus twice-daily doses of inhaled budesonide on symptoms, lung function and bronchial hyperresponsiveness (BHR) in asthmatic children. This study was a randomized, single-blind, parallel clinical trial. Patients received budesonide from an MDI either 800 μg as a daily dose or fractionated in 400 μg twice a day for 12 weeks. Statistical analysis was performed using tests for independent and paired samples. Results In both groups, asthma symptoms significantly decreased. However, the improvement in asthma symptoms, decrease in BHR and treatment adherence were significantly greater in the once-daily group than in the twice-daily group (p < 0.05). No significant differences were found between the two groups in spirometric parameters, morning peak expiratory flow or plasma cortisol values. Conclusions Once-daily administration of 800 μg of inhaled budesonide administered by MDI plus spacer was more effective in controlling symptoms and improving BHR than fractionating the dose to 400 μg twice daily. The differences observed in this study could have been due to the greater adherence to treatment in patients in the once-daily group.