Salbutamol Inhalation Research Articles

Severe uncontrolled eosinophilic asthma, which responded to benralizumab after failure to respond to mepolizumab

We present a case of eosinophilic asthma of a 55-year-old woman who was initially diagnosed with bronchial asthma by the author in February 2008. The diagnosis was confirmed using the Global Initiative for Asthma guidelines. 1 Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI)Global strategy for asthma management and prevention. Bethesda, MD: Global Initiative for Asthma (GINA), National Heart, Lung and Blood Institute (NHLBI). Revised 2006. http://www.ginasthma.com Google Scholar Her forced expiratory volume in 1 second (FEV1) was 63.9% of the predicted value, with an increase of 12.9% in FEV1 after 180 μg salbutamol inhaler. She had no history of smoking. She met the American Thoracic Society criteria for a diagnosis of refractory asthma. 2 American Thoracic SocietyProceedings of the ATS workshop on refractory asthma: current understanding, recommendations, and unanswered question. Am J Respir Crit Care Med. 2000; 162: 2341-2351 Crossref PubMed Scopus (903) Google Scholar She had nonallergic asthma, diagnosed with serum total IgE level 94 IU/mL and negative results of serum specific IgE for common inhaled allergens, including mold, and Dermatophagoides farinae and pteronyssinus. She had occasionally been treated with systemic corticosteroids. Her basal regimen included daily use of budesonide/formoterol 160 μg/4.5 μg inhaler 6 puffs/day and montelukast 10 mg daily.

Evaluation of the histopathological effects of salbutamol inhaler treatment in an experimentally induced rat model of pulmonary contusion

This study aimed to evaluate the effects of salbutamol inhaler treatment in an experimentally induced model of pulmonary contusion. Thirty-two male Wistar albino rats were randomly divided into four groups: the control group (CG), sham group (SG), treatment group 1 (TG1), and treatment group 2 (TG2). Experimental contusion was established by targeting the right lung tissue. After 72 h, histopathological evaluation for the severity of edema, hemorrhage, and leukocyte infiltration was performed in both sides of the lungs. Examination of right lung tissues revealed a significant difference in edema, hemorrhage, leukocyte infiltration, and total lung injury scores between the CG and SG. Both TG1 and TG2 had less edema, hemorrhage, and leukocyte infiltration and lower total lung injury scores compared with the SG. There was no significant difference in edema, hemorrhage, and total lung injury scores between the CG and TG1 or TG2. A significant difference in hemorrhage scores between the SG and TG1 and edema scores between the SG and TG2 was observed, with treatment groups having lower values. A significant difference in total lung injury score was also found between SG and TG1. Salbutamol inhaler therapy during pulmonary contusion may prevent complications by reducing edema, hemorrhage, leukocyte infiltration, and total lung injury score.

Effectiveness of fluticasone furoate/vilanterol versus fluticasone propionate/salmeterol on asthma control in the Salford Lung Study

Objective: The Asthma Salford Lung Study demonstrated the effectiveness of initiating once-daily fluticasone furoate/vilanterol (FF/VI) versus continuing usual care in asthma patients in UK primary care [1]. Here, we report a secondary analysis in a subset of patients with fluticasone propionate/salmeterol (FP/Salm) as their baseline intended maintenance therapy, to evaluate the relative effectiveness of initiating FF/VI versus continuing FP/Salm. Methods: Adults with symptomatic asthma were randomised to initiate FF/VI 100[200]/25 µg or continue FP/Salm. The Asthma Control Test (ACT), Asthma Quality of Life Questionnaire (AQLQ), Work Productivity and Activity Impairment Asthma questionnaire, severe exacerbations, salbutamol inhaler prescriptions and serious adverse events (SAEs) were recorded throughout the 12-month treatment period. Results: One thousand two hundred and sixty-four patients (FF/VI 646; FP/Salm 618) were included in this subset analysis; 978 had baseline ACT score <20 and were included in the primary effectiveness analysis (PEA) population. At week 24, odds of patients being ACT responders (total score ≥20 and/or improvement from baseline ≥3) were significantly higher with FF/VI versus FP/Salm (71% vs. 56%; odds ratio 2.03 [95% CI: 1.53, 2.68]; p < 0.001 [PEA]). Significant benefit with FF/VI versus FP/Salm was also observed for AQLQ responders, activity impairment due to asthma, exacerbation rates, and salbutamol inhalers prescribed. No significant between-group differences were observed for impairment while working or work absenteeism due to asthma. Conclusions: For patients in primary care, initiating FF/VI was significantly better than continuing with FP/Salm for improving asthma control and quality of life, and reducing asthma exacerbations, with no notable difference in SAEs.ClinicalTrials.gov: NCT01706198.

Emergence of Enhanced Quality Expectations in Pharmaceuticals

Commercial viability of any drug product may often bring pain for patients who otherwise wait for their drug to improve their quality of life and breath. Dryness of drug products like thyroxin, warfarin, phenobarbitone, salbutamol inhalers, morphine etc. from the market leave patient on the mercy of nature. The heart wrenching healthcare professional burst out when lifesaving drugs are not available due to any reason. Voice of civil society rises in community where care of others is felt as a moral responsibility beside capitalism and/or socialism. It is also observed and quite possible that quality defects may create similar situations of drug shortage. Manufacturing facility or its control may go out unwittingly due to knowledge limitation. A quality defect that impacts delivery and performance of drug and/or carries harmful potential has always been a matter of top priority. In both cases, ability to detect, report and assess defines presence and thickness of protection wall for the public. Power to predict uncertainty and taking measures well in time is a challenge for industry and regulators to maintain uninterrupted supply of quality drugs.

Exercise performance after salbutamol inhalation in non-asthmatic, non-athlete individuals: a randomised, controlled, cross-over trial

BackgroundAsthma is a frequent diagnosis in competitive sports, and inhaled β2-agonists are commonly used by athletes. Although inhaled β2-agonists do not seem to improve performance in athletes, it has remained...

Surgical closure of a ventricular septal defect in early childhood leads to altered pulmonary function in adulthood: A long-term follow-up

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

The impact of nasal aspiration with an automatic device on upper and lower respiratory symptoms in wheezing children: a pilot case-control study

BackgroundThe impact of proper aspiration of nasal secretions during upper respiratory infection on the frequency and severity of symptoms of lower airways has never been investigated. The study was aimed at testing if cleaning the nasal cavities of children with recurrent wheezing using an automatic nasal aspirator improves the upper and lower respiratory symptoms during the cold season.MethodsParents of wheezing children (age 3-72 mo.) answered questionnaires and learned using a nebulizer equipped (cases) or not equipped (controls) with an automatic nasal aspirator (DuoBaby, OMRON, Japan). During a 90-days monitoring period parents filled an electronic diary (BreathMonitor, TPS, Rome, Italy) on their child’s symptoms of the upper and lower airways.ResultsEighty-nine/91 patients (43 cases, 46 controls) completed the study. Less days with upper (25.0% vs 46.4%, p = 0.004) or lower (21.8% vs 32.8%, p = 0.022) airways symptoms and less days with salbutamol inhalation (12.2% vs 16.9%, p < 0.001) were reported by cases than by controls. The episodes of upper respiratory symptoms were shorter [4.3 days (95%CI:3.8–4.9) vs 5.7 days (95%CI:5.0–6.4), p = 0.007] but not less frequent [2.3 (95%CI: 1.8–2.8) vs 2.6 (95%CI:2.2–3.0), p = 0.122] among cases than among controls. Similarly, the episodes of lower respiratory symptoms tended to be shorter [3.8 days, (95%CI: 3.4–4.2) vs 4.4 days, (95%CI: 4.4–6.0), p = 0.067] but not less frequent [1.9 (95%CI:1.5–2.3) vs 2.1 (95%CI:1.7–2.4), p = 0.240] among the group using the nasal aspirator.ConclusionsIn our pilot study, the use of an automatic nasal aspirator in children with a history of recurrent wheezing was associated with an improved respiratory health during the cold season.

Futility of current urine salbutamol doping control.

AimsSalbutamol is used in the management of obstructive bronchospasm, including that of some elite athletes. It is claimed that high salbutamol (oral) doses may also have an anabolic effect. Therefore, inhalation of salbutamol is restricted by the World Anti‐Doping Agency (WADA) to a maximal daily dose. Urine is tested for violations, but recent cases have resulted in a debate regarding the validity of this approach. It was our aim to determine whether current approaches are sufficiently able to differentiate approved usage from violations.MethodsWe extracted pharmacokinetic parameters from literature for salbutamol and its sulphated metabolite. From these parameters, a semi‐physiological pharmacokinetic model of inhaled and orally administered salbutamol was synthesized, validated against literature data, and used to perform clinical trial simulations (n = 1000) of possible urine concentrations over time resulting from WADA‐allowed and oral unacceptable dosages.ResultsThe synthesized model was able to predict the literature data well. Simulations showed a very large range of salbutamol concentrations, with a significant portion of virtual subjects (15.4%) exceeding the WADA threshold limit of 1000 ng ml−1 at 1 h post‐dose.ConclusionsThe observed large variability in urine concentrations indicates that determining the administered dose from a single untimed urine sample is not feasible. The current threshold inadvertently leads to incorrect assumptions of violation, whereas many violations will go unnoticed, especially when samples are taken long after drug administration. These issues, combined with the dubious assertion of its anabolic effect, leads us to conclude that the large effort involved in testing should be reconsidered.

Effects of magnesium sulfate infusion on clinical signs and lung function of horses with severe asthma.

OBJECTIVE To evaluate whether MgSO4 solution administered IV would improve the clinical signs and lung function of horses with severe asthma and potentiate the effects of salbutamol inhalation in those horses. ANIMALS 6 adult horses with severe asthma. PROCEDURES Asthmatic horses were used in 3 crossover design experiments (6 treatments/horse). Clinical scores for nasal flaring and the abdominal component associated with breathing and lung function were determined before and after administration of salbutamol (800 μg, by inhalation), MgSO4 solution (2.2 mg/kg/min, IV, over 20 minutes), and combined MgSO4-salbutamol treatment. The data were collected during experimental procedures to assess salbutamol inhalation versus mock inhalation, MgSO4 infusion versus infusion of saline (NaCl) solution (adjusted to the same osmolarity as the MgSO4 solution), and the combined MgSO4-salbutamol treatment versus salbutamol inhalation alone. RESULTS Infusion of MgSO4 significantly improved clinical scores when administered alone or in combination with salbutamol inhalation. With the combination treatment, lung function improved, albeit not significantly. Tidal volume also increased following combined MgSO4-salbutamol treatment. Salbutamol alone significantly improved lung function, whereas saline solution administration and a mock inhalation procedure had no effect on the studied variables. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that MgSO4 infusion alone or in combination with salbutamol inhalation improved the clinical signs of severely asthmatic horses. The effects of MgSO4 were not associated with significant lung function improvement, which suggested that the changes observed were attributable to alterations in the horses' breathing patterns. Infusion of MgSO4 solution at the studied dose offers little advantage over currently used medications for the treatment of severe equine asthma.

Intravenous Magnesium Sulphate: An Effective Therapy for Acute Severe Attack of Bronchial Asthma

Asthma is a global public health problem of 21st century and occurs due to complex interaction between genetic, behavioral and environmental factors. There are many drugs available for asthma and magnesium sulphate is given intravenously as an important adjunct therapy during the acute severe attack of asthma Objective: This study was panned to determine the effect of intravenous MgSO4 on pulmonary function test in acute severe attack of asthma. Methodology: A double blind placebo control study was conduced on about 132 asthmatics, which were aged between 18-60 years at Mayo Hospital Emergency with FEV1 ≤ 30% of the predicted value. Spirometry of all asthmatics (study and placebo groups) in the emergency department was performed by Spirolab III. Detailed history, general physical and systemic examination was conducted and all parameters were recorded. Modified Borg scale was used to determine the grade of dyspnea from 0-10. A total of 2ml of venous blood was taken to determine the serum magnesium levels. All patients were given Salbutamol inhalation and intravenous (I/V) Hydrocortisone. The study group was given 2gm of MgS04 intravenously in 20 minutes in a burette and Placebo group was given placebo (0.9% normal saline). Salbutamol inhalation was given at regular intervals and Spirometry was performed to determine lung functions. Results: The two groups (study group and placebo-treated group) were compared for FEV1 , FEV1 % predicted, PEFR and PEFR % predicted. There was 1.06 L increase in FEV1 in study group compared to 0.8 L in placebo group (p&lt;0.05). The mean FEV1 in the study group was 47.75 % predicted as compared to 43.52% predicted in the placebo group. Similarly, PEFR also improved to 59.87% predicted in study group as compared to 48.7% predicted in the placebo treated patient (p= &lt; 0.01). Conclusion: Intravenous MgSO4 causes improvement in lung functions during asthmatic attack.

USEFULNESS OF THE FORCED OSCILLATION TECHNIQUE IN THE DIAGNOSIS OF COUGH VARIANT ASTHMA WITH PROLONGED OR CHRONIC COUGH

Usefulness of carrying out the reversibility test after inhaling bronchodilator by forced oscillation technique (FOT) in addition to spirometry was investigated in the diagnosis of bronchial asthma (BA), cough variant asthma (CVA) and allergic rhinitis (AR) with prolonged or chronic cough. The subjects were the 622 patients at Idaimaeminamiyojo Clinic in Sapporo who complained cough over three weeks, and underwent bronchial reversibility test with salbutamol by using spirometry and FOT. We divided them into 5 groups; BA, BA+AR, CVA, CVA+AR, AR, and examined their lung functions. The mean of improvement of FEV1 after inhalation of salbutamol was significantly different (p<0.001); 465ml (26%) of BA, 136ml (5.5%) of CVA, and 44ml (1.6%) of AR. However, in CVA, the mean reversibility value was not over the diagnostic criteria of BA; 200ml (12%). Improvement of respiratory resistant at 5Hz (R5) using FOT in BA/CVA were 25.7%/24.1%, and significantly higher (p<0.001) than that in AR, and these results were alike even in cases accompanied by AR; BA+AR, CVA+AR, and AR. AUC value in the ROC curve for diagnosis of CVA from AR with R5 was 0.870, and highest among with R5, R20, R35 and Fres. When the cut off value of R5 improvement was 15%, sensitivity was 74% and specificity was 81%. It was suggested that the additional bronchial reversibility test using FOT may be useful especially in the diagnosis of cough variant asthma where the reversibility in spirometry alone is not sufficient.

Sputum Eosinophilia and Magnetic Resonance Imaging Ventilation Heterogeneity in Severe Asthma.

Inflammation and smooth muscle dysfunction are integral components of severe asthma that contribute to luminal obstruction causing airflow limitation, ventilation heterogeneity, and symptoms. This is important for guiding treatment decisions directed at the inflammatory (e.g., anti-T-helper cell type 2 monoclonal antibodies) and noninflammatory, smooth muscle-mediated (e.g., bronchial thermoplasty) components of severe asthma. To investigate the contribution of eosinophilic bronchitis and smooth muscle dysfunction to magnetic resonance imaging (MRI) ventilation heterogeneity in patients with severe asthma. We measured the inhaled hyperpolarized gas MRI response to salbutamol as a marker of smooth muscle dysfunction, and sputum eosinophils as a marker of airway inflammation, and their contributions to ventilation heterogeneity (quantified as the ventilation defect percent [VDP]) in 27 patients with severe asthma. Spirometry and forced oscillation airway resistance measurements were also acquired pre- and postsalbutamol. Patients were dichotomized on the basis of sputum eosinophilia, and pre- and postsalbutamol VDP and physiological measurements were evaluated. MRI VDP improved with salbutamol inhalation in patients in whom sputum eosinophilia was uncontrolled (≥3%, n = 16) (P = 0.002) and in those in whom it was controlled (<3%, n = 11) (P = 0.02), independent of improvements in FEV1, indicating smooth muscle response. In those patients in whom sputum eosinophilia was uncontrolled, greater VDP persisted postsalbutamol (P = 0.004). Postsalbutamol VDP correlated with sputum eosinophils (r = 0.63; P = 0.005). In patients with severe asthma, MRI regionally identifies the inflammatory and noninflammatory components of airway disease. Ventilation heterogeneity persists postsalbutamol in patients with uncontrolled eosinophilic bronchitis, which may be the functional consequence of airway inflammation.

Comparison of the Clinical Efficacy of Salbutamol with Jet and Mesh Nebulizers in Asthmatic Children

Background Ultrasonic, jet, and mesh nebulizers have all been used in the treatment for asthma. Mesh nebulizers reportedly offer the best inhalation efficiency. Methods This study aimed to clarify the utility of the mesh nebulizer, compared to jet nebulizers, in the treatment of pediatric asthma patients. Participants included 88 children <6 years old who were receiving treatment for asthma at Murayama Pediatric Clinic. Heart rate, peripheral oxygen saturation in arterial blood, and Mitsui symptom scores were compared before and after treatment with a mesh nebulizer (n = 43) or jet nebulizer (n = 45) using a salbutamol inhalation solution (0.2 ml for children ≧ 2 years old, n = 51; 0.1 ml for children < 2 years old, n = 37). Results Other than required inhalation time, clinical findings did not differ between mesh and jet groups. In both groups, heart rate increased significantly in patients treated with 0.2 ml (1000 microg) of salbutamol. Conclusions and Clinical Relevance The required inhalation time of the mesh nebulizer was superior to the jet nebulizer. Children ≧ 2 years with mild asthma attacks experienced a significantly increased heart rate in both groups. The dose of salbutamol (0.2 ml for ≧2 years) used for asthma attacks should be reconsidered in mild asthma.

CLINICAL-GENETIC PHENOTYPING BRONCHIAL ASTHMA

Objective – to determine BA phenotypes using cluster analysis based on clinical and genetic traits in the Ukrainian population. Materials and methods. The study involved 195 patients with asthma. The diagnosis of asthma was made on the basis of the recommendations of GINA (2016) and order № 868 of 08.10.2013 of the Ministry of Health of Ukraine. To assess the control of asthma, an ACQ-5 questionnaire was used. The function of external respiration (FVD) was studied by means of the diagnostic complex Cardioplus (Ukraine) and the results were evaluated according to national recommendations. All patients underwent a reversibility test using 4 inhalations of salbutamol (400 μg). For the cluster analysis, 24 variables were used – clinical and instrumental, anamnestic and genetic parameters. For the cluster analysis, the SPSS-21 program was used. Gln27Glu (rs1042714) polymorphism of the ADRB2 gene was determined using the polymerase chain reaction method. The control group for the genetic study was 95 practically healthy persons without allergopathology. Results. Using the cluster analysis, we identified 3 phenotypes of BA: the 1-st phenotype (cluster A, n=81) − allergic asthma which occurs at a young age with a partially controlled course and a good response to inhaled glucocorticoids (IGCC) and β2-agonists long-acting (LABA); the 2-nd phenotype (cluster B, n=38) − non-allergic asthma, most of the women with overweight are characterized by an onset of BA at young age with uncontrolled course and inadequate response to medium doses of IGCC and LABA; the 3-d phenotype (cluster C, n=76) − non-allergic asthma which is associated with obesity diagnosed predominantly in women and has a partially controlled course. Conclusions. Carriers of the Glu27Glu genotype were more frequent among BA patients from cluster B, Gln27Glu genotype − in BA patients from cluster A and C, and Gln27Gln genotype − in BA patients from cluster A. The risk of BA was 5.5 times higher in carriers of Glu allele in comparison with carriers of the Gln allele of Gln27Glu polymorphism of ADRB2.

EFFICIENCY OF INHALATION AND PARENTAL THERAPY OF ACUTE BRONCHIAL OBSTRUCTION SYNDROME BY INFECTIOUS OR ALLERGIC GENESIS IN CHILDREN. PRINCIPLES AND TECHNIQUE OF INHALATIONS

Relevance. Diseases of the respiratory organs occupy the first ranked place in the structure of the incidence of children, reaching 50-75 % in the regions of Ukraine. The prevalence of the syndrome of bronchial hyperactivity increases . Objective: to study the effectiveness of nebulizer therapy for relief of acute bronchial obstruction syndrome in children with exacerbation of recurrent bronchitis or bronchial asthma. Materials and methods. 52 children of school age with acute bronchial hyperactivity (recurrent bronchitis – 28, bronchial asthma – 24) were examined. Two groups were formed by randomization: the main group (27 children) and the control group (25 children). Both groups were representative by sex, age, nosological diagnosis and severity of the disease. All children received basic therapy with topical glucocorticosteroids by nebulization. Children of the main group received intensive treatment by salbutamol inhalation during the first treatment day, and on 2–5 days as in the control group only 3 times a day. Children of the control group received inhalations together with intravenous drip infusions of euphyllin and dexamethasone. Results. In both groups, there was a dynamic regression of cough and sputum excretion, but in the main group, the rate of disappearance of cough by the 5th day of treatment was 3 times, and by the 10th day – 2,3 times higher, than in the control (p &lt; 0.05); the rate of disappearance of sputum within 10 days is 1,7 times higher, respectively (p &lt;0.05). Positive changes were confirmed by an auscultative pattern, the normalization of which occurred earlier for 1 week in patients receiving intensive nebulization bronchodilator therapy during the first day of the treatment. Conclusions. Competent use of nebulizers allows to increase the effectiveness of treatment of children with acute bronchial obstructive syndrome. Early relief of bronchospasm promotes faster normalization of inspiratory flow and respiration recovery. As a result, the terms of recovery and length of stay of children in the hospital are shortened.

Influence of different doses of interferon atomization inhalation on the short-term clinical efficacy, lung function and adverse effects in children with bronchiolitis

Objective To investigate the influence of conventional and high dose of interferon atomization inhalation on the short-term clinical efficacy, lung function and adverse effects of children with bronchiolitis. Methods 160 children with bronchiolitis were chosen and randomly divided into two groups, 80 cases in each group.On the basis of salbutamol inhalation, A group was given recombinant interferon α-2b for 200 000 IU·kg-1·d-1, and B group was given recombinant interferon α-2b for 400 000 IU·kg-1·d-1.The short-term clinical efficacy, the disappeared time of symptoms and signs, the hospital staying time, the disease severity score, the levels of RR and SpO2 before and after treatment and the incidence of adverse effects were compared between the two groups. Results The excellence effects and total clinical effects of B group were significantly higher than those of A group(χ2=7.27, P 0.05). Conclusion Compared with conventional dose of interferon, high dose interferon atomization inhalation in the treatment of children with bronchiolitis can effectively higher the disease control effects, speed up the disease rehabilitation process, improve the pulmonary ventilation function and without aggravate drug adverse reactions. Key words: Interferon; Dose; Atomization inhalation; Children with bronchiolitis

Influence of inhaled budesonide and salbutamol on oxidative stress and serum inflammatory cytokines in children with bronchial asthma

Objective To observe the clinical effect of budesonide combined with salbutamol in the treatment of children with bronchial asthma, and its influence on oxidative stress and serum interleukin-2(IL-2), soluble IL-2 receptor (sIL-2r) levels. Methods 70 children with bronchial asthma were divided into observation group and control group according to the different treatment, 35 cases in each group.The observation group was inhaled budesonide combined with salbutamol, the control group was given salbutamol inhalation therapy.The clinical efficacy of the two groups was observed, and the changes of serum oxidative stress factor, IL-2 and sIL-2r levels before and after treatment in the two groups were compared. Results In the observation group, 20 cases were cured, 7 cases were markedly effective, effective in 5 cases, the total effective rate was 94.3%.In the control group, 17 cases were cured, 6 cases were markedly effective, effective in 4 cases, the total effective rate was 77.1%.The total effective rate between the two groups had statistically significant difference(χ2=26.543, P<0.05). After treatment, the malondialdehyde (MDA), end products(AOPP) of the observation group were (16.26±1.76)U/L, (42.123±5.745)μmol/L, respectively, which were lower than those of the control group [(22.16±2.84)U/L, (63.63±6.22)μmol/L, t=23.354, 25.348, all P<0.05]. The glutathione peroxidase (GSH-PX), superoxide dismutase(SOD) of the observation group were (236.46±32.25)ng/L, (19.643±3.587)ng/L, respectively, which were higher than those of the control group [(197.43±18.42)ng/L, (18.244±2.446)ng/L, t=18.943, 15.123, all P<0.05]. The IL-2, sIL-2r levels of the observation group were (5.28±2.65)μg/L, (30.376±2.147)mg/L, respectively, which were significantly lower than those of the control group [(9.84±3.22)μg/L, (37.564±1.323)mg/L], the differences were statistically significant(t=21.378, 24.643, all P<0.05). Conclusion Inhaled budesonide combined with salbutamol in the treatment of children with bronchial asthma is helpful to control the symptoms of asthma, and can inhibit oxidative stress, reduce serum sIL-2r and IL-2 levels, it is worthy of promotion. Key words: Asthma; Administration, inhalation; Salbutamol; Budesonide; Child

Efficacy and usability of a novel nebulizer targeting both upper and lower airways

BackgroundUpper and lower airways diseases share in part their pathogenic mechanisms and frequently occur simultaneously as “United Airway Disease.” Local treatment with nebulizers delivers anti-symptomatic drugs in either the upper or the lower airways, according to the particle size generated by the nebulizer. To our knowledge, no nebulizer combines both application ways.The aim of this study is to test the efficacy and usability of a new nebulizer (OMRON A3 complete), generating aerosols with particles diameters of 2-4.5 μm, 4.5-7.5 μm or >7.5 μm, according to the user’s choice.MethodsSeventy-seven patients between 5 and 17 years of age with a diagnosis of rhinitis or asthma were examined. Oxymetazoline or Salbutamol were prescribed according to best clinical practice guidelines. Both drugs were administered through the OMRON A3 Complete nebulizer, with a particle dimension of >7.5 μm to treat nasal obstruction and 2-4.5 μm for bronchial obstruction. The efficacy of treatment was assessed by total nasal inspiratory airflow and FEV-1, Tiffeneau index (FEV1/FVC) and MMEF 25/75 respectively, 10 min before and after treatment. Symptom improvement and usability were measured by patients’ and doctors’ questionnaires.ResultsOverall, 77 patients seeking care for acute respiratory symptoms were assigned to the upper (n = 39) or lower (n = 38) airways disease group. For symptoms of the upper airways, 92% (95% CI, 77-97%) of the patients reported subjective improvement, while 87% (95% CI, 73-94%) did so for the lower airways. The average total nasal inspiratory airflow improved significantly (p = 0.030) among the patients with upper airways symptoms, from 275 ml/s (95% CI, 207-342 ml/s) to 359 ml/s (95% CI, 300-419 ml/s) after Oxymetazoline administration. All selected lung function parameters (FEV1, Tiffeneau Index and MMEF25-75) significantly improved among the patients with lower airways symptoms after inhalation of Salbutamol (p < 0.001). The nebulizer was assessed as “easy to use” by over 95% of participants in both groups.ConclusionsThe OMRON A3 efficiently delivers anti-symptomatic drugs in both upper and lower airways in a user-friendly way. This device may be useful to facilitate adherence to a complete treatment of respiratory symptoms in patients with symptoms of the so-called United Airway Disease.

Structure and functional impact of seed region variant in MIR-499 gene family in bronchial asthma

BackgroundSmall non-coding RNAs (microRNAs) have been evolved to master numerous cellular processes. Genetic variants within microRNA seed region might influence microRNA biogenesis and function. The study aimed at determining the role of microRNA-499 (MIR-499) gene family polymorphism as a marker for susceptibility and progression of bronchial asthma and to analyze the structural and functional impact of rs3746444 within the seed region.MethodsGenotyping for 192 participants (96 patients and 96 controls) in the discovery phase and 319 subjects (115 patients and 204 controls) in the replication phase was performed via Real Time-Polymerase Chain Reaction technology. Patients underwent the methacholine challenge test and biochemical analysis. Gene structural and functional analysis, target prediction, annotation clustering, and pathway enrichment analysis were executed. Predicted functional effect of rs37464443 SNP was analyzed.ResultsmiR-499 gene family is highly implicated in inflammation-related signaling pathways. Rs374644 (A > G) in MIR499A and MIR499B within the seed region could disrupt target genes and create new genes. The G variant was associated with high risk of developing asthma under all genetic association models (G versus A: OR = 3.27, 95% CI = 2.53–4.22; GG versus AA: OR = 9.52, 95% CI = 5.61–16.5; AG versus AA: OR = 2.13, 95% CI = 1.24–3.46; GG + AG versus AA: OR = 4.43, 95% CI = 2.88–6.82). GG genotype was associated with poor pre-bronchodilator FEV1 (p = 0.047) and the worst bronchodilator response after Salbutamol inhalation, represented in low peaked expiratory flow rate (p = 0.035).ConclusionsmiR-499 rs3746444 (A > G) polymorphism was associated with asthma susceptibility and bronchodilator response in Egyptian children and adolescents. Further functional analysis is warranted to develop more specific theranostic agents for selecting targeted therapy.

Efficacy of Very Low Dose Inhaled Corticosteroid And Reduction of Misuse of Antibiotics and Hospital Admission in Infants and Toddlers With Recurrent Wheezy Chest

Background: Wheeze in infants and toddlers are a common symptom and sign. Inhaled Corticosteroids are considered the most effective treatment available for long-term control of asthma or recurrent wheezing of children. The aim of the present study was to see the efficacy of very low dose inhaled Beclomethasone in reducing the misuse of antibiotics and hospital admission among the infants and toddlers with recurrent wheezing. Materials and methods: This was a prospective study done among 70 infants and toddlers of 4months to 3 years of age having a recurrent wheeze. Open -ended questionnaires were used. All patients were studied with Beclomethasone Dipropionate HFA inhaler 1puff (50 micrograms) twice daily and Salbutamol inhaler 1-2 puffs (Each puff contain 100 micrograms) 3 to 4 times daily when needed via small volume spacer with a mask. Sixty patients completed the study for total 3 months and were included in the analysis. Patients were followed up every 4 weeks interval and symptoms, use of antibiotics and need for hospital admission all were calculated. Data were analyzed by SPSS 20. Results: Among the 70 patients, persistent wheezing was present in 7.1% cases, recurrent cough was present in 21.4% cases and recurrent wheezing was present in 71.4% cases. 14.2% cases had a family history of asthma and 85.8% had no such family history. Among 60 patients those completed the study, day cough and day wheezing were reduced to 30(50%) and 5(8.3%) respectively following the first month of low dose ICS therapy. Day cough and day wheezing were reduced to 10(16.6%) and 1(1.6%) after 2 months and after 3 months these were reduced to 1(1.6%) and 0% respectively. Night cough and night wheeze were reduced to 40(66.6%) and 20(33.3%) respectively after the first month of ICS therapy. After 2nd month these were reduced to 15(25%) and 5(8.3%) and after 3rd month these were 2(3.3%) and 0% respectively. Antibiotics received before initiation of ICS therapy 100% (n=70) and after initiation of ICS therapy was 16.6% (n=60). Hospital admission rate before initiation of ICS therapy was 66.66% (n=70) and after ICS therapy was 8.33% (n=60). Both hospital admission and need of antibiotics were reduced after the initiation of low dose ICS therapy which was statistically significant (p&lt;0.01). Conclusion: Our study has shown the improvement in symptoms and also decreases the use of antibiotics and reduces the frequency of hospitalization following treatment with low dose Inhaled Corticosteroid.&#x0D; JCMCTA 2017 ; 28 (1) : 8 - 12