Salbutamol Inhalation Research Articles

Real-life acute lung function changes after lumacaftor/ivacaftor first administration in pediatric patients with cystic fibrosis

The combination of lumacaftor and ivacaftor (LUM/IVA) has been reported to induce a mean acute absolute drop of −4.1% predicted forced expiratory volume in 1s (FEV1) after a unique administration in healthy subjects. The aim of the present study was to assess acute FEV1 changes after the first dose of LUM/IVA in CF patients. A total of 32 pediatric patients were included. Respiratory manifestations occurred in only 3 patients (9.4%), but FEV1 consistently decreased (−10.4±4.6%, range: −1.5; −21.8%). FEV1 only partially resumed after salbutamol inhalation. Patients with previously known significant reversible airway obstruction and low FEV1 were more at risk of FEV1 decrease.

Small airway function before and after cold dry air challenge in pediatric asthma patients during remission.

We wanted to compare cold dry air challenge (CACh) induced changes in spirometric parameters with changes in nitrogen multiple breath washout (N2 MBW) parameters in pediatric asthma patients during clinical remission over the past year (ie, with "inactive asthma"). As N2 MBW assesses ventilation heterogeneity we expected to gain detailed information about peripheral airways contribution. In subjects with normal spirometry N2 MBW, spirometry and body plethysmography were performed at baseline, after CACh, and after salbutamol inhalation. An initial measurement of the fraction of exhaled nitric oxide (FeNO) was conducted. Forty-three (20 female) subjects, mean age 13.7 years (range 6.5-18.6) performed reproducible N2 MBW measurements. Ten were tested hyperresponsive (23.3%) and 33 normoresponsive (76.7%). Baseline spirometry and body plethysmography as well as FRC (N2 MBW) were similar in both groups. Scond (0.031 vs 0.022), Sacin (0.057 vs 0.067), and FeNO (92.0 vs 28.5 ppb) were not statistically different between hyperresponsive and nomoresponsive subjects at baseline. Subjects with airway hyperresponsiveness (AHR) showed significant increases in lung clearance index (LCI, P = 0.011) and Scond (P = 0.008) after CACh, and significant decreases after salbutamol (LCI: P = 0.005; Scond: P = 0.005). In contrast, normoresponsive subjects showed no relevant changes after CACh, and only a decrease of Scond after salbutamol (P = 0.007). There were significant correlations between the CACh induced changes in FEV1 and changes in LCI (r = -0.45, P = 0.003), Scond (r = -0.30, P = 0.047), and Sacin (r = -0.47, P = 0.008), respectively. Our study provides evidence of small airway involvement in children and adolescents with inactive asthma and airway hyperresponsiveness.

Beta2-adrenergic receptor gene haplotypes and bronchodilator response in Egyptian patients with chronic obstructive pulmonary disease

PurposeChronic obstructive pulmonary disease (COPD) is a multi-factorial disorder caused by environmental determinants and genetic risk factors. Understanding the genetic predisposition of COPD is essential to develop personalized treatment regimens. Beta2-adrenergic receptor (ADRB2) gene polymorphisms have been implicated in the pathogenesis of obstructive pulmonary diseases. This study was conducted to assess the genetic association between Arg16Gly and Gln27Glu polymorphisms and COPD in the Egyptian patients, and to analyze their impact on the clinical outcome and therapeutic response. Patients/methodsThe study population included 115 participants (61 COPD patients and 54 healthy controls) were genotyped for the Arg16Gly (rs1042713) and Gln27Glu (rs1042714) polymorphisms. Pulmonary function test was done and repeated in patients after salbutamol inhalation. ResultsThe Gly16 and Gln27 alleles represented 57% and 70% of the whole study population, and only 3 haplotypes were detected; Arg16/Gln27, Gly16/Gln27, and Gly16/Glu27. Genotypes and haplotypes homozygous for Arg16 and Gln27 were more likely to develop COPD (p<0.05). However, individuals carrying Glu27 allele conferred protection against COPD development (p=0.002). Furthermore, Arg16 genotypes and haplotypes were significantly associated with higher grades of dyspnea, more COPD symptoms and frequent exacerbations. In contrast, patients carrying Glu27 allele had better bronchial airway responsiveness to β2-agonists. ConclusionsOur findings suggested that the ADRB2 gene polymorphisms may have vital role in COPD risk, severity, and bronchodilator response among Egyptian population. Larger epidemiological studies are needed for results validation.

Immediate salbutamol responsiveness does not predict long-term benefits of indacaterol in patients with chronic obstructive pulmonary disease

BackgroundThe purpose of this study was to evaluate the correlation between immediate responsiveness with the short-acting β2-agonist salbutamol and effects of treatment with the ultra-long-acting β2-agonist indacaterol in patients with chronic obstructive pulmonary disease (COPD).MethodsThe REVERBREZ study was a phase IV, multicentre, open-label study in which patients with moderate-to-severe COPD received indacaterol 150 μg once-daily for 5 months. The primary endpoint was the correlation between immediate response of forced expiratory volume in 1 s (FEV1) post-inhalation of salbutamol (400 μg) at study entry and the change from baseline in trough FEV1 after 1 month of indacaterol. Secondary endpoints included dyspnoea measured by the modified Medical Research Council (mMRC) grade and health-related quality of life measured by the clinical COPD questionnaire (CCQ).ResultsOf the 602 patients enrolled from 177 centres in France, 543 patients received at least one indacaterol dose, 512 patients completed 1 month of indacaterol treatment (primary endpoint), and 400 patients completed 5 months of treatment. At study entry, mean FEV1 values before and after salbutamol inhalation were 1.54 ± 0.50 L and 1.65 ± 0.53 L, respectively. Based on the magnitude of an immediate response of FEV1 after salbutamol inhalation at study entry, patients were classified into reversible (Rv, ≥12% and ≥200 mL from pre-salbutamol value; n = 106) and non-reversible (NRv, <12% or <200 mL from pre-salbutamol value; n = 431) groups. After 1 month of indacaterol treatment, mean absolute and relative difference in trough FEV1 were 100 mL and 9%, respectively. No significant correlation was found between the immediate FEV1 response to salbutamol at study entry and change from baseline in trough FEV1 after 1 month of indacaterol treatment (correlation coefficient = 0.056 [95% CI;−0.032, 0.144] for absolute response and 0.028 [95% CI;−0.06, 0.116] for relative response). At all subsequent visits, mMRC and CCQ scores, and FEV1 improved from baseline with no significant difference between the Rv and NRv groups.ConclusionsImmediate FEV1 response to salbutamol did not predict the long-term benefits observed with indacaterol treatment in patients with COPD. Patients considered reversible or non-reversible to salbutamol showed comparable improvements in lung function, dyspnoea and health-related quality of life.Trial registrationClinicalTrials.gov: NCT01272362. Date: January 5, 2011

The Missing Antibody: The Pitfalls of ANCA Testing

A 44-year-old white woman presented to the hospital with acute shortness of breath while on a flight back to England from a holiday in Turkey. She denied having a productive cough, hemoptysis, or chest or calf pain. She was asthmatic, and her symptoms were improved by repeated administration of her salbutamol inhaler during the flight.

Bronchodilator response of advanced lung function parameters depending on COPD severity

BackgroundCOPD is defined as partly irreversible airflow obstruction. The response pattern of bronchodilators has not been followed in advanced lung function parameters.PurposeThe aim of this study was to investigate bronchodilator response pattern in advanced lung function parameters in a continuous fashion along forced expiratory volume in 1 second (FEV1) percent predicted (%p) in COPD patients and controls.Patients and methodsEighty-one smokers/ex-smokers (41 controls and 40 COPD) performed spirometry, body plethysmography, impulse oscillometry and single-breath helium dilution carbon monoxide diffusion at baseline, after salbutamol inhalation and then after an additional inhalation of ipratropium.ResultsMost pulmonary function parameters showed a linear increase in response to decreased FEV1%p. The subjects were divided into groups of FEV1%p <65 and >65, and the findings from continuous analysis were verified. The exceptions to this linear response were inspiratory capacity (IC), forced vital capacity (FVC), FEV1/FVC and expiratory resistance (Rex), which showed a segmented response relationship to FEV1%p. IC and FVC, with break points (BP) of 57 and 58 FEV1%p respectively, showed no response above, but an incresed slope below the BP. In addition, in patients with FEV1%p <65 and >65, response of FEV1%p did not correlate to response of volume parameters.ConclusionResponse of several advanced lung function parameters differs depending on patients’ baseline FEV1%p, and specifically response of volume parameters is most pronounced in COPD patients with FEV1%p <65. Volume and resistance responses do not follow the flow response measured with FEV1 and may thus be used as a complement to FEV1 reversibility to identify flow, volume and resistance responders.

Salbutamol effects on systemic potassium dynamics during and following intense continuous and intermittent exercise.

Salbutamol inhalation is permissible by WADA in athletic competition for asthma management and affects potassium regulation, which is vital for muscle function. Salbutamol effects on arterial potassium concentration ([K+]a) during and after high-intensity continuous exercise (HIcont) and intermittent exercise comprising repeated, brief sprints (HIint), and on performance during HIint are unknown and were investigated. Seven recreationally active men participated in a double-blind, randomised, cross-over design, inhaling 1000µg salbutamol or placebo. Participants cycled continuously for 5min at 40% [Formula: see text]O2peak and 60% [Formula: see text]O2peak, then HIcont (90s at 130% [Formula: see text]O2peak), 20min recovery, and then HIint (3 sets, 5×4s sprints), with 30min recovery. Plasma [K+]a increased throughout exercise and subsequently declined below baseline (P<0.001). Plasma [K+]a was greater during HIcont than HIint (P<0.001, HIcont 5.94±0.65 vs HIint set 1, 4.71±0.40mM); the change in [K+]a from baseline (Δ[K+]a) was 2.6-fold greater during HIcont than HIint (P<0.001). The Δ[K+] throughout the trial was less with salbutamol than placebo (P<0.001, treatment main effect, 0.03±0.67 vs 0.22±0.69mM, respectively); and remained less after correction for fluid shifts (P<0.001). The Δ[K+] during HIcont was less after salbutamol (P<0.05), but not during HIint. Blood lactate, plasma pH, and the work output during HIint did not differ between trials. Inhaled salbutamol modulated the [K+]a rise across the trial, comprising intense continuous and intermittent exercise and recovery, lowering Δ[K+] during HIcont. The limited [K+]a changes during HIint suggest that salbutamol is unlikely to influence systemic [K+] during periods of intense effort in intermittent sports.

Right Sided Aortic Arch Resembling Asthma.

Exertional dyspnoea and shortness of breath at rest are common complaints in asthmatic patients. However, symptoms sometimes do not resolve under optimal medical treatment. In such cases infrequent causes of dyspnoea may be the underlying basis. We present a 38-year-old patient who suffered from shortness of breath not amenable to medical treatment for asthma for five years. In her medical history, the patient was on salbutamol inhalation as well as budesonide/formoterol inhalation for 5 years and the symptoms did not ameliorate. We diagnosed a right sided aortic arch after investigations. In this rare anomaly, both trachea and oesophagus might be encircled and compressed by large vessels as well as the aortic arch. Although some signs of right sided aortic arch can be recognized in chest radiograph and spirometry, accurate diagnosis is made by contrast enhanced computed tomography or angiography. Delay in diagnosis of right sided aortic arch may result in unnecessary investigations and prolonged periods of ineffective treatment. Diagnosis of right sided aortic arch leads to improvement in symptoms and withdrawal of unnecessary treatment.

Iatrogenic Cushing's Syndrome in a Small Case Series of HIV Patients on Steroid Inhalation and Antiretroviral Therapies

Cushing's syndrome is uncommon in patients on therapeutic doses of inhaled steroids. We studied 2 cases of human immunodeficiency virus (HIV) infection who had a rapid onset of Cushing's syndrome secondary to fluticasone propionate interacting with their antiretroviral therapy. Case 1 is a 27-year-old woman with a history of drug addiction problems, anxiety disorder, progressive multifocal leukoencephalopathy and asthma. She presented to the emergency room following a 3-week history of frequent fluticasone inhalation for anxiety type symptoms. Her medications included Prezista, Norvir (ritonavir), fluticasone and Bactrim. Clinical findings were abdominal obesity and extensive purple striae. Laboratory results showed normal midnight salivary cortisol, low 24-hour urinary free cortisol and normal overnight dexamethasone suppression of morning cortisol. Case 2 is a 38-year-old woman with history of rapid 50-pound weight gain and painful purple striae associated with fluticasone inhaler abuse for anxiety symptoms. Other medical problems were drug addiction problems, anxiety and asthma. Her medications were Fluoxetine, Olanzapine, Montelukast, Prezista, Norvir, Truvuda, salbutamol inhaler and ranitidine. Laboratory results showed a low 24-hour urinary free cortisol and undetectable plasma adrenocorticotropic hormone (ACTH).

Inhalation of a Short-Acting β2-Adrenoreceptor Agonist Induces a Hypercoagulable State in Healthy Subjects.

BackgroundCatecholamine infusion elicits an increase in clotting factors and this increase has been attributed to stimulation of β2-adrenorecptors (β2AR). Accordingly, we tested the hypothesis that inhalation of a short-acting selective β2AR agonist can induce a procoagulant state in healthy individuals.MethodsWe recruited 23 healthy volunteers (nine females; mean age: 26±0.8 years; body mass index: 24.7±0.5 kg/m2) and randomly allocated them into two groups, the β2AR arm (seventeen subjects) and the saline arm (six subjects). Hemodynamics, plasma norepinephrine concentration, and procoagulant, anticoagulant, and fibrinolytic profiles of each participant were determined using specific assays before and after inhalation of either 2 mL nebulized normal saline or a mixture of 1 mL saline and 1 mL of salbutamol (5 mg salbutamol sulfate), a selective β2AR agonist, which were delivered by a nebulizer over ten minutes.ResultsSaline inhalation had no effect on the procoagulant, anticoagulant and fibrinolytic profiles of the six healthy volunteer in the study's saline arm. Salbutamol inhalation caused (a) a significant increase in the activity or levels of the procoagulant factors; FVIII increased by 11±3% (p = 0.04), von Willebrand factor increased by 7±1% (p = 0.03), and (b) a significant decrease in the activated partial prothrombin time from 27.4±0.4 seconds to 25.5 ±0.5 seconds (p<0.001) in the 17 volunteers in the study's β2AR arm. D-dimer and prothrombin fragments F1+2 were elevated by 200 ±90% and 505.0 ±300.0%, respectively. In addition, the activity of the anticoagulant protein C pathway (demonstrated by the protein C Global assay) decreased from 1.0±0.08 to 0.82±0.06 (p<0.001). Although plasma levels of tissue plasminogen activator decreased, all other indices of the fibrinolytic system did not change following salbutamol inhalation.ConclusionWe found that a single inhalation of salbutamol, a short-acting β2AR agonist, activates the clotting system without affecting the fibrinolytic system. This induction of a procoagulant state in healthy subjects warrants further investigation in patients treated with these agents.

Short-term cardiovascular and autonomic effects of inhaled salbutamol

Asthma independently increases the risk of developing cardiovascular disease. As inhaled β-agonists have systemic cardiovascular effects, and elevations in arterial stiffness and sympathetic nerve activity are associated with increased cardiovascular morbidity/mortality, this study examines the effect of salbutamol use on pulse wave velocity (PWV) and muscle sympathetic nervous activity (MSNA). Healthy men and women (26.2±1.5years) were recruited for: Day 1: 4 inhalations of placebo followed by 4 inhalations of salbutamol (4×100μg); Day 2: placebo only; Day 3: carotid-femoral PWV measurements before/after placebo/salbutamol. Heart rate (HR), mean arterial pressure (MAP), and carotid-radial PWV were obtained on Day 1 and 2. MSNA was obtained on Day 1. Salbutamol increased HR and total MSNA (Baseline1: 2.8±2.8au; Placebo: 2.4±2.1au; Baseline2: 2.7±3.0au; Salbutamol: 3.3±2.9au; p=0.05), with no changes in MAP or PWV. There were no effects of placebo on HR, MSNA, or PWV. Acute salbutamol use increases sympathetic activity suggesting that salbutamol could contribute to cardiovascular morbidity/mortality in individuals using inhaled β-agonists.

A cross-sectional questionnaire study of the rules governing pupils' carriage of inhalers for asthma treatment in secondary schools in North East England.

Objectives. The primary objective of this study was to assess the rules governing secondary school pupils’ carriage of inhalers for emergency treatment of asthma in the North East of England.Design. This study was based upon a postal questionnaire survey.Setting. The setting for this study was mainstream free-to-attend secondary schools which admit 16 year old pupils within the 12 Local Authority areas which make up the North East of England.Participants. All 153 schools meeting the inclusion criteria were invited to participate in the study, of which 106 (69%) took part.Main Outcome Measures. Our three main outcome measures were: whether pupils are permitted to carry inhalers on their person while at school; whether advance permission is required for pupils to carry inhalers, and from whom; and whether the school has an emergency ‘standby’ salbutamol inhaler for use in asthma emergencies, as permitted since October 2014 under recent amendments to The Human Medicines Regulations 2012.Results. Of 98 schools submitting valid responses to the question, 99% (n = 97) permitted pupils to carry inhalers on their person while at school; the remaining school stored pupils’ inhalers in a central location within the school. A total of 22% of included schools (n = 22) required parental permission before pupils were permitted to carry inhalers. Of 102 schools submitting valid responses to the question, 44% (n = 45) had purchased a ‘standby’ salbutamol inhaler for use in asthma emergencies.Conclusions. Most secondary schools in North East England permit pupils to carry inhalers on their person. The requirement in a minority of schools for parental permission to be given possibly contravenes the standard ethical practices in clinical medicine for children of this age. Only a minority of schools hold a ‘standby’ salbutamol inhaler for use in asthma emergencies. Wider availability may improve outcomes for asthma emergencies occurring in schools.

The clinical use of hypertonic saline/salbutamol in treatment of bronchiolitis

AimTo compare the efficacy of nebulised 3% saline solution (with salbutamol) or 0.9% saline solution (with salbutamol) in the treatment of mild to moderate bronchiolitis. MethodsIt was a randomised, double-blind trial. Seventy-eight children (up to 18 month of life) with mild to moderate bronchiolitis hospitalised in Pediatric Unit Hospital of Zdroje were enrolled. The infants received inhalation of salbutamol (0.15mg/kg, max. 1.5mg=1.5ml) dissolved in 3ml 3% saline – treatment group (n=41), or 3ml 0.9% saline – control group (n=37). The therapy was repeated six times daily until discharge. The duration of hospital stay and rapidity of clinical improvement were assessed. ResultsTaking the significance level specified at 0.05 into account, there were no statistically significant differences in the length of hospital stay, with 3.06±1.613 days in the treatment group and 3.11±1.634 days in the control group (p=0.43). Neither were observed statistically significant differences in clinical severity scores after 24, 48 and 72h (p24=0.192, p48=0.425, p72=0.220). The positive rate for RSV was 53%. No significant adverse events, such as bronchospasm, were observed. ConclusionsNebulised 3% saline (with salbutamol) is not superior to 0.9% (with salbutamol) in the treatment of mild to moderate bronchiolitis.

Pharmacogenetic Effects of Inhaled Salbutamol on 10-km Time Trial Performance in Competitive Male and Female Cyclists.

To determine the effects of single nucleotide polymorphisms (SNPs) in the adrenergic β2-receptor gene (ADRB2, rs1042713, and rs1042714) and epithelial Na channel gene (SCNN1A, rs2228576) on cycling performance after the inhalation of salbutamol. Randomized double-blind, mixed-model repeated measures. University Research Setting. Sixty-nine trained (maximal oxygen consumption: 62.3 ± 7.6 mL·kg·min) male and female cyclists, aged 19 to 40 years. Participants performed two 10-km time trials 60 minutes after the inhalation of 400 μg of salbutamol or placebo. Subjects were genotyped for the three SNPs (rs1042713: AA 8, AG 30 GG 31; rs1042714: CC 19, CG 35, GG 15; rs2228576: GG: 31 GA: 34 AA: 4). Forced expiratory volume in 1 second (FEV1) was assessed immediately before and 30 minutes after inhalation. Performance was measured by mean power output maintained over the duration of the time trial. There was a significant increase in FEV1 after the inhalation of salbutamol [mean (SD) = 5.68% (4.7)] compared with placebo [0.84% (2.8); P < 0.001]; however, this did not lead to an improvement in 10-km cycling time trial performance. Neither the bronchodilatory response nor the time trial performance after salbutamol was affected by genotype at any of the 3 SNPs. In cyclists, FEV1 was significantly improved after salbutamol administration regardless of genotypic variation at the ADRB2 (rs1042713 and rs1042714) and SCNN1A (rs2228576) genes. Despite this improvement in lung function, 10-km time trial performance was not altered after the inhalation of salbutamol. Our findings did not show genotype-dependent differences in bronchodilatory responses and athletic performance to inhaled salbutamol, suggesting that genotype-specific drug therapy will not improve asthmatic athletes' care nor athletic performance.

Изменения рецепторной активности β 2 -адренорецепторов Т-лимфоцитов человека под действием β 2 -агонистов

Changes in the activity of β2-adrenergic receptors of human T-lymphocytes under the effect of salbutamol (a short-acting β2-agonist) have been evaluated with a new modified radioligand method utilizing [^(125)I]cyanopindolol and a specific ligand ICI 118551. In healthy volunteers, the receptor activity decreased after 30 min upon the inhalation of salbutamol and restored to the initial level after 2 h. At the same time, there were changes in the transcription level of the ADRB2 gene, which encodes the protein component of the β2-adrenoreceptor. The dynamics of β2-adrenergic receptor activity of T-lymphocytes after salbutamol treatment in patients with cardiorespiratory pathology significantly differed from that in healthy volunteers.

Salbutamol and exercise induced inspiratory flow limitation in asthmatic children

Exercise induced bronchoconstriction (EIB) is a frequent and specific symptom of childhood asthma featured by expiratory flow limitation. A recent study showed that exercise can also induce inspiratory flow limitation, independent of EIB. The aim of this study was to investigate whether salbutamol protects against exercise induced inspiratory flow limitation in asthmatic children.Methods: The study had a prospective double-blind placebo-controlled randomized cross-over design with two exercise challenge tests preceded by the inhalation of 200µg salbutamol or placebo. Children 8-16 years old with documented exercise induced inspiratory flow limitation performed two exercise challenge tests (ECT’s) to assess EIB. EIB was defined as a fall in forced expiratory volume in 1 second (FEV1) ≥ 13% whereas inspiratory flow limitation was defined as a fall in mid inspiratory flow (MIF50) ≥ 25%. Results: 63% of the children (19/30) with exercise induced flow limitation showed an inspiratory flow limitation. Salbutamol significantly reduced the mean exercise induced fall in MIF50 in children with exercise induced inspiratory flow limitation compared to placebo (17.6% versus 24.9%, p=0.004). Conclusions: We observed a significant but inconsistent, individually variable protection of salbutamol against exercise induced inspiratory flow limitation in contrast to the consistent protective effect of salbutamol against EIB. We confirmed that a substantial number of the children with exercise induced flow limitation have an inspiratory flow limitation. Asthmatic children who experience persistent exercise induced asthmatic symptoms despite the use of (prophylactic) salbutamol, may suffer from an inspiratory flow limitation as a component of their asthma.

Co-Relation of Body Mass Index with the Prevalence and Severity of Asthma in Urban Children Aged 7-12 Years

A cross-sectional study was undertaken to assess the co-relation of BMI with the prevalence and severity of asthma in 23 school children aged 9.13 2.20 and the BMI of 16.27 3.11. Automated spirometer was used to assess the lung function tests of the children. We used mainly PEF as a guideline to make the diagnosis of asthmatic or non-asthmatic based on the spirometric results. Reversibility of airway obstruction was done by repeating spirometry after two puffs of salbutamol inhaler. The results indicate that BMI, which is a measure of body fat, has a strong co-relation with the lung function tests. A significant decrease was observed in the values of Pre-PEFR and FEV1 with an increasing BMI indicating that body fat has a bearing on the severity of asthma (p=0.001). No significant relationship was identified between % FEV1 and BMI. Per-PEFR showed a trend towards becoming significant (p=0.187). This study supports the view that there is a definite trend co-relating severity of asthma symptoms and body weight.

Different patterns of exhaled nitric oxide response to β2-agonists in asthmatic patients according to the site of bronchodilation

In asthmatic patients undergoing airway challenge, fraction of exhaled nitric oxide (FENO) levels decrease after bronchoconstriction. In contrast, model simulations have predicted both decreased and increased FENO levels after bronchodilation, depending on the site of airway obstruction relief. We sought to investigate whether β2-agonists might induce divergent effects on FENO values in asthmatic patients as a result of airway obstruction relief occurring at different lung depths. FENO, FEV1, and the slope of phase III of the single-breath washout test (S) of He (S(He)) and sulfur hexafluoride (S(SF6)) were measured in 68 asthmatic patients before and after salbutamol inhalation. S(He) and S(SF6) decreases reflected preacinar and intra-acinar obstruction relief, respectively. Changes (Δ) were expressed as a percentage from the baseline. No FENO change (|ΔFENO| ≤ 10%) was found in 16 patients (mean [SD]: 2.5% [5.2%]; ie, FENO= group); a ΔFENO value of greater than 10% was found in 23 patients (31.7% [20.3%]; ie, the FENO+ group); and a ΔFENO value of less than -10% was found in 29 patients (-31.5% [17.3%]; ie, the FENO- group). All groups had similar ΔFEV1 values. In the FENO= group neither S(He) nor S(SF6) changed, in the FENO+ group only S(He) decreased significantly (-21.8% [SD 28.5%], P = .03), and in the FENO- group both S(He) (-29.8% [24.0%], P < .001) and S(SF6) (-27.2% [23.3%], P < .001) decreased. Three FENO behaviors were observed in response to β2-agonists: a decrease likely caused by relief of an intra-acinar airway obstruction that we propose reflects amplification of nitric oxide back-diffusion, an increase likely associated with a predominant dilation up to the preacinar airways, and FENO stability when obstruction relief involved predominantly the central airways. In combination, these results suggest a new role for FENO in identifying the site of airway obstruction in asthmatic patients.

Horse Allergy: Curly Horses Allow Horse Allergic Riders To Ride Again.

To test the hypothesis that so called hypoallergenic horses (Curly horses) allow horse allergic riders to ride again, we investigated 40 horse allergic riders in a period of 37 months. Methods: We tested these patients (pts.) by skin prick test (SPT) with different non-curly and Curly horses and studied the riding hours and horse brushing by measurements of peak expiratory flow (PEF) and Tiffeneau tests (FEV1) as well as peak nasal inspiratory flow (PNIF) over 12 months. The results in 37/40 pts. showed no relevant reactions of the lower airways or nasal flow. Only in 3/40 patients an initial significant fall of FEV1 was observed, reversed by a single inhalation of salbutamol and not repeated despite further riding contact. In contrast to other allergic events (e. g. baker's asthma) a further and regular contact with these horses abolished the mild allergic reactions of the start period of contact. This may be due to hypoallergenic properties of these horses, whose test material produces weaker reactions in the SPT than that of normal horses. After a period of three years, a loss of reactivity to normal horses could be confirmed in some of the riders. Conclusion: The tested purebreed Curly horses may be a suitable alternative for horse allergic riders if the methodological precautions of this study are followed.

Planned Cesarean Delivery at Term and Adverse Outcomes in Childhood Health.

Planned cesarean delivery comprises a significant proportion of births globally, with combined rates of planned and unscheduled cesarean delivery in a number of regions approaching 50%. Observational studies have shown that offspring born by cesarean delivery are at increased risk of ill health in childhood, but these studies have been unable to adjust for some key confounding variables. Additionally, risk of death beyond the neonatal period has not yet been reported for offspring born by planned cesarean delivery. To investigate the relationship between planned cesarean delivery and offspring health problems or death in childhood. Population-based data-linkage study of 321,287 term singleton first-born offspring born in Scotland, United Kingdom, between 1993 and 2007, with follow-up until February 2015. Offspring born by planned cesarean delivery in a first pregnancy were compared with offspring born by unscheduled cesarean delivery and with offspring delivered vaginally. The primary outcome was asthma requiring hospital admission; secondary outcomes were salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, cancer, and death. Compared with offspring born by unscheduled cesarean delivery (n = 56,015 [17.4%]), those born by planned cesarean delivery (12,355 [3.8%]) were at no significantly different risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, obesity at age 5 years, inflammatory bowel disease, cancer, or death but were at increased risk of type 1 diabetes (0.66% vs 0.44%; difference, 0.22% [95% CI, 0.13%-0.31%]; adjusted hazard ratio [HR], 1.35 [95% CI, 1.05-1.75]). In comparison with children born vaginally (n = 252,917 [78.7%]), offspring born by planned cesarean delivery were at increased risk of asthma requiring hospital admission (3.73% vs 3.41%; difference, 0.32% [95% CI, 0.21%-0.42%]; adjusted HR, 1.22 [95% CI, 1.11-1.34]), salbutamol inhaler prescription at age 5 years (10.34% vs 9.62%; difference, 0.72% [95% CI, 0.36%-1.07%]; adjusted HR, 1.13 [95% CI, 1.01-1.26]), and death (0.40% vs 0.32%; difference, 0.08% [95% CI, 0.02%-1.00%]; adjusted HR, 1.41 [95% CI, 1.05-1.90]), whereas there were no significant differences in risk of obesity at age 5 years, inflammatory bowel disease, type 1 diabetes, or cancer. Among offspring of women with first births in Scotland between 1993 and 2007, planned cesarean delivery compared with vaginal delivery (but not compared with unscheduled cesarean delivery) was associated with a small absolute increased risk of asthma requiring hospital admission, salbutamol inhaler prescription at age 5 years, and all-cause death by age 21 years. Further investigation is needed to understand whether the observed associations are causal.