China
Africa
Explore chapters and articles related to this topic
Antiasthma Agents during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
One of the first-lines therapies, beclomethasone (a synthetic glucocorticoid) is given by inhalation for bronchial asthma (ACOG, 2008). Hospital readmissions for asthma decreased 55 percent in pregnant women using inhaled beclomethasone (Wendel et al., 1996). Animal models have found an increased frequency of cleft in rodents models with steroids used in pregnancy for asthma, including, beclomethasone (Esaki et al., 1976; Furuhashi et al., 1977; Nomura et al., 1977; Tamagawa et al., 1982). However, beclomethasone was not associated with an increased frequency of congenital anomalies in 395 infants exposed to this class of drug (beclomethasone, budesonide, flunisolide, fluticasone, triamcinolone) during the first trimester (Rosa, personal communication, cited in Briggs et al., 2017; Schatz, 2001). In one prospective study of this agent in pregnancy, it was not associated with an increase in the frequency of malformations in 45 pregnancies in 40 women (Greenberger and Patterson, 1983). Among 277 infants whose mothers used beclomethasone during the first trimester, the frequency of congenital anomalies was not increased (Nemazy et al., 2004). A review that included more than 1000 first trimester exposed pregnancies, the frequency of malformations was not increased (de Aguiar et al., 2014). The frequency of birth defects was not increased among 200 infants whose mothers used beclomethasone during embryogenesis in the Swedish Birth Defects Registry (Kallen, 2019).
Respiratory disorders
Published in Anne Lee, Sally Inch, David Finnigan, Therapeutics in Pregnancy and Lactation, 2019
There are several steroids for intranasal use formulated as sprays (beclomethasone, budesonide, flunisolide, fluticasone) or drops (betamethasone). Beclomethasone is available from pharmacies without prescription. These are probably the agents of choice for prophylaxis, particularly when symptoms affect only the nose. Intranasal cromoglycate is an alternative but it is believed to be less effective than a topical steroid. None of these agents are likely to pose a significant risk during pregnancy.
Allergic Rhinitis
Published in John C Watkinson, Raymond W Clarke, Louise Jayne Clark, Adam J Donne, R James A England, Hisham M Mehanna, Gerald William McGarry, Sean Carrie, Basic Sciences Endocrine Surgery Rhinology, 2018
The treatment algorithm is similar to that for adults but it may be more difficult to get a child to use a nasal spray. As many of these children also have asthma, however, they may be used to using an inhaler. Oral non-sedating antihistamines are the standard first-line treatment but a trial of a leukotriene receptor antagonist should also be considered if a nasal spray is not tolerated or if the steroid load is excessive. Fluticasone (from 4 years old) and mometasone and triamcinolone (from 6 years old) have low systemic bioavailability and are the steroids of choice.89 As with adults depot steroids are not recommended. Growth should be monitored if the child is already using steroids (such as an inhaled steroid for asthma or steroid creams for eczema) although there is no evidence of an effect on the hypothalamic-pituitary-adrenal axis with normal doses.90 Beclometasone has been associated with growth retardation and is not recommended for children.58 SCIT is generally not recommended for children under 5 years, though SLIT may be used increasingly in the future. Its efficacy in young children is, however, still uncertain.73,91
Defined daily dose definition in medication adherence assessment in asthma
Published in European Clinical Respiratory Journal, 2023
Päivi Saukkosalmi, Hannu Kankaanranta, Iida Vähätalo, Lauri Sillanmäki, Markku Sumanen
All ICS dispensed during 2011 in the SII register were collected. The total amount of both ICS alone as well as combined to long-acting β2-agonists were calculated for each asthma patient. This has been done even in cases where the corticosteroid used might have changed during the year. To estimate adherence to ICS, the proportion of days covered (PDC) over one year was calculated for every patient. In the current study adherence refers to PDC and good adherence was considered when PDC was at least 80%. As a reference dosing for PDC calculation we used four different options. Firstly, the ATC/DDD system of WHO was used to define daily doses for the pure ICS products (later: WHO DDD) as well as for the ICS in the unit doses of combination inhalers (later: Modified WHO DDD) (Table 1). Secondly, as WHO DDDs are not indicated in the treatment guidelines, for comparison, we used daily doses based on moderate dose range of ICS recommended in GINA report [8] by using the lower and upper limit of medium doses. National current care guideline [22] was used for beclomethasone powder dose, because it was not available in GINA report. The different daily ICS doses for available inhalers are shown in Table 1.
A step-down experience in asthma treatment: a retrospective cohort study
Published in Journal of Asthma, 2022
Betül Özdel Öztürk, Zeynep Çelebi Sözener, Ömür Aydin, Dilsad Mungan
Step down attempts were applied to the patients with well controlled asthma according to decision of the physician at the visit. The number of step-down attempts was noted for each patient. We named the concept of step-down in the treatment in two different ways. First, if the attempt to reduce beclomethasone equivalent ICS dose resulted in a reduction in the treatment step, this was defined as step-down. However, if it did not cause a change in the treatment step, the decrease in the dose of beclomethasone equivalent ICS was defined as in-step dose reduction (Table 1). The step-down attempt was considered successful if the descending step was maintained or a lower step was reached at the last visit. However, if the treatment step was increased at any time between the day of step-down attempt and the last visit, it was considered unsuccessful.
Detecting asthma exacerbations using daily home monitoring and machine learning
Published in Journal of Asthma, 2021
Olivier Zhang, Leandro L. Minku, Sherif Gonem
We utilized a large dataset of daily PEF and symptom scores which were recorded by participants in the SAKURA study (NCT00839800), an international multicentre randomized controlled trial comparing budesonide/formoterol as maintenance and reliever therapy versus budesonide/formoterol maintenance plus terbutaline as reliever, in patients age ≥ 16 years with persistent asthma (10). Eligibility criteria included a documented history of persistent asthma for at least 6 months, reversible airway obstruction (increase in forced expiratory volume in one second [FEV1] of at least 12% relative to baseline with administration of a bronchodilator), use of maintenance inhaled corticosteroids (ICS) for at least 3 months before study entry, and having at least one asthma exacerbation in the 12 months prior to study entry. Current or previous smokers with a smoking history of ≥ 10 pack years were excluded. The study population had a mean age of 46 years with 68% being female. The mean beclometasone dipropionate equivalent ICS dose at study entry was 1023 µg/day, and 62% of patients were using long-acting β2 agonists at study entry. The mean baseline FEV1 was 70% predicted, with mean reversibility following administration of a bronchodilator of 23%.