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Antiasthma Agents during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Fluticasone is an inhaled corticosteroid used to treat asthma. First trimester exposure to fluticasone in 62 infants resulted in no increased frequency of congenital anomalies (Howley et al., 2020). Among 5,362 infants born to women who used fluticasone during organogenesis, the frequency of birth defects was not increased (Charlton et al., 2016). Analysis of the risk for congenital heart defects was done for fluticasone and first trimester use. Among 65 infants exposed to fluticasone, the frequency of congenital heart defects was not increased (Van Zutphen et al., 2015). The Swedish Birth Defects Registry included 946 infants whose mothers used fluticasone during embryogenesis, and the frequency of birth defects was not increased (Kallen, 2019).
Drug Targeting to the Lung: Chemical and Biochemical Considerations
Published in Anthony J. Hickey, Sandro R.P. da Rocha, Pharmaceutical Inhalation Aerosol Technology, 2019
Peter A. Crooks, Narsimha R. Penthala, Abeer M. Al-Ghananeem
Fluticasone propionate (28) and mometasone furoate (29) have both been formulated for use in asthma (Bernstein et al. 1999). Many of the adverse effects of elevated systemic glucocorticoid levels have been reduced through the use of inhalation as a method of drug delivery (Barnes et al. 1998). Inhalation therapy targets the local affected area, where it maximizes local efficacy, while reducing systemic bioavailability. Therefore, at therapeutic doses of inhaled glucocorticoids, the risk of systemic effect is considerably reduced when compared to oral glucocorticoid therapy. Mometasone furoate (29) is a synthetic glucocorticoid that is structurally similar to the adrenocorticosteroids and prednisolone. The structure was designed to optimize potency; the furoate group at position C17 greatly increases lipid solubility, while the 21-chloromoiety is important for maximum potency and topical activity (Onrust and Lamb 1998).
Acquired Laryngotracheal Stenosis
Published in John C Watkinson, Raymond W Clarke, Christopher P Aldren, Doris-Eva Bamiou, Raymond W Clarke, Richard M Irving, Haytham Kubba, Shakeel R Saeed, Paediatrics, The Ear, Skull Base, 2018
Michael J. Rutter, Alessandro de Alarcón, Catherine K. Hart
A recent observation has been the correlation between eosinophilic oesophagitis, laryngeal inflammation and a poor outcome following laryngotracheal reconstruction.4 Eosinophilic oesophagitis has a characteristic appearance on oesophagogastroduodenoscopy, with oesophageal furrows often having microscopic white plaques noted. However, the definitive diagnosis is made on biopsy, with greater than 20 eosinophils per high-power field being noted. In children with eosinophilic oesophagitis, evaluation for underlying food allergies is indicated. In children in whom a food allergy is not proven, treatment with oral fluticasone is suggested. An initial dosing regimen of 440 ¼g, sprayed on the tongue twice a day and swallowed, is usually efficacious. Follow-up oesophagoscopy with further biopsies to confirm resolution of disease is suggested prior to undertaking laryngeal reconstruction, which is usually delayed for 6 months.
Updates in the diagnosis and practical management of allergic rhinitis
Published in Expert Review of Clinical Pharmacology, 2023
Chiara Trincianti, Maria Angela Tosca, Giorgio Ciprandi
Similarly, MP-AzeFlu provided effective, rapid, and sustained symptom control in a real-life setting among 170 patients (≥12 years) from Denmark, modifying mean ± standard deviation symptom severity visual analog score (VAS) value from 67.1 ± 19.3 mm at baseline to 28.4 ± 23.7 mm on the 14 days of use [44]. Berger et al. conducted an open-label trial on children aged 4–12 years with a history of AR comparing MPAzeFlu and fluticasone propionate. MP-AzeFlu led to a more significant reduction in total symptom score, achieving in 80% of patients mild or no symptom state up to 16 days quicker than with FP. In addition, more children who received MPAzeFlu experienced mild or no symptoms throughout the study period versus FP (73.4 vs. 66.0%) [45]. These studies demonstrate that MP-AzeFlu as a combination treatment can satisfy patient needs and expectations, such as prompt relief, affecting nasal and ocular symptoms in all patient types, and helping improve patients’ adherence to therapy [46].
Small airways targeted treatment with smart nebulizer technology could improve severe asthma in children: a retrospective analysis
Published in Journal of Asthma, 2022
Wytse B. van den Bosch,, Sanne F. Kloosterman,, Eleni-Rosalina Andrinopoulou,, Rients Greidanus,, Mariëlle W. H. Pijnenburg,, Harm A. W. M. Tiddens,, Hettie M. Janssens,
Table 4 and Figure 4 show asthma medication use before, during, and after treatment with the Akita®. Before start of treatment 16 patients were using high dose ICS with a long-acting β agonist (LABA) and/or leukotriene modifier (LTRA), 14 patients were using combination inhalers (ICS/LABA) and one patient was using high dose ciclesonide without LABA/LTRA and received methylprednisolone injections. All patients administered their asthma medication using a pMDI with valved holding chamber. At the start of treatment 1 patient received budesonide 0.5 mg twice daily instead of 1 mg twice daily. For fluticasone propionate two patients received 1 mg twice daily and one patient 1 mg once daily instead of 2 mg twice daily. During treatment with the Akita® tapering of budesonide and fluticasone proprionate dose resulted in a 185.1 µg and 196.4 µg decrease respectively. After one year of treatment 5/21 patients were still using additional ICS treatment (Figure 4): 3/5 ICS monotherapy and 2/5 combination inhalers. Before initiation of treatment three patients used omalizumab but stopped because their asthma remained uncontrolled. During treatment with the Akita® one patient was on omalizumab and another patient started with omalizumab 3 months after start of treatment.
Inhaled corticosteroid prescriptions in the ED for recurrent asthma using IT clinical decision support: revisit after cessation of an incentive program
Published in Journal of Asthma, 2022
Krystal Cherney, Blake Bulloch, Cherisse Mecham, Rupali Drewek, Lucia Mirea
Eligible patients were identified by the electronic alert, which activated after a physician initiated the ED asthma protocol order. The alert activated for patients meeting the following eligibility criteria: age 4–18 years (children less than 4 years of age excluded to avoid possibly enrolling children with bronchiolitis, which is a stipulation specific to this study), two or more past ED asthma protocol orders within 365 days, and no active ICS prescription within 90 days. Patients with comorbid conditions including developmental delay, bronchopulmonary dysplasia due to prematurity, cystic fibrosis, sickle cell disease, and/or interstitial lung disease were excluded from further consideration. For each patient confirmed eligible, the alert sent an e-notification to the ED provider indicating the frequency of “ED/Urgent Care visit(s) within 1 year, with the use of ED asthma protocol order set.” Providers were instructed to: “Please consider prescribing Fluticasone MDI 110 mcg 1 puff twice a day, if the primary diagnosis is asthma (and not other causes of wheezing) AND the patient was not already on inhaled steroids AND if no contraindications.” Fluticasone was suggested based on its availability through the State Medicaid’s preferred drug list.