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Respiratory, endocrine, cardiac, and renal topics
Published in Evelyne Jacqz-Aigrain, Imti Choonara, Paediatric Clinical Pharmacology, 2021
Evelyne Jacqz-Aigrain, Imti Choonara
Inhaled drugs are preferred because of their high therapeutic-toxic ratio, i.e. high concentrations of drug are delivered directly to the airways, with potent therapeutic effects and few systemic side effects. Several systems for inhalation exist: metered dose inhaler, dry powder inhaler or nebuliser. The use of a spacer, which facilitates the use of a metered dose inhaler, increases the deposition and decreases the side effects. For these reasons, a spacer is the treatment of choice in children below the age of 4 years. In infants and young children a spacer with a mask is indicated. Several factors will guide the choice of a spacer. Spacer and metered dose inhaler should fit properly, but also the mask or mouth piece should fit to the child. The volume of the spacer should be adapted to the lung volume of the patient and the child should be capable of moving the valves of the spacer. For children aged from 4 to 6 years, dry powder inhalers can be used, depending on the cooperation and inspiratory effort of the child. During attacks, since inspiratory effort is decreased, bronchodilators can be administered using metered dose inhaler and spacer, or using a nebuliser.
Asthma and COPD
Published in Pudupakkam K Vedanthan, Harold S Nelson, Shripad N Agashe, PA Mahesh, Rohit Katial, Textbook of Allergy for the Clinician, 2021
Balamugesh Thangakunam, Devasahayam J Christopher
One of the goals of treatment in asthma is to minimize persistent airflow limitation (GINAsthma 2011). In COPD, normalization of pulmonary function is not possible and the goal is adequate symptom control (COPDGold 2019). Inflammation in asthma is usually steroid responsive; hence inhaled steroids are the cornerstone of treatment for all stages of persistent asthma-except mild intermittent asthma (Berger and Smith 1988). Regular bronchodilators are prescribed only when symptoms are not controlled with inhaled corticosteroids. In COPD, the inflammation is not so steroid responsive, hence the first line of treatment is usually an inhaled bronchodilator. However, there is evidence of usefulness of inhaled steroids in moderate to very severe COPD and in those with recurrent exacerbations (COPDGold 2019). Regular treatment with inhaled steroids in such patients; improves symptoms, lung function and quality of life and reduces the frequency of exacerbations (Jones 2003, Mahler et al. 2002, Szafranski et al. 2003). However, they may not prevent the long-term decline in lung function or improve mortality (Drummond et al. 2008).
Low-Dose Naltrexone
Published in Sahar Swidan, Matthew Bennett, Advanced Therapeutics in Pain Medicine, 2020
Chronic obstructive pulmonary disease is a preventable and manageable disease that is not fully reversible due to destruction of the tissues in the airway. Major inflammatory cells involved in the pathology of COPD include TNFα, ILs, and leukotrienes. Bronchodilators are the mainstay of treatment for COPD and help reduce symptoms as well as improve quality of life. However, they may not slow the progression of the disease. Acute exacerbations of COPD increase disease progression and mortality. There is limited research on COPD exacerbations, but it is known that inflammatory mediators are present in sputum collected from patients who are experiencing an acute exacerbation. Low-dose naltrexone has shown to be effective at mediating inflammatory markers such as TNFα and ILs, so there may be a benefit to LDN therapy in either symptom management and/or prevention of acute exacerbations. COPD is the fourth leading cause of death in the U.S. and the only leading cause to increase in incidence over the past 30 years. Research into the impact of LDN on COPD mortality and morbidity would be invaluable.
Airwave oscillometry and spirometry in children with asthma or wheeze
Published in Journal of Asthma, 2023
Shannon Gunawardana, Mark Tuazon, Lorna Wheatley, James Cook, Christopher Harris, Anne Greenough
Eight children (17%) had a positive bronchodilator response as determined by the results of spirometry. They had a median age of 8.75 years (6.8–16.9 years). The eight children had median changes in R5 of −36% (range: −30% to −50%) and in X5 of 39% (15%–54%). Only three children (6.4%) had a positive bronchodilator response as assessed by AOS using the ERS definition. All three children had positive bronchodilator responses as assessed by spirometry. The bronchodilator ΔR5 correlated with ΔFEV1 (p < 0.001, r = −0.574), ΔFEV1/FVC (p < 0.001, r = 0.–0.577), and ΔFEF75 (p = 0.015, r = −0.424). The bronchodilator ΔAX correlated with ΔFEV1 (p = 0.003, r = −0.512), ΔFEV1/FVC (p = 0.005, r = 0.–0.487), and ΔFEF75 (p = 0.034, r = −0.376; Table 3).
Managing hospitalized patients with a COPD exacerbation: the role of hospitalists and the multidisciplinary team
Published in Postgraduate Medicine, 2022
Alpesh N. Amin, Sharon Cornelison, J. Andrew Woods, Nicola A. Hanania
Three groups of medications most commonly used for COPD exacerbations are bronchodilators, corticosteroids, and antibiotics [1]. Short-acting β2-agonists, with or without short-acting muscarinic antagonists, are recommended for the initial management of a COPD exacerbation [1]. To achieve optimal outcomes during hospitalization, delivery of bronchodilator treatment with a nebulizer or a metered-dose inhaler with spacer may be the most appropriate options. Hospitalists should determine whether the patient has been using other COPD medications at home and whether these should be continued during the hospital setting. Such medications may include maintenance treatments for COPD such as long-acting β2-agonists (LABAs), long-acting muscarinic antagonists (LAMAs), LABA/inhaled corticosteroid (ICS) combinations, theophylline, and oral phosphodisterase-4 inhibitors [1]. However, clinical studies evaluating the usefulness of long-acting bronchodilators for the treatment of patients during a COPD exacerbation have demonstrated limited efficacy and increased costs [40,41]. Thus, hospitalists should consider if these treatments are appropriate in an acute setting. Furthermore, The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report recommends initiating long-acting bronchodilators as soon as possible, prior to hospital discharge [1].
Contemporary management and treatment strategies for asthma during pregnancy
Published in Expert Review of Respiratory Medicine, 2021
Jennifer A. Namazy, Michael Schatz
First patented in 1972, albuterol is one of the most commonly used asthma medications. Although these are a lot of reassuring data, there is still some question regarding its safety. Lin et al [72,73] using data from the US multicenter case-control study of the National Birth Defects Prevention Study, reported the use of bronchodilators to be associated with an increased risk of esophageal atresia among infants (OR, 2.39; 95% confidence interval (CI), 1.23 to 4.66). Another cohort study involving 4558 women [74], there was an increased risk of cardiac defects exposed to bronchodilators during pregnancy (OR, 1.4; 95% CI, 1.1 to 1.7). However, the observations in both of these studies may be a result of confounding. Asthma exacerbations may be associated with both increased use of bronchodilators and congenital malformations.