Efficacy and side effects of beta(2)-agonists by inhaled route in acute asthma in children: Comparison of salbutamol, terbutaline, and fenoterol

Thirty-seven separate episodes of acute bronchial asthma were studied in 21 asthmatic children. the bronchodilator, cardiovascular, and tremorigenic responses following administration of salbutamol (SAL), terbutaline (TER) and fenoterol (FEN) by closed-port intermittent nebulization were compared for a period of 8 hr. SAL was used at the maximum dose recommended by the manufacturer and TER and FEN at the average doses commonly used in children. Eleven acute attacks were treated with SAL, 12 with TER, and 14 with FEN. Pulmonary function was evaluated by clinical assessment and by the spirometric indices FEV(1) and FEF(25-75). Tremor was objectively measured, as well as heart rate (HR), respiratory rate, and blood pressure. the onset of bronchodilating effect occurred at 5 min for all three drugs and there were no differences in intensity and duration of bronchodilation between drugs. ALl three drugs caused rapid onset of tremor (5 min) and this tended to be more intense with SAL. There was a slight decrease in HR in the TER group, whereas SAL and FEN caused increase in HR, with mean values significantly greater than in the TER group from 5 to 30 min after drug administration. Our results indicate that the three short-acting beta(2)-agonists studied are equally effective in treatment of acute bronchospasm by the inhaled route in children, in the doses used. Our findings imply that a dose of SAL twice as great as that commonly used by nebulization in children is equipotent to those usually employed for TER and FEN, as far as therapeutic effect is concerned, but it could generate more intense tremorigenic and tachycardic side effects.Universidade Federal de São Paulo,DEPT PEDIAT,DIV RHEUMATOL ALLERGY & CLIN IMMUNOL,São Paulo,BRAZILUniversidade Federal de São Paulo,DEPT PEDIAT,DIV RHEUMATOL ALLERGY & CLIN IMMUNOL,São Paulo,BRAZILWeb of Scienc

Environmental prevention in atopic eczema dermatitis syndrome (AEDS) and asthma: avoidance of indoor allergens

Indoor allergens represent an important precipitating factor for both asthma and atopic eczema dermatitis syndromes (AEDS). There is also accumulating evi- dence that sensitization to those allergens is associated with the onset of atopic disorders. Patients with AEDS present aeroallergen-specific T-cell responses associated with worsening of symptoms when exposed to specific aeroallergens. Furthermore, application of indoor allergens to the skin of patient with AEDS induces a local eczematous response in one-third of these patients. Exposure to high concentrations of mite allergens in early infancy have been demonstrated to be a risk factor for developing atopic dermatitis during the first 3 years of life. Moreover, a clear dose—response relationship has been documented between mite exposure and disease activity. Primary prevention of AEDS by avoiding indoor allergen exposure has been proved to be effective only when allergenic foods have also been avoided. Mite allergen avoidance in infants with AEDS and food allergy may however, prevent mite sensitization and the onset of asthma. Indoor allergen avoidance has been demonstrated to be eiiective in the majority of studies performed in patients with established AEDS. Negative results may be explained either by individual susceptibility variation. by long duration of dis- ease with the consequent irreversible pathological changes in the target tissue or by exposure to allergens outside the house. Education of the patients and public consciousness of the problems are crucial for the eiiicacy of indoor allergen avoidance in allergic diseases