176 research outputs found
Long-term intervention in childhood asthma
In this thesis we first describe what is known from the literature on the effect of
asthma drugs on airway responsiveness to histamine and methacholine (Chapter
II).
Chapter Ill describes the results of an acute effect study of an inhaled corticosteroid
on AHR (sensitivity) to methacholine.
In Chapter IV a study in children in which the effect of an inhaled corticosteroid was
compared with the effect of a beta,-agonist on airway caliber, airway
responsiveness to methacholine and symptoms during a period of 6 months is
described.
Chapter V describes the results of the first part of the multicenter study, in which
the effect of long-term treatment with an inhaled beta,-agonist plus an inhaled
corticosteroid was compared with the effect of an inhaled beta,-agonist-only on
clinical endpoints, airway caliber, bronchodilator response and airway
responsiveness to histamine. This part had to be discontinued after a median
treatment period of 22 months because of the high withdrawal rate in the beta,agonist-
only group.
The second part of the study was concerned with the continuation of the patients
on beta,-agonist plus inhaled corticosteroid up to 28 to 36 months after
randomization, in which the further course of endpoints was studied and the
remission rate was evaluated. The results are described in Chapter VI.
The third part deals with the effect of cessation of inhaled corticosteroid in those
children on inhaled corticosteroid who had a follow-up of at least 28 months on
July 1, 1991 (Chapter VII)
Training for the future
Aim The aim of this prospective study was to examine the association between behavioural problems and medical and psychological outcomes in clinically treated children and adolescents with asthma. Methods Patients (n=134) were recruited from two high-altitude asthma clinics in Switzerland and one asthma clinic in the Netherlands. Outcome measures were Asthma Control Test (ACT), Paediatric Asthma Quality of Life Questionnaire (PAQLQ(S)), forced expiratory volume in 1sec (FEV1) and fractional concentration of exhaled nitric oxide (FeNO). Parents completed the Child Behaviour Checklist (CBCL) (predictor variable). Data were collected at the start and end of treatment. Multiple regression analysis was used while adjusting for demographic variables, clinic and length of stay. Results More severe internalizing behavioural problems were associated with less improvement of total quality of life (t=2.26, p=0.03) and the domains symptoms (t=2.04, p=0.04) and emotions (t=2.3, p=0.02) after clinical treatment. Behavioural problems were not associated with a change of lung function measurements (FEV1 and FeNO) and asthma control (ACT) during treatment. Conclusion A focus of healthcare professionals on the treatment of internalizing behavioural problems may optimize the quality of life in clinically treated youth with asthma
Inhaled corticosteroids and growth of airway function in asthmatic children
Airway inflammation and remodelling play an important role in the
pathophysiology of asthma. Remodelling may affect childhood lung function,
and this process may be reversed by anti-inflammatory treatment. The
current study assessed longitudinally whether asthma affects growth of
airway function relative to airspaces, and if so whether this is redressed
by inhaled corticosteroids (ICS). Every 4 months for up to 3 yrs, lung
function was assessed in 54 asthmatic children (initial age 7-16 yrs), who
inhaled 0.2 mg salbutamol t.i.d. and 0.2 mg budesonide t.i.d.
(beta2-agonist (BA)+ICS), or placebo (PL) t.i.d. (BA+PL) in a randomised,
double-blind design. Measurements were carried out before and after
maximal bronchodilation. Airway growth was assessed from the change of
forced expiratory volume in one second and of maximal expiratory flows (at
60% and 40% of total lung capacity (TLC) remaining in the lung) relative
to TLC, as measures of more central, intermediate and more peripheral
airways. Growth patterns were compared with the longitudinal findings in
376 healthy children. Airway patency after maximal bronchodilation in
patients on BA+PL remained reduced compared to healthy subjects, whereas
in patients on BA+ICS a marked improvement was observed to subnormal. No
differences between patients and controls could be demonstrated for growth
patterns of central and intermediate airway function. Compliance with
BA+ICS was 75% of the prescribed dose, resulting in significant, sustained
improvement of symptoms and postbronchodilator calibre of central and
intermediate airways to subnormal within 2 months, but postbronchodilator
small airway patency remained reduced, though improved compared to
patients on BA+PL. Anti-inflammatory treatment of asthmatic children is
associated with normal functional development of central and intermediate
airways. The persistently reduced postbronchodilator patency of peripheral
airways may reflect remodelling, or insufficient anti-inflammatory
treatment
Excessive body weight is associated with additional loss of quality of life in children with asthma
Inhaled corticosteroids in childhood asthma: the story continues
Inhaled corticosteroids (ICS) are the most effective anti-inflammatory drugs for the treatment of persistent asthma in children. Treatment with ICS decreases asthma mortality and morbidity, reduces symptoms, improves lung function, reduces bronchial hyperresponsiveness and reduces the number of exacerbations. The efficacy of ICS in preschool wheezing is controversial. A recent task force from the European Respiratory Society on preschool wheeze defined two different phenotypes: episodic viral wheeze, wheeze that occurs only during respiratory viral infections, and multiple-trigger wheeze, where wheeze also occurs in between viral episodes. Treatment with ICS appears to be more efficacious in the latter phenotype. Small particle ICS may offer a potential benefit in preschool children because of the favourable spray characteristics. However, the efficacy of small particle ICS in preschool children has not yet been evaluated in prospective clinical trials. The use of ICS in school children with asthma is safe with regard to systemic side effects on the hypothalamic–pituitary–adrenal axis, growth and bone metabolism, when used in low to medium doses. Although safety data in wheezing preschoolers is limited, the data are reassuring. Also for this age group, adverse events tend to be minimal when the ICS is used in appropriate doses
Peak flow variation in childhood asthma: correlation with symptoms, airways obstruction, and hyperresponsiveness during long term treatment with inhaled corticosteroids
Background-Guidelines for asthma management focus on treatment with inhaled corticosteroids and on home recording of peak expiratory flow (PEF). The effect of maintenance treatment with inhaled corticosteroids on PEF variation and its relation to other parameters of disease activity were examined in 102 asthmatic children aged 7-14 years. Methods-During 20 months of treatment with inhaled salbutamol, with or without inhaled budesonide (600 mu g daily), forced expiratory volume in one second (FEV1), the dose of histamine required to provoke a fall in FEV1 of more than 20% (PD20), the percentage of symptom free days, and PEF variation were assessed bimonthly. PEF variation was computed as the lowest PEF as a percentage of the highest PEF occurring over 14 days, the usual way of expressing PEF variation in asthma selfmanagement plans. For each patient using inhaled corticosteroids within subject correlation coefficients (rho) were computed of PEF variation to the percentage of symptom free days, FEV1, and PD20. Results-PEF variation decreased significantly during the first two months of treatment with inhaled corticosteroids and then remained stable. The same pattern was observed for symptoms and FEV1. In contrast, PD20 histamine continued to improve throughout the whole follow up period. In individual patients predominantly positive associations of PEF variation with symptoms, FEV1, and PD20 were found, but the ranges of these associations were wide. Conclusions-During treatment with inhaled corticosteroids the changes in PEF variation over time show poor concordance with changes in other parameters of asthma severity. When only PEF is monitored, clinically relevant deteriorations in symptoms, FEV1, or PD20 may be missed. This suggests that home recording of PEF alone may not be sufficient to monitor asthma severity reliably in children
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