Kinesitherapy and Ultrahigh-Frequency Current in Children with Bronchial Asthma

The aim is to compare the effect of the combination of kinesitherapy and ultrahigh-frequency current in children with bronchial asthma with a control group without rehabilitation. There were 24 children with bronchial asthma of average age of 8 followed for 10 days. They were randomized into two groups—12 children in the “physiotherapeutic” and 12 in the “control.” All were treated with equal standard pharmacotherapy. The first group was treated also with kinesitherapy and ultrahigh-frequency current. At the beginning and end of the therapeutic course, the spirometric and anthropometric parameters were documented. In the statistical analysis were included the proportions between the actual and the expected spirometric parameters, adjusted for all anthropometric parameters. The ratios between the actual and the expected spirometric parameters improved significantly in both groups after 10-day treatment compared with before treatment (P < 0.05). In the “physiotherapeutic” group, the improvement after the treatment was significantly greater, when compared with the “control” group (P < 0.05). In conclusion, there is a significant therapeutic effect, upgrading that of pharmacotherapy when children with bronchial asthma were treated for 10 days with the combination of kinesitherapy and ultrahigh-frequency current

A real – life observational pilot study to evaluate the effects of two-week treatment with montelukast in patients with chronic cough

BACKGROUND: Different conditions make the proximal airways susceptible to tussigenic stimuli in the chronic cough (CC) syndrome. Leukotrienes can be implicated in the inflammatory mechanism at play in it. Montelukast is a selective cysteinyl-leukotriene receptor antagonist with proven effectiveness in patients with asthma. The aim of our real-life pilot study was to use montelukast to relieve cough symptoms in patients with CC allegedly due to the two frequent causes other than asthma – upper airway cough syndrome and gastroesophageal reflux (GER). METHODS: 14 consecutive patients with CC were evaluated before and after 2 weeks of treatment with montelukast 10 mg daily. Cough was assessed by validated cough questionnaire. Questionnaires regarding the presence of gastroesophageal reflux were also completed. Cough reflex sensitivity to incremental doubling concentrations of citric acid and capsaicin was measured. Lung function, airway hyperresponsiveness and exhaled breath temperature (EBT), a non-invasive marker of lower airway inflammation, were evaluated to exclude asthma as an underlying cause. Thorough upper-airway examination was also conducted. Cell counts, eosinophil cationic protein (ECP), lactoferrin, myeloperoxidase (MPO) were determined in blood to assess systemic inflammation. RESULTS: Discomfort due to cough was significantly reduced after treatment (P < 0.001). Cough threshold for capsaicin increased significantly (P = 0.001) but not for citric acid. The values of lactoferrin and ECP were significantly reduced, but those of MPO rose. EBT and pulmonary function were not significantly affected by the treatment. CONCLUSION: Patients with CC due to upper airway cough syndrome or gastroesophageal reflux (GER) but not asthma reported significant relief of their symptoms after two weeks of treatment with montelukast. ECP, lactoferrin, MPO altered significantly, highlighting their role in the pathological mechanisms in CC. Clinical trial ID at Clinicaltrials.gov is NCT01754220

Choosing the right controller for a child with asthma - not only the correct drug matters

Introduction: Current clinical evidence suggests that although contemporary inhaled therapy (main­ly inhaled corticosteroids - ICS) for asthma has the potential to control disease in most patients, con­trol is often not achieved in practice. One prominent reason for poor control is poor inhaler tech­nique, because no matter how good a drug is, it cannot be effective if it does not reach the targeted airways.Materials and methods: We present clinical cases of children with asthma who despite a proper dose and a good drug of choice (following Global Initiative for Asthma guidelines) have very bad control. One of them is a 15-year-old boy with combined ICS with Ellipta device once daily, the second child is a 3-year-old boy with pMDI (Metered Dose Inhaler `Puffer`) with improper use of spacer, the third one is a 5-year-old girl with nebulised ICS and the forth one is a 14 year old girl with pMDI. All 4 patients had a deterioration in their asthma symptoms and required multiple inpatient treatments. Changing the inhaler and a re-education of patients and mothers lead to better results.Results: A year after the intervention all 4 kids have good control without need to be re-hospitalized. The result shows the importance of the right technique. This is why doctors should spend more time explaining to the patients how to properly use their medication to achieve the best possible results.Conclusion: Inhaling medication into the lungs can be very effective - but frequently it is not. The most common reasons for patients not responding to treatment are: being given an inappropriate in­haler, not using the inhaler device properly or failing to take the medication as directed. Proper edu­cation and correct drug and inhaler choice are crucial for maintain perfect asthma control, which is the ultimate goal for all asthma specialists