1,721,119 research outputs found
Farmaci antiaalergici II: Steroidi per uso inalatorio nella terapia dell'asma in eta' pediatrica.
No full textFarmaci antiaalergici II: Steroidi per uso inalatorio nella terapia dell'asma in eta' pediatrica
Asthma and obesity in childhood: on the road ahead
No full textEpidemiological data show a link between asthma and obesity, suggesting many different mechanisms that may underlie the association. However, diagnosis of asthma is often self-reported by patients or caregivers. Definition of asthma is crucial, particularly in childhood. Obesity can be associated with symptoms commonly attributed to asthma, such as wheezing, dyspnoea and sleep apnoea. Obese subjects are less fit and may have more frequent bouts of breathlessness on exertion accompanied by an exaggerated symptom perception. Therefore, the link between the two diseases should be analysed by focusing not only on reported diagnosis of asthma but also on objective markers that can better characterize the asthma phenotype. These markers should include lung function parameters, bronchial hyper-reactivity, atopic sensitization and indices of lung inflammation. As we look back and move forward, a multidisciplinary approach is increasingly necessary to understand the complexity of obesity and asthma, keeping in mind that diet and exercise could influence both diagnosis and treatment. In the meantime, in clinical settings, physicians should be cautious about diagnosing asthma in obese children on the basis of self-reported symptoms alone and should confirm the diagnosis by using objective measurements and marker evaluations that can better identify asthma phenotype and exclude overdiagnosis
Effective desensitization to imiglucerase in a patient with type I Gaucher disease.
No full textWe describe a child who had anaphylactic hypersensitivity to imiglucerase therapy
for Gaucher disease. Treatment was stopped and symptoms returned. After immune
desensitization to imiglucerase using a rush protocol, the patient was able to
resume treatment and has not had further hypersensitivity complications to date
Double-blind evaluation of effectiveness and safety of flunisolide aerosol for treatment of bronchial asthma in children.
No full textA double-blind study was carried out in 20 asthmatic children in order to
evaluate the therapeutic efficacy and safety of inhaled corticosteroid
flunisolide. 0.5 mg of the drug was administered by a jet nebulizer twice daily
for 2 months. Respiratory symptoms, pulmonary function values and methacholine
PC20-FEV1 were evaluated, as also morning cortisol levels, plasma cortisol
increase after ACTH test, and 24-h urinary cortisol excretion. The data obtained
show the efficacy of the drug in reducing symptoms. No significant difference was
observed in pulmonary function values and in bronchial reactivity results between
the two groups. No effect of flunisolide was observed on
hypothalamic-pituitary-adrenal function. This study confirms the efficacy and
safety of flunisolide (0.5 mg b.i.d.) in the treatment of asthmatic children
Preliminary study on the effect of broxaterol on bronchial hyperresponsiveness in asthmatic children: influence of allergen exposure.
No full textAbstract: Increased bronchial hyperresponsiveness (BHR) has been reported in adult asthmatic patients after regular treatment with beta2-agonists. In this study we evaluated the effect of a 4-weeks treatment period with broxaterol, a new beta2-agonist, on BHR in asthmatic children living in two different environmental conditions. Two groups of patients', 24 domiciled at sea level, allergen exposed (group 1), and 24 resident at high altitude (Misurina, 1,756 m) in an allergen-free environment (group 2), have been tested. Children were randomly treated with broxaterol 400 mug q.i.d. or sodium chromoglycate 10 mg q.i.d. (as control treatment) by the metered dose inhaler for 4 weeks. Pulmonary function tests and methacholine challenge were performed at the beginning and at the end of the study. Throughout the study period a diary card was completed and peak expiratory flow rate (PEFR) was measured three times daily. Forty-two of the patients admitted concluded the study. No significant change was observed in the methacholine PC20 throughout the study period regardless of the type of treatment and/or environment. The amplitude percentage mean of diurnal changes in PEFR during the study period showed no statistically significant differences between treatments or centres, or in the interaction of treatment with centre, time with treatment, time with centre, time with centre and treatment (p > 0.05). Therefore in this pilot study regular treatment with broxaterol for 4 weeks did not cause an increase in BHR in asthmatic children both in conditions of allergen exposure and in an environment free of offending allergens
Predictive features for persistence of atopic dermatitis in children.
No full textAllergen exposure plays an important role in atopic dermatitis (AD). Because
immunological mechanisms underlying asthma and AD have great similarities, we
evaluated whether features such as allergen sensitization, immune response,
disease severity and duration or allergen exposure could be considered predictive
for AD persistence. Seventy-one AD children (age range 14-158 months) were
enrolled and followed for 3 consecutive years for AD severity using the SCORAD
index (SI). At enrollment, reactivity to inhalant and food allergens using the
skin prick test (SPT) and house dust mite (HDM) atopy patch test (APT), and HDM
allergens in house dust were evaluated. After 3 years, 38 children outgrew their
AD (AD- group), while in 33 AD persisted (AD+ group). At enrollment, AD+ children
had a higher SI, higher rate of positivity to SPT and APT for mites (p = 0.001),
and higher environmental exposure to HDM allergens (p = 0.035). The AD+ children
developed more respiratory symptoms in comparison to AD- children (p < 0.001).
None of the AD- children presented APT positivity. In our study population,
positivity of SPT and APT for HDM, environmental allergen exposure levels and
severity of the disease at enrollment presented a significant predictive power
towards AD persistence. Subjects with positive skin reactivity to HDM should be
considered at risk of AD persistence and of possible development of allergic
respiratory disorders
Low-density areas on high-resolution computed tomograms in chronic pediatric asthma
No full textObjective: In children with chronic persistent asthma, we evaluated whether the presence of increased residual volume (RV) after anti-inflammatory treatment correlates with the detection of low-density areas on high-resolution computed tomography (HRCT), similar to those in emphysema. Methods: Children with a confirmed diagnosis of asthma (n = 32) were enrolled in a prospective study. All patients had reduction of airflow in the peripheral airways, increased RV and increased serum eosinophil cationic protein (ECP) values indicating airway inflammation. All the children were treated with salmeterol (50 mug twice daily) and fluticasone (250 mug twice daily) for a 3-month period. Results: At the end of treatment, peripheral eosinophil counts, serum ECP, forced expiratory volume in 1 second (FEV1), mean forced expiratory flow during the middle half of forced vital capacity (FEF25-76), RV, and total lung capacity values improved in all the patients. HRCT was normal in 22 children (68.8%); in the remaining 10 subjects, low-density areas were found despite normalization of FEV1, FEF25-75, and significant reduction in ECP. A significant correlation was found between persistence of RV values > 150% predicted and the presence of low-density areas on HRCT (r = 0.84, P < .0001). Conclusions: Structural changes similar to emphysema are also present in asthmatic children. Our findings suggest that the persistence of increased RV may be used to identify subjects with low-density areas on HRCT. (J Pediatr 2002;141:104-8)
Double-blind trial of house-dust mite immunotherapy in asthmatic children resident at high altitude.
No full textTwenty-three Dermatophagoides pteronyssinus (Dpt)-sensitive asthmatic children
aged 7-14 years entered a double-blind, placebo-controlled trial of standardized
immunotherapy (IT) (Alpare) while resident at high altitude. Dpt sensitivity was
evaluated by skin prick tests at different allergen concentrations at the
enrollment and after 6 and 12 months of treatment. Bronchial hyperreactivity was
evaluated at the same time points, and on each occasion, histamine challenge and,
the following day, Dpt bronchial challenge were performed. All patients,
irrespective of active treatment, improved clinically and in lung function with
increased PC20 and Dpt-PD20. Alpare-treated patients had a significantly
decreased sensitivity on Dpt skin testing (P < 0.009) and felt that their asthma
had improved (P < 0.001) compared with placebo-treated subjects, but there was no
difference between the treatment groups in lung function or bronchial challenge
response. IT neither increased nor decreased bronchial histamine sensitivity. Our
results indicate that Dpt IT benefits asthmatic children, but improvement by
allergen avoidance at high altitude is even greater
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