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Latest & greatest articles for asthma
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Preventing bronchoconstriction in exercise-induced asthma with inhaled heparin. We have previously reported that inhaled heparin prevents allergic bronchoconstriction in sheep and inhibits the anti-IgE-mediated release of histamine from mast cells in vitro. Since the release of such mediators has been implicated in exercise-induced asthma, we investigated whether inhaled heparin could also attenuate the bronchoconstrictor response in this disease.On five days we studied 12 subjects (...) with a history of exercise-induced asthma. On day 1 they underwent a standardized exercise challenge on a treadmill to document the presence of exercise-induced asthma. Minute ventilation was estimated with a calibrated respiratory inductive plethysmograph. The workload was increased until the heart rate reached 85 percent of the predicted maximal value, and was sustained for 10 minutes. The magnitude of bronchoconstriction was assessed by measuring specific airway conductance before and after the exercise
Double-blind trial of steroid tapering in acute asthma. It is customary to tail off the dose of oral steroids after treatment of an acute exacerbation of asthma; the main reason for this practice is to avoid rebound asthma. We have carried out a randomised double-blind study to find out whether a tapering course of oral prednisolone has any advantage over an abruptly terminated course of prednisolone for an episode of acute asthma requiring hospital admission. We studied 35 patients admitted (...) to hospital with acute asthma; their mean peak expiratory flow rate (PEFR) on admission was 173 L/min and their mean age was 32 years (range 18-55); all were using inhaled steroids on discharge (mean dose 908 micrograms daily). Each patient received 40 mg enteric-coated prednisolone daily for 10 days followed by a tapering course of either prednisolone 5 mg tablets (active taper) or identical placebo tablets (placebo taper), reducing from 7 tablets on day 11 to no tablets by day 18. The primary outcome
1993LancetControlled trial quality: predicted high
Interaction and dose equivalence of salbutamol and salmeterol in patients with asthma. To examine the pharmacological interaction of salmeterol and salbutamol and to derive an estimate of dose equivalence of salmeterol for airway and systemic effects in patients with asthma.Randomised double blind crossover study.12 patients with mild asthma.Placebo or salmeterol 50, 100, 200 micrograms given on separate days followed two hours later by inhaled salbutamol in cumulative doses up to 3600
Cost-effectiveness of a structured treatment and teaching programme on asthma Cost-effectiveness of a structured treatment and teaching programme on asthma Cost-effectiveness of a structured treatment and teaching programme on asthma Trautner C, Richter B, Berger M Record Status This is a critical abstract of an economic evaluation that meets the criteria for inclusion on NHS EED. Each abstract contains a brief summary of the methods, the results and conclusions followed by a detailed critical (...) assessment on the reliability of the study and the conclusions drawn. Health technology Structured treatment and teaching programme for asthma sufferers (ATTP). Type of intervention Prevention and treatment. Economic study type Cost-benefit analysis. Study population Adult patients with moderate to severe asthma. The mean age was 40 (range: 16-75) years and the median duration of asthma was 12 (range: 1-56) years.57% of the study population were employed. Setting University hospital. The economic study
Trial of cyclosporin in corticosteroid-dependent chronic severe asthma. The treatment of chronic severe asthma is unsatisfactory for many patients. In a randomised, double-blind, placebo-controlled, crossover trial we have tested whether cyclosporin, which is thought to act primarily by inhibition of T lymphocyte activation, improves lung function in corticosteroid-dependent asthmatics. After a 4-week run-in period, 33 patients with longstanding asthma (mean duration 27 years), and who had (...) than 0.004) and 17.6% in FEV1 (p less than 0.001). The frequency of disease exacerbations requiring an increased prednisolone dose was reduced by 48% in patients on cyclosporin compared with placebo (p less than 0.02). Diurnal variation in PEFR decreased by a mean of 27.6% (p = 0.04). Cyclosporin for 12 weeks was well tolerated by this group of chronic asthmatics, in whom the mean whole-blood trough concentration was 152 micrograms/l. These findings provide further evidence of a role for activated
1992LancetControlled trial quality: predicted high
Long-term effects of a long-acting beta 2-adrenoceptor agonist, salmeterol, on airway hyperresponsiveness in patients with mild asthma. Asthma is characterized by hyperresponsiveness of the airways to bronchoconstrictive stimuli. Long-acting beta 2-adrenoceptor agonists have been introduced as a new therapeutic approach, but there is growing concern about whether control of asthma may deteriorate with the regular use of these agents. We investigated the long-term effects of the beta 2 agonist (...) salmeterol on bronchodilation and on airway hyperresponsiveness to the bronchoconstrictive agent methacholine in mild asthma.In a parallel, double-blind study, 24 patients with mild asthma were randomly assigned to treatment with either inhaled salmeterol (50 micrograms, twice daily) (n = 12) or placebo (n = 12) during an eight-week trial. Methacholine challenge was performed before, during, and after the treatment period. Methacholine responsiveness was measured as the provocative concentration (PC20
Tolerance to the nonbronchodilator effects of inhaled beta 2-agonists in asthma. Tolerance to the direct bronchodilator effects of beta 2-agonists does not appear to occur in asthma. However, it is not known whether this is true for the nonbronchodilator effects of these agents, which protect the airways against bronchoconstrictive stimuli.We investigated whether tolerance develops to the protective effect of inhaled terbutaline on airway responsiveness to the bronchoconstrictors methacholine (...) (which acts directly on airway smooth muscle) and AMP (which acts indirectly by stimulating the release of mediators from mast cells) during sustained treatment with terbutaline. In a randomized, double-blind, crossover study, 12 patients with mild asthma each inhaled a single dose of terbutaline (500 micrograms) or placebo before a challenge with a series of doubling doses of inhaled methacholine or AMP, before and after treatment for seven days with 500 micrograms of terbutaline four times daily
A comparison of salmeterol with albuterol in the treatment of mild-to-moderate asthma. An effective, long-acting bronchodilator could benefit patients with asthma who have symptoms not controlled by antiinflammatory drugs. We compared a new long-acting, inhaled beta 2-adrenoceptor agonist, salmeterol, with a short-acting beta 2-agonist, albuterol, in the treatment of mild-to-moderate asthma.We randomly assigned 234 patients (150 male and 84 female patients 12 to 73 years old) to one of three (...) and mild.For the management of mild-to-moderate asthma, salmeterol given twice daily is superior to albuterol given either four times daily or as needed.
High-dose intramuscular triamcinolone in severe, chronic, life-threatening asthma. Despite oral corticosteroid therapy, some patients with asthma have frequent exacerbations requiring emergency room visits, hospitalization, and occasionally, mechanical ventilation. We compared the effects of high-dose intramuscular triamcinolone with oral prednisone in patients with severe chronic asthma.In a double-blind, placebo-controlled, cross-over study that spanned all seasons, we treated 12 patients (...) during the triamcinolone period than during the prednisone period (P less than 0.04). Steroidal side effects were more pronounced after treatment with triamcinolone than after treatment with prednisone (P less than 0.1).We conclude that high-dose intramuscular triamcinolone is more effective than low-dose prednisone in patients with severe, chronic, life-threatening asthma, but steroidal side effects are somewhat worse.
Effect of low concentrations of ozone on inhaled allergen responses in asthmatic subjects. The relation between inhalation of ambient concentrations of ozone and airway reactivity to inhaled allergens may be important in asthma, since both agents can produce inflammatory changes in the airways. Seven asthmatic patients (mean age 40 [SD 13] years), with seasonal symptoms of asthma and positive skin tests for ragweed or grass, took part in a study to investigate whether exposure to low (...) in urban areas, can increase the bronchial responsiveness to allergen in atopic asthmatic subjects. This effect does not seem to be the result of changes in baseline airway function.
Growth of asthmatic children during treatment with budesonide: a double blind trial. To determine whether the inhaled glucocorticosteroid budesonide has any adverse effect on short term linear growth in children with mild asthma.Outpatient clinic in secondary referral centre.15 children aged 6-13 years with normal statural growth velocity during the previous year, no signs of puberty, and no use of systemic or topical steroids in the two months before the study. DESIGN OF INTERVENTIONS: Double (...) growth in children with mild asthma.
Effect of a short course of prednisone in the prevention of early relapse after the emergency room treatment of acute asthma. Relapse after the treatment of acute asthma in the emergency room is common (occurring in 25 to 30 percent of cases) and is not accurately predicted by any available measurements. We studied the usefulness of prednisone in reducing this high rate of relapse.One hundred twenty-two patients treated in the emergency room for acute exacerbations of asthma were assigned (...) perceived need for further asthma treatment.The overall risk of relapse was significantly lower in the prednisone group (P less than 0.05), with a significantly reduced rate of relapse during the first 10 days of follow-up (3 of 48, as compared with 11 of 45 in the placebo group; P less than 0.05). Thereafter (days 11 through 21), there was no further significant difference in relapse rates between treatment groups (five in the prednisone group and six in the placebo group). During the first week after
Lung function improvement in asthma with a cysteinyl-leukotriene receptor antagonist. In a double-blind study ten asthmatic patients with impaired lung function received the cysteinyl-leukotriene receptor antagonist ICI 204,219 (40 mg by mouth) and placebo in random order on 2 days at least 1 week apart. The increase in forced expiratory volume in 1 s (FEV1) above baseline was significantly greater after ICI 204,219 than after placebo. This effect persisted after nebulised salbutamol (...) . These findings suggest that cysteinyl-leukotrienes are one of the causes of persistent bronchoconstriction in chronic asthma.
Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. The presence of airway inflammation even in mild asthma points to the potential value of antiinflammatory therapy. We compared the effect of an inhaled corticosteroid, budesonide, with that of an inhaled beta 2-agonist, terbutaline, in the long-term treatment of newly detected asthma.We studied 103 patients (29 male and 74 female patients 15 to 64 years old) in whom asthma had (...) ), and the difference was sustained. Patients' diaries kept during the first three months of the study and during the last month of the first and second years showed budesonide to be more effective than terbutaline in improving peak expiratory flow in the morning (average increase from the pretreatment value, 32.8 liters per minute for budesonide vs. 4.8 liters per minute for terbutaline; P less than 0.001) and in the evening (P less than 0.01). Budesonide was also more effective in reducing the symptoms of asthma
Can morbidity associated with untreated asthma in primary school children be reduced?: a controlled intervention study. To determine whether an intervention programme based on existing school and community resources can reduce school absence and improve participation in games lessons and sport in children with unrecognised or undertreated asthma.Parallel group controlled intervention study.102 primary schools in Nottingham: 49 were randomised to receive the intervention and 53 to be control (...) schools.All children aged 5 to 10 years with parent reported absence from school because of wheezing in the previous year and taking no treatment or beta agonists only.Children with asthma were referred to their general practitioner for assessment of symptoms and treatment. Teachers were given education on asthma by the school nurse in 44 of the 49 intervention schools.Changes in school absence and missed games and swimming lessons because of wheezing, and schools' policy towards management of asthma
Non-adrenergic, non-cholinergic nervous system and overnight airway calibre in asthmatic and normal subjects. Increased parasympathetic tone does not fully explain the night-time bronchoconstriction responsible for nocturnal cough and wheezing in asthmatic subjects. The overnight variation in function of the other neural pathway innervating bronchial smooth muscle--the non-adrenergic, non-cholinergic (NANC) system--was thus examined. NANC function was tested after parasympathetic and beta (...) -adrenergic blockade in 12 normal subjects and 12 patients with mild asthma by comparing the bronchodilator effect (measured as oscillatory resistance, Ros) of capsaicin (an NANC stimulant) at 0400 h with that at 1600 h. The order in which capsaicin or diluent was given was randomised, and observers were blind as to which substance had been inhaled. Bronchodilatation was greater at 1600 h than at 0400 h in both the normal subjects (mean decrease in Ros 1-3 min after capsaicin at 1600 h 9% [SEM 1], at 0400
Bronchodilator treatment in moderate asthma or chronic bronchitis: continuous or on demand? A randomised controlled study. To examine the effect of bronchodilator treatment given continuously versus on demand on the progression of asthma and chronic bronchitis and to compare the long term effects of a beta 2 adrenergic drug (salbutamol) and an anticholinergic drug (ipratropium bromide).Two year randomised controlled prospective 'crossover' study in which patients were assigned to one of two (...) parallel treatment groups receiving continuous treatment or treatment on demand.29 general practices in the catchment area of the University of Nijmegen.223 patients aged greater than or equal to 30 with moderate airway obstruction due to asthma or chronic bronchitis, selected by their general practitioners.1600 micrograms salbutamol or 160 micrograms ipratropium bromide daily (113 patients) or salbutamol or ipratropium bromide only during exacerbations or periods of dyspnoea (110). No other pulmonary
Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. The effects of two pranayama yoga breathing exercises on airway reactivity, airway calibre, symptom scores, and medication use in patients with mild asthma were assessed in a randomised, double-blind, placebo-controlled, crossover trial. After baseline assessment over 1 week, 18 patients with mild asthma practised slow deep breathing for 15 min twice a day for two consecutive 2-week periods. During (...) assessment period; all improved more with the PCL exerciser than with the placebo device, but the differences were not significant. There was a statistically significant increase in the dose of histamine needed to provoke a 20% reduction in FEV1 (PD20) during pranayama breathing but not with the placebo device. The usefulness of controlled ventilation exercises in the control of asthma should be further investigated.
Randomised, double-blind, placebo-controlled trial of methotrexate in steroid-dependent asthma. 69 patients with steroid-dependent asthma (mean daily prednisolone dose 14.2 [SD 6.1] mg) took part in a randomised, double-blind, placebo-controlled study of 24 weeks' treatment with methotrexate 15 mg weekly. The patients were seen every 4 weeks by the same physician, who reduced the daily prednisolone dose by 2.5 mg if the daily diary card variables and measurements of lung function were unchanged
1990LancetControlled trial quality: predicted high
Short term linear growth in asthmatic children during treatment with prednisolone. To see whether small daily doses of prednisolone have any adverse effect on short term linear growth in children with mild asthma.Double blind, random order crossover trial of two dosages of prednisolone. During run in and washout periods patients were given placebo. All treatment periods were of two weeks' duration.Outpatient clinic referrals in a secondary referral centre.14 Children (10 boys) aged 7-11 years (...) in both prednisolone treatment periods. The mean difference between the run in period and the treatment period with 2.5 mg prednisolone daily was 0.63 mm/week (95% confidence interval 0.47 to 0.80 mm/week) and between the run in period and the treatment period with 5.0 mg prednisolone daily 0.57 mm/week (0.38 to 0.77 mm/week).Small daily doses of prednisolone suppress short term linear growth in children with mild asthma. The clinical relevance of this finding needs further study.