This study assessed the effects of treatment with fluticasone in children younger than 2 years old with recurrent wheezing and risk factors of developing asthma. This double-blind placebo-controlled study randomized children to receive fluticasone (125 mug; n = 14) or placebo (n = 12) twice daily for 6 months. Pulmonary function was assessed at the beginning and end, and parents filled out a daily diary recording respiratory symptoms, need for rescue medication, and emergency care. The SD score of maximum flow at functional residual capacity was -0.74 +/- 0.6 at the beginning and 0.44 +/- 1 at the end for the fluticasone group (p = 0.001), and -0.79 +/- 0.3 at the beginning and -0.78 +/- 1.4 at the end for the placebo group (p = 0.97). A statistically significant difference (p = 0.02) was observed between treatments. The percentage of symptom-free days was 91.3 +/- 7% for fluticasone and 83.9 +/- 10% for placebo (p = 0.05). The number of respiratory exacerbations was 2.1 +/- 1.7 and 4.1 +/- 3 (p = 0.04), and the percentage of days on albuterol was 8.6 +/- 6% and 16.3 +/- 9% (p = 0.028). Treatment with fluticasone twice daily for 6 months improves pulmonary function and clinical outcomes in children with asthma younger than 2 years.
Our objective was to evaluate the efficacy and safety of two doses of fluticasone propionate (FP) in young children with recurrent wheezing and risk factors for asthma. Our study design was a randomized, double-blind, placebo-controlled comparison of inhaled FP 50 mcg twice daily (FP 100) and 125 mcg twice daily (FP 250), for 6 months. Outcome measures included number of wheezing episodes, days on albuterol, height standard deviation score (height SDS), osteocalcin (OC), bone alkaline phosphatase fraction (AKP), insulin-like growth factor-binding protein 3 (IGFBP-3), and serum levels of cortisol (SC). Our subjects were 30 patients, aged 7-24 months. Mean wheezing episodes were 6.0 +/- 1.9, 1.9 +/- 1.9, and 2.8 +/- 1.2; mean days of albuterol use were 24.3 +/- 1.3, 6.5 +/- 0.8, and 9.1 +/- 0.8, per patient for placebo, FP100, and FP250 groups, respectively. There was a significant reduction in clinical outcome in the two FP groups compared to placebo (P < 0.01). No significant correlations were found between FP dosage and height SDS, OC, AKP, IGFBP-3, and SC. In conclusion, in young children with asthmatic symptoms, FP at 50 and 125 mcg b.i.d. for 6 months significantly improved respiratory symptoms without causing significant side effects on growth and bone metabolism.
Background: Exhaled nitric oxide (eNO) has been proposed for monitoring airway inflammation, diagnosis, and prediction of steroid responsiveness in asthma. However, its utility after elective suspension of asthma medication is still unclear. We aimed to determine the association between eNO values and the subsequent loss of asthma control (LAC) in asymptomatic asthmatic children after inhaled corticosteroids (ICS) withdrawal. Methods:We conducted a prospective observational cohort study. Forty-two children (23 boys), mean age 11 years, with clinically controlled asthma, according to GINA guidelines, and receiving low-dose of ICS (budesonide 200 μg/day or equivalent) were included immediately after the withdrawal of ICS. eNO, Asthma Control Test (ACT) and spirometry were monthly assessed, during 54 weeks or until the presence of at least one of the following criteria of LAC: 1) asthma exacerbation, 2) obstructive spirometric pattern, 3) ACT ≤ 19.Results: eNO baseline geometric mean (eNO b ), measured 4 weeks after discontinuation of ICS, was 23.7 ppb (SD: 1.16). An eNO b cutoff point of 21.8 ppb was determined to better discriminate between high and low eNO groups. Twenty-five subjects (71.4%) had LAC. High eNO b was associated to LAC (OR: 9.01; 95CI: 1.10-74.26). In addition, LAC occurred earlier in high eNO b than in low eNO b patients (8 vs 28 weeks, respectively; P = 0.017). Conclusions:Our findings suggest that eNO predicts loss of asthma control and may contribute for clinical follow up decisions during childhood asthma after ICS withdrawal. K E Y W O R D Sasthma, exhaled nitric oxide, inhaled corticosteroids
Chronic hypoxia in high altitude constitutes an associated factor for fetal growth restriction, even when there is genetic adaptation, as observed in studies performed in populations living at high altitudes (Tibet, Andes, Europe and North America). Socioeconomic and nutritional deprivation is frequently observed in those populations, being also associated to fetal growth. Objective: To analyze anthropometric measures at birth in relation with altitude, and to assess the effect of maternal nutrition status, socioeconomic conditions and altitude on those measures. Population and methods: The study was based on the information registered in the Perinatal Information System (SIP -Clap-OPS) by the provincial team from the province of Jujuy and forwarded to national level, between 1996 -1998. Variables included pre-gestational BMI, maternal weight gain, maternal education, birth weight (BW), length at birth (LB), and head circumference (HC). Cases were grouped in three categories according to the altitude of the institution where the childbirth was attended: 84.1% R1, 5.8% R2 and 10.1% R3, being the latter the area at higher altitude (Puna). Confounding variables were controlled by exclusion and analytical tools. Results: From 25,811 registries, 24,651 with complete information were selected. Mean BW was 3259 Ϯ 538 g in R1; 3162 Ϯ 420 in R2, and 3080 Ϯ 483 in R3, with a difference of 179 grams between R1 and R3, (F 110.7; p Ͻ 0.001) and 209 g between R1 and R3 (F 199; p Ͻ 0.001) in term deliveries. In this group, LB difference was 0.3 cm (Fϭ274,9, pϽ0.001), and HC difference was 0.6 cm (F102.7; p Ͻ 0.001) between low and highlands (R1 and R3, respectively). Multivariate analysis, by linear regression, showed a final model to predict BW ϭ -1557.4 183.2 * birth at high altitude ϩ 28.9 * parity ϩ 13.3 * 8.7 BMI ϩ 8.7 * maternal weight gain ϩ 113.3 * gestational age at birth ϩ ⌺. Conclusion: Altitude influences BW significantly. Nevertheless, nutritional and social factors have a direct and sinergic relationship with BW. Background. Reduced iron is one of the most commonly used iron fortificants, because of its low cost and lack of chemical reactivity. The bioavailability of this fortificant has not been reliably measured in humans because of technical difficulties. Objective. To assess iron bioavailability of wheat flour fortified with reduced iron. Methods. Homemade bread fortified with two reduced iron compounds was produced. We used an in vitro digestion and the Caco-2 cells model to measure the bioavailability of two types of reduced Fe (8 and Ͼ20 m particle size), using ferritin formation by Caco-2 cells and intracellular Fe concentration as indicators of Fe incorporated to the enterocyte. Results. In vitro digestion experiments showed higher values of solubility and dialyzability of reduced-8 m Fe compared to reduced Ͼ20 m Fe. Intracellular iron and ferritin concentrations in Caco-2 cells exposed to digest from bread fortified with reduced-8 m Fe were higher than in bread fortified with reduced Ͼ20 m Fe. When brea...
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