SummaryThis study investigated the effect of diclofenac on the lung function of 70 children aged 6±15 years with a diagnosis of asthma, recruited from a hospital respiratory clinic. Peak¯ow and a forced expiratory¯ow-volume loop were measured and the patients were then given 1±1.5 mg.kg À1 effervescent diclofenac orally. Spirometry was repeated at 10, 20 and 30 min, a 15% decrease in results being considered a signi®cant reduction in lung function. No patient demonstrated a consistent reduction in lung function of > 15% during the study and there were no reports of wheezing or increased bronchodilator use after completion of the spirometry. In conclusion, we studied a group of genuine asthmatics and found no clinically signi®cant incidence of bronchospasm with the use of a single therapeutic dose of diclofenac. Attempts to provide adequate postoperative analgesia, particularly after day case surgery, are hampered in children with asthma by the recommendation to avoid nonsteroidal anti-in¯ammatory drugs (NSAIDs) [1]. The avoidance of this class of drugs is based on the risk of NSAID-induced bronchospasm, a complication with a 5±10% incidence in adult-onset asthmatics [2]. Because the incidence of childhood asthma is estimated at 13.1% in Great Britain [3], a large number of children undergoing surgery are denied a class of drugs that would otherwise form a major part of their pain management. Diclofenac has been used cautiously for postoperative pain relief in asthmatic children for some years in this hospital. We are unaware of any signi®cant episodes of bronchospasm associated with its use in this group of patients. We therefore formed the impression that diclofenac-induced bronchospasm has a considerably lower incidence in children than that reported in adult asthmatics. This study was carried out to test this hypothesis. MethodsLocal research ethics committee approval was granted for the study and participants and parents gave informed consent. Children aged 6±15 years with a diagnosis of asthma and taking regular prophylactic medication were recruited on attendance at a hospital respiratory clinic (90%) or at presentation for day case surgery (10%). Exclusion criteria included: a previous adverse reaction to NSAIDs, known renal disease or risk of gastro-intestinal bleeding, current deterioration in lung function (FEV 1 < 80% predicted) and medication with theophyllines or leukotriene receptor antagonists. Patients taking longacting b 2 agonists were asked to omit the medication for 12 h before the study.A questionnaire, based on the International Study of Asthma and Allergies in Childhood (ISAAC) [4], allowed assessment of the type and severity of asthma, the incidence of atopy and a review of current medication. Asthma was categorised as`severe' if there were more than 12 episodes of wheezing in the last year or if speech had been limited to only one or two words between breaths, and`moderate' if there were fewer than 12 episodes of wheezing in the last year, but wheezing occurred in the absence of viral sy...
An eight-year-old boy with a Burkitt's lymphoma of the upper airway is described. The use of sevoflurane for induction of anaesthesia in patients with airway obstruction is discussed. The logistical problems of upper airway surgery and anaesthesia in this type of patient are considered.
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