Bronchodilation in infants with malacia or recurrent wheeze

Abstract

Background: Controversy remains regarding the effectiveness of bronchodilators in wheezy infants. Aims: To assess the effect of inhaled β 2 agonists on lung function in infants with malacia or recurrent wheeze, and to determine whether a negative effect of β 2 agonists on forced expiratory flow (V′ maxFRC ) is more pronounced in infants with airway malacia, compared to infants with wheeze. Methods: We retrospectively analysed lung function data of 27 infants: eight with malacia, 19 with recurrent wheeze. Mean (SD) age was 51 (18) weeks. Mean V′ maxFRC (in Z score) was assessed before and after inhalation of β 2 agonists. Results: Baseline V′ maxFRC was below reference values for both groups. Following inhalation of β 2 agonists the mean (95% CI) change in mean V′ maxFRC in Z scores was −0.10 (−0.26 to 0.05) and −0.33 (−0.55 to −0.11) for the malacia and wheeze group, respectively. Conclusions: In infants with wheeze, inhaled β 2 agonists caused a significant reduction in mean V′ max -

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

“…Double-blind placebo-controlled studies have demonstrated significant bronchodilatory effects [95][96][97][98] and protective effects against bronchoconstrictor agents [99,100] in infants and preschool children treated with rapidly acting inhaled b 2 -agonist. Thus, infants possess functional b 2 -receptors from birth, and stimulation of these receptors can produce the same effects as in older children, although paradoxical responses to inhaled b 2 -agonists have been reported in infants [50,101]. Oral administration of b 2 -agonist is also effective but is limited by systemic side-effects [102].…”

“…Noisy breathing is common among infants aged ,6 months but only a small proportion have wheeze [15]. Reported noisy breathing that responds to bronchodilator therapy is likely to be genuine wheeze and to be caused, at least in part, by constriction of airway smooth muscle [50].…”

“…Studies have shown reduced forced expiratory flows associated with wheeze [50,52,60,61]. Low lung function in school-age children [62][63][64] and infants [65] appears to track into early adulthood.…”

Recurrent bronchial obstruction and asthma in children during the first five years of life

“…Вопреки распро-страненному мнению о низкой чувствительности детей раннего возраста к этим препаратам, доказано, что у младенцев с рождения имеются функциониру-ющие β 2 -адренорецетроры и их стимуляция приво-дит к такому же клиническому эффекту, как и у детей более старшего возраста. Однако у некоторых мла-денцев (возможно, с дистонией бронхов или при не-обратимой обструкции) на препараты этой группы возникает парадоксальный терапевтический эффект [15]. Назначение короткодействующих β 2 -агонистов per os не рекомендуется из-за медленного начала дей-ствия и более выраженных, чем при ингаляционном введении, системных нежелательных эффектов [16].…”

Asthma therapy for children under 5 years of age

“…Difficulties in defining phenotypes and objective outcome parameters combined with the transient nature of symptoms which often resolve spontaneously have confounded many studies [14]. Some studies showed a beneficial effect of short-acting b 2 -receptor agonists on lung function and clinical parameters [15][16][17], some did not show any effect [18][19][20][21], or even worsening of Asthma therapy for children Boehmer and Merkus 35 [22][23][24]. A meta-analysis concluded that there is no clear evidence to support the use of b 2 -receptor agonists for recurrent wheeze in children under 2 years old [14].…”