Evaluation of lung function and deposition of aerosolized bronchodilators carried by heliox associated with positive expiratory pressure in stable asthmatics: A randomized clinical trial

Alcoforado, Luciana; Brandão, Simone Cristina Soares; Rattes, Catarina; Brandão, Daniella Cunha; Lima, Vitoria Maria de; Lima, Gildo Ferreira; Fink, James B.

doi:10.1016/j.rmed.2013.03.020

Cited by 19 publications

(13 citation statements)

References 23 publications

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“…39,40 Methods to reduce airway closure, such as application of positive expiratory pressure, may thus have benefit for improving inhaled drug deposition. 41 Our data reveal a median closing index of 0.67 among a large, diverse group of patients with asthma. This value is very similar to the mean value (0.60) found by Chapman et al in a much smaller (n = 62) groups of patients with asthma.…”

Section: Discussionmentioning

confidence: 62%

“…In the multivariable linear regression model, a higher closing index was associated with higher age (10 year increments) (0.04, 95% CI = 0.02, 0.05, P < 0.005) and obesity (0.07, 95% CI = 0.03, 0.10, P < 0.001) after controlling for race, sex and study ( Table 3). Age of asthma onset and baseline use of 31 (20,41) 41 (26,50) 37 (26,47) 11 (9,14) 22 (12,38) <0.001…”

Section: Resultsmentioning

confidence: 99%

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Older age and obesity are associated with increased airway closure in response to methacholine in patients with asthma

et al. 2019

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Background and objective: The reduction of forced expiratory volume in 1 s (FEV 1 ) in response to methacholine challenge in asthma may reflect two components: airway narrowing, assessed by the change in FEV 1 /forced vital capacity (FVC), and airway closure, assessed by the change in FVC. The purpose of this study was to determine the degree and determinants of airway closure in response to methacholine in a large group of asthmatic patients participating in studies conducted by the American Lung Association-Airways Clinical Research Centers (ALA-ACRC). Methods: We used the methacholine challenge data from participants in five studies of the ALA-ACRC to determine the closing index, defined as the contribution of airway closure to the decrease in FEV 1 , and calculated as %ΔFVC/%ΔFEV 1 . Results: There were a total of 936 participants with asthma, among whom the median closing index was 0.67 relative to that of a published healthy population of 0.54. A higher closing index was associated with increased age (10-year increments) (0.04, 95% CI = 0.02, 0.05, P < 0.005) and obesity (0.07, 95% CI = 0.03, 0.10, P < 0.001). There was no association between the closing index and asthma control. Conclusion: Our findings confirm that airway closure in response to methacholine occurs in a large, diverse population of asthmatic participants, and that increased airway closure is associated with older age and obesity. These findings suggest that therapies targeting airway closure may be important in patients with a high closing index.Airway closure during methacholine challenge contributes importantly to airway hyperresponsiveness in asthma and is associated with older age and obesity.provocative concentration of methacholine causing a 20% decrease in FEV 1 ; SARA, Study of Acid Reflux and Asthma; SARCA, Study of Acid Reflux in Childhood Asthma; STAN, Study of Asthma and Nasal Steroids.

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Section: Discussionmentioning

confidence: 62%

Section: Resultsmentioning

confidence: 99%

Older age and obesity are associated with increased airway closure in response to methacholine in patients with asthma

et al. 2019

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“…É descrito na literatura que a terapia com PEP eleva o gradiente de pressão transpulmonar e melhora a expansão pulmonar, a oxigenação e a resposta a broncodilatadores inalatórios (ALCOFORADO et al, 2013), o que pode explicar as variações ocorridas na SpO 2 neste trabalho. Por outro lado, intervenções terapêuticas utilizando PEP oscilante mostraram um desempenho semelhante em muitos aspectos, exceto pela PEP em um dos instrumentos de OOAF, sendo possível sugerir que os vários modos de terapia com PEP podem ter diversos efeitos clínicos e fisiológicos.…”

Section: Resultsunclassified

Perfil Clínico-Epidemiológico De Casos De Hanseníase Em Um Centro De Saúde Escola Em Belém, Pará, No Ano De 2017

Cordovil¹,

Neto²,

Castro³

et al. 2019

PESQUISA EM SAÚDE:experiências Do Centro De Saúde Escola Do Marco

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“…When Heliox is used to drive bronchodilator nebulization, deeper lung delivery of the agent is seen [98]. Improved FEV 1 is seen using Heliox-driven bronchodilator nebulization compared to using pure oxygendriven systems [99,100]. In children (ages 2-21 years) using Heliox-powered albuterol, nebulization failed to demonstrate shorter hospitalizations in moderate-to-severe AEA compared to oxygen-driven albuterol nebulization [101].…”

Section: Helioxmentioning

confidence: 99%

The Acute Management of Asthma

Albertson

Sutter

Chan

2014

Clinic Rev Allerg Immunol

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Patients presenting to the emergency department (ED) or clinic with acute exacerbation of asthma (AEA) can be very challenging varying in both severity and response to therapy. High-dose, frequent or continuous nebulized short-acting beta2 agonist (SABA) therapy that can be combined with a short-acting muscarinic antagonist (SAMA) is the backbone of treatment. When patients do not rapidly clinically respond to SABA/SAMA inhalation, the early use of oral or parenteral corticosteroids should be considered and has been shown to impact the immediate need for ICU admission or even the need for hospital admission. Adjunctive therapies such as the use of intravenous magnesium and helium/oxygen combination gas for inhalation and for driving a nebulizer to deliver a SABA and or SAMA should be considered and are best used early in the treatment plan if they are likely to impact the patients' clinical course. The use of other agents such as theophylline, leukotriene modifiers, inhaled corticosteroids, long-acting beta2 agonist, and long-acting muscarinic antagonist currently does not play a major role in the immediate treatment of AEA in the clinic or the ED but is an important therapeutic option for physicians to be aware of and to consider initiating at the time of discharge from clinic, hospital, or ED to reduce later clinical worsening and readmission to the ED and hospital. A comprehensive summary is provided of the currently available respiratory pharmaceuticals approved for asthma and other airway syndromes. Clinicians must be prepared to use the entire spectrum of medications available for the treatment of acute asthma exacerbations and the agents that should be initiated to prevent worsening or additional exacerbations. They need to be familiar with the major potential drug toxicities associated with their use.

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Evaluation of lung function and deposition of aerosolized bronchodilators carried by heliox associated with positive expiratory pressure in stable asthmatics: A randomized clinical trial

Cited by 19 publications

References 23 publications

Older age and obesity are associated with increased airway closure in response to methacholine in patients with asthma

Older age and obesity are associated with increased airway closure in response to methacholine in patients with asthma

Perfil Clínico-Epidemiológico De Casos De Hanseníase Em Um Centro De Saúde Escola Em Belém, Pará, No Ano De 2017

The Acute Management of Asthma

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