Special Considerations in the Approach to Asthma in Infancy and Early Childhood

Zeiger, Robert S.

doi:10.3109/02770908309077377

Cited by 12 publications

(2 citation statements)

References 52 publications

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“…There is little evidence from clinical trials, however, to recommend treatment of such infants with bronchodilators. [12][13][14][15][16][17][18][19][20][21][22][23] Nebulised water produces bronchoconstriction in asthmatic subjects.7 In the 10 infants we studied all of whom had history of wheezing, we confirmed that nebulised water in the regimen we gave caused bronchoconstriction. The measurements showing deterioration in lung function correlated well with the patients' clinical signs during the study.…”

Section: Discussionmentioning

confidence: 75%

Nebulised salbutamol does have a protective effect on airways in children under 1 year old.

O’Callaghan

Milner

Swarbrick

1988

Archives of Disease in Childhood

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SUMMARY Ten infants under the age of 1 year each of whom gave a history of recurrent wheezing attacks were studied with a total body plethysmograph. All the infants were free of wheeze when studied and were sedated with chloral hydrate. All 10 showed a significant deterioration in lung function when given nebulised water for two minutes with an increase in airways resistance and a decrease in specific conductance at one and five minutes after nebulisation compared with baseline readings. Measurements returned to baseline values within 15 minutes. When the same amount of nebulised water was given 20 minutes after nebulised salbutamol, however, there was no significant deterioration in lung function at one and five minutes after administration of nebulised water.We conclude that the airways were protected against the bronchoconstricting effect of nebulised water by the 12 adrenoreceptor stimulant salbutamol.Many doctors believe that (32 adrenoreceptor stimulants have little or no effect on the airways of infants under the age of 1 year. These children do, however, have (2 adrenoreceptors' and smooth muscle2 in their airways and theoretically should respond to (32 adrenergic stimulants. Nebulised water has a bronchoconstricting effect on asthmatic children and adults,37 and we have found that it also causes bronchoconstriction in wheezy infants (unpublished data).The present study was designed to find out if nebulised salbutamol protects the airways of wheezy infants. Nebulised water was used as a bronchoconstricting challenge. Patients and methodsPatients studied were under 1 year old and attending this hospital for routine assessment. All had had more than two wheezy episodes in the preceding months. Table 1 shows their age, sex, and history of bronchiolitis. At the time of the study all were clinically well and at least four months had elapsed since their bronchiolitic illnesses. Each study was done in the outpatient clinic, all patients were awake, and allowed home within three hours of arrival.The infants were sedated with chloral hydrate (120 mg/kg), and thoracic gas volume and airways resistance were measured with total body plethysmography.i" The total body plethysmograph had a capacity of 260 litres, and a servo controlled heating system maintained the face mask, shutter system, and rebreathing bag at 36°C. Thoracic gas volume was measured at the end of inspiration, and the tidal volume was subtracted before calculation. The children were nursed supine and firm latex masks applied to their faces. The dead space of each mask was 88 ml. There was a bias flow of air at 5 1/minute to the face mask. Signals were relayed to the axis of a cathode ray oscilloscope, all readings were made by the same observer,

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Section: Discussionmentioning

confidence: 75%

Nebulised salbutamol does have a protective effect on airways in children under 1 year old.

O’Callaghan

Milner

Swarbrick

1988

Archives of Disease in Childhood

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“…Medication is less effective [5] and response often unpredictable [6]. No studies have looked in any detail at the characteristics of asthma in this age group, though it is recognized that the pattern of disease may be very different [7]. We therefore decided to prospectively study the clinical and immunological characteristics of pre-school children with chronic asthma attending our paediatric respiratory clinic.…”

Section: Introductionmentioning

confidence: 99%

Clinical and immunological characteristics of pre‐school asthma

Loftus

Price

1986

Clin Experimental Allergy

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Summary Ninety‐two children, sixty‐two boys and thirty girls, aged 18 months to 6 years with frequent asthma were studied. Nine were born prematurely and two were ventilated in the neonatal period; two had been admitted to hospital with acute bronchiolitis. Most had an early onset of symptoms, forty‐two developing asthma in infancy. Although overall growth was normal, 63% had some chest deformity. Half had past or present eczema and just over half had chronic rhinitis. Upper respiratory infection appeared to be an important precipitant of attacks in all, and 88% had exercise‐induced asthma. The majority were atopic, 74% had elevated serum IgE levels, skin‐prick tests were positive in 61 of 77 tested and half had eosinophilia. However, allergic factors were clearly identified as causing asthma attacks in only 24%. Immunoglobulin deficiencies were found in thirteen and defective yeast opsonization in eighteen; these children showed no other obvious differences from the remainder. Eighty‐two children were followed up and after 1 year fifty‐one were receiving inhaled steroids. Measurement of serum immunoglobulin, eosinophil count and skin‐prick testing had little influence on management.

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Clinical observations of nebulized flunisolide in infants and young children with asthma and bronchopulmonary dysplasia

König¹,

Shatley²,

Levine³

et al. 1992

Pediatric Pulmonology

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Severe bronchopulmonary dysplasia (BPD) is frequently associated with asthma. The combination is often severe enough to necessitate corticosteroid therapy. There are no commercially available nebulizer solutions of corticosteroids for use in infants and young children. Seven infants and small children with very severe BPD and asthma aged 6-24 months, were treated with flunisolide, 187-250 micrograms q.i.d. in the form of nasal spray delivered by nebulizer. After treatment for 2.5-20 months, four patients showed clinical improvement, one initially improved but later deteriorated and died of cardiac failure, and two patients showed no improvement and died within 3 months. The number of days of hospitalization was significantly reduced from 8.4/month to 2.5/month (P less than 0.05). No side-effects were detected and it was felt that the three patients who died, did so as a consequence of very severe BPD and its cardiac consequences. The suspension remained stable for 80 min when mixed with normal saline, cromolyn sodium, albuterol, or acetylcysteine. It is concluded that nebulized flunisolide is a potentially useful treatment for infants and young children with asthma and BPD.

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Special Considerations in the Approach to Asthma in Infancy and Early Childhood

Cited by 12 publications

References 52 publications

Nebulised salbutamol does have a protective effect on airways in children under 1 year old.

Nebulised salbutamol does have a protective effect on airways in children under 1 year old.

Clinical and immunological characteristics of pre‐school asthma

Clinical observations of nebulized flunisolide in infants and young children with asthma and bronchopulmonary dysplasia

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