Carlos Kofman

Respuesta broncodilatadora del salbutamol administrado como aerosol presurizado mediante aerocámaras con válvulas o espaciadores no valvulados

Introduccion: los medicamentos para tratar el asma utilizan, fundamentalmente, la via inhalatoria. La utilidad de los espaciadores con valvulas (aerocamaras) esta demostrada; sin embargo, recientemente se ha propuesto como alternativa mas economica el uso de espaciadores sin valvulas. La eficacia clinica de estos no se ha demostrado hasta el momento. Objetivo: comparar la respuesta broncodilatadora de un inhalador de dosis medida (IDM) de salbutamol administrado a traves de una aerocamara contra un espaciador sin valvulas. Poblacion, material y metodos: estudio experimental, prospectivo, aleatorizado, simple ciego, de grupos paralelos. Se incluyeron 34 pacientes (6-16 anos) con asma, que presentaban obstruccion bronquial leve o moderada (volumen respiratorio forzado, entre 50% y 79% del valor predictivo), sin haber recibido broncodilatadores recientemente. Luego de una espirometria inicial se asignaron para recibir 100 g de salbutamol (aerosol presurizado) mediante una aerocamara con valvulas (AerochamberMR) o un espaciador sin valvulas (AeromedMR). Se determino la respuesta broncodilatadora del volumen respiratorio forzado y del FMF a los 30 minutos. Resultados: en el grupo con aerocamara ingresaron 17 pacientes (12 varones; volumen respiratorio forzado basal 67 ± 10%), y en el grupo con espaciador sin valvulas ingresaron 17 pacientes (13 varones, volumen respiratorio forzado basal 67 ± 6%). La variacion del FEV1 fue 26 ± 14% contra 16 ± 5% (p= 0,017) y la variacion del FMF fue 92 ± 48% contra 58 ± 29% (p= 0,018), para aerocamaras y espaciadores sin valvulas, respectivamente (ANOVA). Conclusion: el aerosol presurizado de salbutamol administrado a traves de una aerocamara con valvulas produce una respuesta broncodilatadora mayor que el espaciador sin valvulas en ninos con asma.

Usefulness of Nonvalved Spacers for Administration of Inhaled Steroids in Young Children with Recurrent Wheezing and Risk Factors for Asthma

Background In vitro and scintigraphic studies have suggested that effectiveness of metered-dose inhalers (MDI) with nonvalved spacers (NVS) is similar to that of MDI with valved holding chambers (VHC). Nevertheless, there are no clinical studies that compare these techniques in long-term treatment with inhaled steroids in young children with recurrent wheezing and risk factors for asthma. Objective To compare the efficacy of a long-term treatment with Fluticasone Propionate administered by an MDI through both type of spacers, with and without valves, in young children with recurrent wheezing and risk factors for asthma. Patients and Methods Outpatient children (6 to 20 months old) with recurrent wheezing and risk factors for asthma were randomized to receive a 6-month treatment with metered-dose inhaler (MDI) of Fluticasone Propionate 125 mcg BID through an NVS or through a VHC. Parents recorded daily their childs respiratory symptoms and rescue medication use. Results 46 patients of 13.4 ± 5 months old were studied. During the study period, the NVS group (n=25) experienced 3.9 ± 2.4 obstructive exacerbations, and the VHC group (n=21) had 2.6 ± 1.6 (p=0.031). The NVS group had 17.4 ± 14% of days with respiratory symptoms, and the VHC group had 9.7 ± 7% (p=0.019). The NVS group spent 29.8 ± 22 days on albuterol while the VHC group spent 17.9 ± 11 days (p=0.022). Conclusion Long-term treatment with inhaled steroids administered by MDI and NVS is less effective than such treatment by MDI and VHC in infants with recurrent wheezing and risk factors for asthma.

Treatment with inhaled corticosteroids improves pulmonary function in children under 2 years old with risk factors for asthma

Purpose of review To report on recent studies on the effect of inhaled corticosteroids on pulmonary function in young children with asthma. Recent findings Inhaled corticosteroids are considered the most effective treatment for persistent asthma in children. Appropriate control of childhood asthma may prevent more serious disease or irreversible obstruction in later years. While some authors have described an improvement with the use of inhaled corticosteroids in young children, others found no clinical or functional benefit. Various studies have shown that inhaled corticosteroids ameliorate clinical outcomes, and recently a study demonstrated improvement in pulmonary function in young children with asthma. The use of different study designs may explain the lack of consistent results and disagreement regarding the efficacy of inhaled corticosteroids in these patients. Summary Based on the preponderance of evidence, treatment with inhaled corticosteroids in infants and young children with recurrent wheeze and risk factors of developing asthma appears to allow better control of the illness and improve the pulmonary function.