Category Archives: Asthma

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Summary

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: SummaryThus, these findings argue against the routine use of continuous nebulization in the ED treatment of patients with acute asthma, and the decision to use one of these nebulization methods should be based on logistical and cost considerations. Overall, this review supports the equivalence of continuous and intermittent albuterol nebulization in the acute treatment of nonventilated adult asthma patients. Also, patients who received continuous nebulization showed lower pulse rates, and a decrease of serum potassium concentration compared to patients receiving the same P-agonist via intermittent nebuli-zation. However, these findings are based on only five trials and two trials, respectively. Consequently, this information should be interpreted with caution, Since all studies reviewed excluded patients with life-threatening asthma (for example those patients who have been considered for ventilation), these results should not be extrapolated to this group.

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma:

No benefit was observed after 1 h of treatment (severe asthma subgroup: SMD, -0.20; 95% CI, -0.43 to 0.04; x2, 3.5; df, 4; p = 0.5; moderate asthma subgroup: SMD, -0.04; 95% CI, -0.40 to 0.33; x2, 0.4; df, 1; p = 0.5) and after 2 to 3 h of treatment (severe asthma subgroup: SMD, -4.32; 95% CI, -8.78 to 0.14; x2, 1.7; df, 4; p = 0.8; moderate asthma subgroup: SMD, 3.11; 95% CI, -10.2 to 16.4; x2, 1.38; df, 1; p = 0.3). Similarly, the methodological quality of the studies did not alter the results. Thus, there were no differences in pulmonary function between high-quality and low-quality trials after 1 h of treatment (high-quality trials: SMD, -3.5; 95% CI, -11.6 to 4.6; x2, 1.24; df, 1; p = 0.3; low-quality trials: SMD, -2.6; 95% CI, -7.3 to 1.9; x2, 3.59; df, 4; p = 0.5) and after 2 to 3 h of treatment (high-quality trials: SMD, -3.4; 95% CI, -12.0 to 5.3; x2, 0.89; df, 1; p = 0.4; low-quality trials: SMD, -3.6; 95% CI, -8.4 to 1.2; x2, 3.26; df, 4; p = 0.5).

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Sensitivity Analyses

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Sensitivity AnalysesMore specifically, there were no significant group differences in the SMD observed after 1 h of treatment (SMD, -0.15; 95% CI, -0.35 to 0.05) and after 2 to 3 h of treatment (SMD, -0.19; 95% CI, -0.39 to 0.01) [Fig 1]. No significant heterogeneity was demonstrated (p > 0.5). In the same way, the four trials reporting responses to treatment as the change in the percentage predicted of FEV1> did not show group differences after 1 h of treatment (WMD, -1.73; 95% CI, -8.51 to 5.05) and after 2 to 3 h of treatment (WMD, -2.18; 95% CI, -6.24 to 1.88).
Side Effects and Hospital Admissions
Five studies reported the final heart rate. At the end of treatment, there was a significant, but small, decrease in pulse rate when continuous neb-ulization was administered (WMD, -6.82; 95% CI, -8.67 to -3.90 beats/min; x2, 2.55; degrees of freedom [df], 4; p = 0.6) [Fig 2].

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Effects on Pulmonary Function

Results
Sixty-two articles were identified in the initial search. Of these, reviewers found that 16 articles were potentially eligible. Most of the others were excluded because they were not clinical trials of patients with acute asthma. The reasons for subsequent exclusion were nonrandomized trials (n = 6),зД”20-22 only a continuous nebulization group included in the study (n = 1), only pediatric patients included in the study (n = 2),” and non-acute asthma patients included in the study (n = 1). Finally, six articles were selected for inclusion in the meta-analysis. Four studies were from the United States, one was from Canada, and one was from Tunisia. The к statistic for inter-rater agreement on the inclusion or exclusion of potential trials was 1.0. All studies reported pulmonary function measures, five reported heart rates, two reported admission rates, and two reported serum potassium concentrations.

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Statistical Analysis

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: Statistical AnalysisThe two authors independently examined (title and abstract) the output generated from the search. Any potentially relevant articles were obtained, irrespective of the original language of publication. From the full text of potentially relevant articles, the reviewers assessed each study independently, in terms of population, intervention, study design, and outcome, to determine whether the study met the inclusion criteria. Reviewers were masked to the authors’ names, the name of journal, and the date of publication. Agreement among reviewers was measured using к statistics, and disagreement was settled by consensus. The methodological quality of each selected trial was assessed using the instrument of Jadad et al. This instrument evaluates the quality of randomization and blinding, and the reasons for withdrawal on a score of 0 (worst) to 5 (best).
For continuous variables, a random-effects standardized mean difference (SMD) or a weighted mean difference (WMD) and the 95% confidence interval (CI) were calculated for each study. All similar studies were pooled using random-effects SMD or WMD and 95% CIs.

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma: PEF

We searched for studies using the MEDLINE (1966 to 2001), EMBASE (1980 to 2001), and CINAHL (1982 to 2001) databases. The following MeSH terms were used in the search: Emerg* or acute or status and continuous or intermittent or multi-dose or dosage or nebuli* and P-agonist or bronchodilat*. Also, a search of the Cochrane Controlled Trials Register was completed using the above terms. Finally, we checked bibliographies of all trials and review articles that had been identified from the databases and medical journals to determine potentially relevant citations.

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult Asthma

Continuous vs Intermittent ^-Agonists in the Treatment of Acute Adult AsthmaInhaled (P2-agonists are the drugs of choice with which to treat patients with acute severe asthma. In comparison to the systemic approach, inhalation is associated with a more rapid onset of action and fewer systemic side effects. However, there are controversies regarding the use of (P2-agonists in the treatment of patients with acute asthma exacerbations. Thus, there is a consensus that frequent intermittent nebulizations (ie, every 20 min within the first hour) are appropriate, but continuous nebulization also has been proposed. Thus, since the late 1980s, there has been considerable clinical and academic interest in the use of continuous aerosolized bronchodilators for the treatment of acute asthma. This method of therapy has potential advantages in terms of time, costs, and medication delivery. This feature may allow deeper penetration into the airways and greater reduction of broncho-constriction Here buy antibiotics. Furthermore, this may result in fewer side effects.

Association of Asthma Severity and Bronchial Hyperresponsiveness With a Polymorphism: Asthmatic airways

The first possible shortcoming of this study was that the methacholine challenge was performed in only 45 of 88 patients, which would have resulted in a selection bias. The most important reason for not performing the methacholine challenge concerned the patients’ respiratory state. It was difficult to perform the test when FEV1/FVC was reduced or when symptoms such as cough, dyspnea, and wheezing were present. Another reason was patient refusal. A much larger number of subjects would have to be studied in the future. Second, the male/ female ratio differed significantly between the control group and the asthmatic group. Therefore, we analyzed the association between sex and the polymorphisms (exon 1 +49 A/G, promoter —318 C/T) in all 174 subjects (54 male subjects and 120 female subjects) in the asthmatic and control groups.

Association of Asthma Severity and Bronchial Hyperresponsiveness With a Polymorphism: Discussion

Association of Asthma Severity and Bronchial Hyperresponsiveness With a Polymorphism: DiscussionIn this study, the CTLA-4 promoter ( — 318 C/T) polymorphism was found to be associated with asthma severity, but not with asthma, atopy, or bronchial hyperresponsiveness. The CTLA-4 exon 1 (+ 49 A/G) polymorphism was shown to be associated with bronchial hyperresponsiveness, but not with asthma, atopy, or asthma severity. From these results, it appears that the CTLA-4 gene may not be a susceptibility gene, but rather a disease-modifying gene that can modify the asthma phenotype.

Association of Asthma Severity and Bronchial Hyperresponsiveness With a Polymorphism: Polymorphism

The distributions of genotypic frequencies were significantly different for the mild-to-moderate group and the severe group. In particular, the frequency of the T allele was 7.4% in the mild-to-moderate group and 20.4% in the severe group, and the association between severe asthma and the T allele was significant (p = 0.037; Table 3). The positive predictive value of a positive T allele for severe asthma was 55.0% and the negative predictive value was 72.4%. The relationship between bronchial hyperresponsiveness (PC20) and the CTLA-4 promoter (—318 C/T) polymorphism was also studied. PC20 was measured in 45 of the 88 asthma patients, divided into a CC genotype (wild type) group and a CT genotype +TT genotype (mutant-type) group. However, PC20 did not differ between the two groups (p = 0.758; Table 4).

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