RESUMEN
OBJECTIVE: The purpose of this study was to determine whether aeroallergen sensitization phenotypes could predict maintenance of well-controlled asthma. METHODS: Asthmatic children age 2-18 years who enrolled in the CHOC Children's Breathmobile™ program from April 2002 to December 2011 were included in this retrospective analysis if they had been skin tested to a panel of indoor and outdoor aeroallergens and had returned for follow-up care within 6 months of their baseline visit. The study observation period encompassed all year one visits. Asthma severity and control were defined by NHLBI EPR-3 Guidelines criteria. RESULTS: In the 1627 primarily Hispanic children evaluated, those with persistent asthma were more likely than those with intermittent disease to be sensitized to each aeroallergen tested and to have more total sensitizations. Children with intermittent, but not persistent, asthma at baseline who were sensitized to pollen2 (trees or weeds) were less likely to maintain well-controlled asthma at follow-up visits. Whereas, sensitization to dander (cat, dog or feather) showed a protective effect to maintenance of well-controlled asthma in patients with persistent, but not intermittent, baseline disease severity. CONCLUSIONS: Our data suggest that both indoor and outdoor aeroallergens should be assessed regardless of baseline asthma severity, including those with intermittent asthma.
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Alérgenos/inmunología , Asma/etnología , Asma/inmunología , Hispánicos o Latinos , Adolescente , Factores de Edad , Antiasmáticos/administración & dosificación , Asma/tratamiento farmacológico , Niño , Preescolar , Femenino , Humanos , Masculino , Estudios Retrospectivos , Índice de Severidad de la EnfermedadRESUMEN
Allergic rhinitis (AR) is the most common chronic condition in children and is estimated to affect up to 40% of all children. It is usually diagnosed by the age of 6 years. The major impact in children is due to co-morbidity of sinusitis, otitis media with effusion, and bronchial asthma. AR also has profound effects on school absenteeism, performance and quality of life. Pharmacotherapy for AR should be based on the severity and duration of signs and symptoms. For mild, intermittent symptoms lasting a few hours to a few days, an oral second-generation antihistamine should be used on an as-needed basis. This is preferable to a less expensive first-generation antihistamine because of the effect of the latter on sedation and cognition. Four second-generation antihistamines are currently available for children under 12 years of age: cetirizine, loratadine, fexofenadine and azelastine nasal spray; each has been found to be well tolerated and effective. There are no clearcut advantages to distinguish these antihistamines, although for children under 5 years of age, only cetirizine and loratadine are approved. Other agents include pseudoephedrine, an oral vasoconstrictor, for nasal congestion, and the anticholinergic nasal spray ipratropium bromide for rhinorrhoea. Sodium cromoglycate, a mast cell stabiliser nasal spray, may also be useful in this population. For patients with more persistent, severe symptoms, intranasal corticosteroids are indicated, although one might consider azelastine nasal spray, which has anti- inflammatory activity in addition to its antihistamine effect. With the exception of fluticasone propionate for children aged 4 years and older, and mometasone furoate for those aged 3 years and older, the other intranasal corticosteroids including beclomethasone dipropionate, triamcinolone, flunisolide and budesonide are approved for children aged 6 years and older. All are effective, so a major consideration would be cost and safety. For short term therapy of 1 to 2 months, the first-generation intranasal corticosteroids (beclomethasone dipropionate, triamcinolone, budesonide and flunisolide) could be used, and mometasone furoate and fluticasone propionate could be considered for longer-term treatment. Although somewhat more costly, these second-generation drugs have lower bioavailability and thus would have a better safety profile. In patients not responding to the above programme or who require continuous medication, identification of specific triggers by an allergist can allow for specific avoidance measures and/or immunotherapy to decrease the allergic component and increase the effectiveness of the pharmacological regimen.
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Rinitis Alérgica Perenne/tratamiento farmacológico , Rinitis Alérgica Estacional/tratamiento farmacológico , Corticoesteroides/administración & dosificación , Niño , Preescolar , Antagonistas Colinérgicos/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Humanos , Descongestionantes Nasales/uso terapéuticoRESUMEN
BACKGROUND: Both inhaled corticosteroids and leukotriene modifiers are used in the maintenance treatment of persistent asthma. OBJECTIVE: The goal was to compare the efficacy and safety of low-dose fluticasone propionate (FP) and montelukast as first-line maintenance therapy in symptomatic patients by using short-acting beta2-agonists alone to treat persistent asthma. METHODS: In this multicenter, randomized, double-blind, double-dummy, parallel-group study, 533 patients (>15 years old) with persistent asthma who remained symptomatic while taking short-acting beta2-agonists alone were treated with FP (88 microg [2 puffs of 44 microg] twice daily) or montelukast (10 mg once daily) for 24 weeks. RESULTS: Compared with treatment with montelukast, treatment with FP resulted in significantly greater improvements at endpoint in morning predose FEV(1) (22.9% vs 14.5%, P <.001), forced midexpiratory flow (0.66 vs 0.41 L/sec, P <.001), forced vital capacity (0.42 vs 0.29 L, P =.002), morning peak expiratory flow (PEF) (68.5 vs 34.1 L/min, P <.001), and evening PEF (53.9 vs 28.7 L/min, P <.001). Similar improvements in PEF were observed in patients with milder asthma (>70%-80% predicted FEV(1)). At endpoint, FP was more effective than montelukast at decreasing rescue albuterol use (3.1 puffs/day vs 2.3 puffs/day, P <.001), asthma symptom scores (-0.85 [48.6% decrease] vs -0.60 [30.5%], P <.001), and nighttime awakenings due to asthma (-0.64 awakenings/night [62% decrease] vs -0.48 awakenings/night [47.5%], P =.023), and FP increased the percentage of symptom-free days (32.0% vs 18.4% of days, P <.001) compared with montelukast. The adverse event and asthma exacerbation profiles for FP and montelukast were similar. CONCLUSIONS: Low-dose FP is more effective than montelukast as first-line maintenance therapy for patients with persistent asthma who are undertreated and remain symptomatic while taking short-acting beta2-agonists alone.
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Acetatos/uso terapéutico , Androstadienos/administración & dosificación , Asma/tratamiento farmacológico , Quinolinas/uso terapéutico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antiasmáticos/uso terapéutico , Antiinflamatorios/administración & dosificación , Ciclopropanos , Relación Dosis-Respuesta a Droga , Femenino , Fluticasona , Humanos , Masculino , Persona de Mediana Edad , SulfurosRESUMEN
Three open-label extension trials evaluated the safety of budesonide inhalation suspension (BIS; Pulmicort Respules) in 670 children (8 months-9 years of age) with mild-to-severe persistent asthma. Patients were randomized to receive either BIS or conventional asthma therapy (CAT) for 52 weeks. The percentage of patients who discontinued because of clinical adverse events was low and similar among the CAT (0.4%) and BIS (0.7%) groups. After adjusting for length of time in the studies, there were no clinically relevant differences between the BIS and CAT groups in the type, incidence, or intensity of adverse events; vital signs or physical examination outcomes; or changes in clinical laboratory evaluations or oral fungal cultures.
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Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Budesonida/uso terapéutico , Administración por Inhalación , Broncodilatadores/efectos adversos , Budesonida/efectos adversos , Niño , Protección a la Infancia , Preescolar , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Lactante , Bienestar del Lactante , Masculino , Índice de Severidad de la Enfermedad , Tiempo , Factores de Tiempo , Resultado del Tratamiento , Estados Unidos/epidemiología , Privación de TratamientoRESUMEN
Proteins which are secreted or associated with the cell envelope of Mycobacterium tuberculosis may contain protective T-cell epitopes. Prior to this study, a recombinant clone bank of enzymatically active M. tuberculosis-alkaline phosphatase fusions, were screened for immunogenicity in a murine T-cell model. Five of these were selected for further study, and the IFN-gamma secretion and proliferation of human PBMC from purified protein derivative- (PPD)-positive and PPD-negative donors were measured in response to oligopeptides, Mtb-PhoA fusions and one full-length protein. Epitopes from four of the five selected antigens were immunoreactive in the human model and corresponded to cytochrome d ubiquinol oxidase, cytochrome c oxidase subunit II, MTV005.02 and MTV033.08. Thus, this strategy identified novel human immunogenic peptides as possible candidates for a subunit vaccine.
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Antígenos Bacterianos/inmunología , Proteínas Bacterianas/inmunología , Activación de Linfocitos , Linfocitos/inmunología , Mycobacterium tuberculosis/inmunología , Tuberculosis/inmunología , Fosfatasa Alcalina/química , Fosfatasa Alcalina/inmunología , Secuencia de Aminoácidos , Antígenos Bacterianos/química , Proteínas Bacterianas/química , Clonación Molecular , Complejo IV de Transporte de Electrones/genética , Complejo IV de Transporte de Electrones/metabolismo , Epítopos/inmunología , Escherichia coli , Humanos , Interferón gamma/biosíntesis , Datos de Secuencia Molecular , Proteínas Recombinantes de Fusión/química , Proteínas Recombinantes de Fusión/inmunologíaRESUMEN
BACKGROUND: The efficacy and safety of mometasone furoate aqueous nasal spray (MFNS; Nasonex) 200 microg once daily for the treatment and prophylaxis of seasonal allergic rhinitis (SAR) and treatment of perennial rhinitis have been demonstrated in adults. However, the dose response of MFNS in pediatric patients has not yet been characterized. OBJECTIVE: This study was conducted to determine the dose-response relationship of 3 different doses of MFNS in a pediatric population. METHODS: This was a multicenter, double-blind, active- and placebo-controlled study of 679 children 6 to 11 years of age with histories of SAR and documented positive skin test responses. Patients were randomized to one of the following treatment groups for 4 weeks: MFNS 25 microgram once daily, MFNS 100 microgram once daily, MFNS 200 microgram once daily, beclomethasone dipropionate 84 microgram twice daily (168 microgram/day), or placebo. Physician evaluations were performed at days 4, 8, 15, and 29, and patient evaluations were analyzed for days 1 to 15 and 16 to 29. RESULTS: The mean reduction from baseline in physician-evaluated total nasal symptom scores at day 8 (the primary efficacy variable) was significantly greater in the MFNS and beclomethasone dipropionate groups than in the placebo group (P
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Antiinflamatorios/administración & dosificación , Pregnadienodioles/administración & dosificación , Rinitis Alérgica Estacional/tratamiento farmacológico , Administración Intranasal , Antiinflamatorios/farmacocinética , Niño , Preescolar , Relación Dosis-Respuesta a Droga , Método Doble Ciego , Tolerancia a Medicamentos , Femenino , Glucocorticoides , Humanos , Masculino , Furoato de Mometasona , Placebos , Pregnadienodioles/farmacocinética , Equivalencia TerapéuticaRESUMEN
OBJECTIVE: The Pediatric Asthma Diary was developed and validated to assess efficacy of interventions in children with asthma. DESIGN, PATIENTS, AND SETTING: Diary validation was performed in a three week, prospective study of 106 children aged 6-14 years with asthma. Children were classified at baseline as either stable (requiring no additional asthma treatment) or new onset/worse (requiring either addition of or increase in anti-inflammatory treatment). RESULTS: A daytime symptom scale and "day without asthma" were defined from diary questions. Both measures demonstrated significant validity and responsiveness to anti-inflammatory treatment. The stable group experienced a higher percentage of days without asthma during week 1 compared with the new onset/worse group (39.6% v 11.6%, respectively). The new onset/worse patients experienced significant improvement in days without asthma (24.5%) compared with stable patients (6.4%). CONCLUSIONS: The Pediatric Asthma Diary daytime symptom scale and day without asthma are acceptable measures for use in asthma intervention studies of children aged 6-14 years.
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Asma/tratamiento farmacológico , Indicadores de Salud , Registros Médicos , Absentismo , Adolescente , Asma/fisiopatología , Niño , Volumen Espiratorio Forzado , Humanos , Estudios Prospectivos , Reproducibilidad de los Resultados , Índice de Severidad de la Enfermedad , Resultado del Tratamiento , Estados UnidosRESUMEN
STUDY OBJECTIVES: This study investigates the long-term cardiovascular safety of salmeterol powder vs placebo in adolescent and adult patients with mild persistent asthma. DESIGN: Multicenter, randomized, double-blind, placebo-controlled, parallel-group study. SETTING: Eighteen US clinical centers. PATIENTS: Three hundred fifty-two patients (> or = 12 years) with mild persistent asthma (duration > or = 6 months) requiring pharmacotherapy; with FEV1 of 70 to 90% of predicted and without abnormal ECG/continuous ambulatory ECG (Holter). INTERVENTIONS: Randomized to twice-daily salmeterol powder (50 microg) or placebo via breath-actuated device for 52 weeks. Backup albuterol was available to control asthma symptoms. MEASUREMENTS AND RESULTS: Cardiovascular safety was regularly assessed by 12-lead ECG with a 15-s lead II rhythm strip, 24-h continuous ambulatory ECG (Holter) monitoring, serial vital sign measurements, and review of adverse cardiovascular events. No deaths occurred during the study. No clinically significant between-group differences were observed in pulse rate, ECG QTc interval, median number of ventricular or supraventricular ectopic events, incidence of ventricular ectopic couplets and runs, or incidence of > 100 ventricular or supraventricular ectopic events in 24 h. No clinically significant between-group differences were observed in arterial BP or incidence of adverse cardiovascular events. Salmeterol was well tolerated throughout the 52-week study period, with a cardiovascular safety profile similar to that of placebo. CONCLUSIONS: Long-term, twice-daily pharmacotherapy with salmeterol powder is safe and is not associated with unfavorable clinically significant changes in cardiac function or increases in cardiovascular adverse effects.
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Agonistas Adrenérgicos beta/farmacología , Albuterol/análogos & derivados , Asma/tratamiento farmacológico , Sistema Cardiovascular/efectos de los fármacos , Adolescente , Agonistas Adrenérgicos beta/uso terapéutico , Adulto , Anciano , Albuterol/farmacología , Albuterol/uso terapéutico , Niño , Enfermedad Crónica , Método Doble Ciego , Electrocardiografía , Femenino , Corazón/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , Xinafoato de Salmeterol , Factores de Tiempo , Resultado del TratamientoRESUMEN
BACKGROUND: Fluticasone propionate is a topically active glucocorticoid with potent antiinflammatory activity in the treatment of asthma. OBJECTIVE: This study evaluated the safety and efficacy of fluticasone propionate administered via the Diskus and Diskhaler powder delivery devices in subjects with mild-to-moderate asthma. METHODS: Fluticasone propionate (500 microg twice daily) or placebo was administered via the Diskus and Diskhaler to 213 adolescent and adult asthma subjects in a randomized, double-blind, double-dummy, parallel-group study for 12 weeks. Subjects were stratified according to baseline therapy of inhaled corticosteroids or beta2-agonists alone. Subjects were dropped from the study if they met predefined criteria for lack of efficacy. RESULTS: Fluticasone propionate improved pulmonary function both in subjects previously treated with inhaled corticosteroids or beta2-agonists alone. At endpoint, fluticasone propionate significantly improved forced expiratory volume in 1 second (P < .001), morning and evening peak expiratory flow (P < .001), and asthma symptom scores (P < or = .016), and significantly reduced nighttime awakenings (P = .016; Diskhaler group only) and rescue albuterol use (P < .001). Overall, efficacy measurements for the Diskus and Diskhaler were similar. More placebo-treated subjects (34%) withdrew from the study due to lack of efficacy than subjects in the Diskus (5%) or Diskhaler (5%) groups. The incidence and severity of adverse events were similar across groups. Measurement of plasma fluticasone propionate and cortisol concentrations showed no apparent influence of device on systemic exposure. CONCLUSION: Fluticasone propionate powder, administered via the Diskus or Diskhaler inhalation devices, was well tolerated and effective in the treatment of mild-to-moderate persistent asthma.
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Androstadienos/administración & dosificación , Antiasmáticos/administración & dosificación , Asma/tratamiento farmacológico , Nebulizadores y Vaporizadores , Administración por Inhalación , Adolescente , Agonistas Adrenérgicos beta/administración & dosificación , Agonistas Adrenérgicos beta/uso terapéutico , Adulto , Albuterol/administración & dosificación , Albuterol/uso terapéutico , Androstadienos/efectos adversos , Androstadienos/uso terapéutico , Antiasmáticos/efectos adversos , Antiasmáticos/uso terapéutico , Asma/fisiopatología , Broncodilatadores/administración & dosificación , Broncodilatadores/uso terapéutico , Niño , Método Doble Ciego , Embalaje de Medicamentos , Quimioterapia Combinada , Diseño de Equipo , Femenino , Fluticasona , Volumen Espiratorio Forzado/efectos de los fármacos , Humanos , Hidrocortisona/metabolismo , Sistema Hipotálamo-Hipofisario/efectos de los fármacos , Masculino , Pacientes Desistentes del Tratamiento , Ápice del Flujo Espiratorio/efectos de los fármacos , Sistema Hipófiso-Suprarrenal/efectos de los fármacos , Polvos , Seguridad , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
BACKGROUND: Previous trials demonstrated the effectiveness of the leukotriene receptor antagonist zafirlukast in patients with mild-to-moderate asthma. OBJECTIVES: We sought to assess the efficacy and safety of zafirlukast and its effect on patients' quality of life (QOL) during a 13-week, double-blind, placebo-controlled, multicenter trial in adults and adolescents with moderate reversible airflow obstruction. METHODS: Patients (age range, 12 to 68 years) with total daytime asthma symptoms scores of 10 or greater over 7 consecutive days (maximum, 21/wk), FEV1 45% or greater but less than or equal to 80% of predicted value (>/=6 hours after beta2 -agonist), and reversible airway disease were randomized to 20 mg zafirlukast twice daily (nZ = 231) or placebo twice daily (nP = 223). Efficacy was assessed from changes in daytime and nocturnal symptoms, beta2 -agonist use, nasal congestion score, and pulmonary function. QOL was evaluated with a disease-specific Asthma Quality of Life Questionnaire. Safety was determined from adverse event information and clinical laboratory test results. RESULTS: Zafirlukast was significantly (P <.001) more effective than placebo, with reductions from baseline in the daytime asthma symptoms score (-23%), nighttime awakenings with asthma (-19%), and beta2 -agonist use (-24%) and improvements from baseline in morning (+25 L/min) and evening (+18 L/min) peak expiratory flow rates. Compared with placebo, zafirlukast significantly (P /=0.5-unit change from baseline; P
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Asma/tratamiento farmacológico , Broncodilatadores/uso terapéutico , Enfermedades Pulmonares Obstructivas/tratamiento farmacológico , Compuestos de Tosilo/uso terapéutico , Adolescente , Adulto , Anciano , Broncodilatadores/efectos adversos , Niño , Método Doble Ciego , Femenino , Humanos , Indoles , Masculino , Persona de Mediana Edad , Fenilcarbamatos , Calidad de Vida , Sulfonamidas , Compuestos de Tosilo/efectos adversosRESUMEN
BACKGROUND: The number of allergy skin tests required to evaluate patients with respiratory allergy has recently been challenged by the managed care community. OBJECTIVES: The purpose of this study was to determine which aeroallergens are prevalent in patients with respiratory allergy (allergic rhinitis and bronchial asthma) in California. METHODS: Utilizing aeroallergens thought to be relevant from recent aerobiologic and botanic data, 141 allergic and 17 asymptomatic control subjects were tested for the prevalence of 103 allergens. A standardized prick puncture technique and standardized interpretation of wheal/flare responses were utilized using the same lot of allergen for 13 allergy practices distributed throughout California. Frequency curves based on prevalence were established to determine the number of tests required to give up to 90% of positive responses for tree, weed and grass pollen, mold spores, and miscellaneous allergens which included house dust mite, cat, dog, and cockroach allergens. RESULTS: Positive responses in allergic subjects for grasses ranged from 46% to 54%, for weeds 19% to 37%, and for trees 10% to 42%. For molds the range was from 11% to 22%. The response rate for Dermatophagoides pteronyssinus was 53%, for Dermatophagoides farinae 42%, for cat pelt 39% and cat hair 37%, for cockroach 23% and dog dander 19%. Asymptomatic control subjects responded to only 4% of all allergens tested. Ninety percent of all positive tests required three miscellaneous allergens (house dust mite, cat, and cockroach), 9 molds, 2 grasses, 16 weeds, and 27 trees for a total of 57 allergens (56% of total tested). There was no clear relationship between locale and specific allergen response, probably related to the limited number of subjects tested and variability within the same geographic region. Several seldom tested tree and weed allergens showed a higher prevalence rate than several commonly tested for allergens. CONCLUSIONS: This preliminary study suggests that approximately 57 aeroalleroens might be adequate to detect 90% of all positive responses in patients with respiratory allergy in California. This study was limited by subject number and variability between study sites. It is hoped a standardized model can be developed from this pilot study to definitively determine which aeroallergens are relevant in the United States.
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Contaminantes Atmosféricos/inmunología , Hipersensibilidad Respiratoria/inmunología , Adulto , Contaminación del Aire Interior , Alérgenos/análisis , California/epidemiología , Femenino , Humanos , Inmunización , Masculino , Hipersensibilidad Respiratoria/epidemiología , Pruebas CutáneasRESUMEN
A double-blind, randomized, placebo-controlled, parallel-group, multicenter study was conducted to compare the effectiveness of an extended-release formulation of a classical antihistamine, brompheniramine, and a second-generation compound, loratadine, in the treatment of allergic rhinitis. Subjects with symptoms of allergic rhinitis received brompheniramine 12 mg twice daily (n = 112), loratadine 10 mg once daily (n = 112), or placebo twice daily (n = 114) for 7 days. Study medications were blinded using a double-dummy technique. Subjects completed an overall evaluation of symptom relief on a daily basis and returned on treatment days 3 and 7, at which times the investigator assessed symptom severity. The investigator and subject each completed a global efficacy evaluation, and subjects were interviewed regarding adverse experiences. The primary efficacy variable was the physicians' global efficacy evaluation on day 3. Symptoms also were analyzed as summed severity scores for all symptoms and for the nasal symptom cluster of rhinorrhea, sneezing, and nasal blockage. At all post-baseline evaluations (days 3, 7, and averaged over the two days), brompheniramine was significantly better than loratadine and placebo for both sets of summed symptom scores and all three global assessments. Loratadine was significantly better than placebo for physician ratings of total symptom severity averaged over the two days and for the physician and subject ratings of the nasal cluster on day 3. Central nervous system-related symptoms were the most frequently reported adverse experiences; somnolence was reported most frequently by patients taking brompheniramine, and its occurrence was less frequent as treatment continued. A nonprescription, extended-release formulation of brompheniramine 12 mg twice daily provided significantly better relief of symptomatic allergic rhinitis than loratadine 10 mg once daily.
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Antialérgicos/uso terapéutico , Bromofeniramina/uso terapéutico , Antagonistas de los Receptores Histamínicos H1/uso terapéutico , Loratadina/uso terapéutico , Rinitis Alérgica Perenne/tratamiento farmacológico , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antialérgicos/efectos adversos , Bromofeniramina/efectos adversos , Niño , Método Doble Ciego , Femenino , Antagonistas de los Receptores Histamínicos H1/efectos adversos , Humanos , Loratadina/efectos adversos , Masculino , Persona de Mediana Edad , Placebos , Rinitis Alérgica Perenne/patología , Índice de Severidad de la Enfermedad , Resultado del TratamientoRESUMEN
The antiviral activity of 1,7-disulphoanthraquinone (DSA) against hepatitis B viruses was investigated by measuring the titer of HBV surface antigen in the treated serum obtained from the blood of patients with acute infection. The presence of HBsAg was tested by the Vitek Immuno Diagnostic Assay System (VIDAS). The concentration of DSA in the samples was equal to 0.01, 0.1 and 1%, respectively. The results presented clearly showed an extensive disintegration of the virus envelope at elevated temperatures, which resulted in a substantial decrease in the concentration of HBsAg in the serum containing DSA. The concentration of HBsAg decreased also upon UV irradiation of the serum containing DSA in a photochemical reactor for 5 to 15 min, but the effect of degradation was not complete.
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Antraquinonas/farmacología , Antivirales/farmacología , Antígenos de Superficie de la Hepatitis B/sangre , Virus de la Hepatitis B/efectos de los fármacos , Hepatitis B/virología , Antígenos de Superficie de la Hepatitis B/efectos de la radiación , Calor , Humanos , Juego de Reactivos para Diagnóstico , Rayos UltravioletaRESUMEN
BACKGROUND: The inhaled corticosteroid, fluticasone propionate, was compared with the oral bronchodilator theophylline in the maintenance treatment of asthma. OBJECTIVE: The objective of the present study was to compare the efficacy and safety of twice-daily inhaled fluticasone propionate, 50 micrograms, and fluticasone propionate, 100 micrograms, with that of theophylline in the maintenance treatment of mild-to-moderate asthma. METHODS: In this randomized, double-blind, placebo-controlled, parallel-group study, 353 adult and adolescent patients with asthma inadequately controlled with inhaled beta-agonist therapy alone received fluticasone propionate, 50 micrograms, or fluticasone propionate, 100 micrograms, by metered-dose inhaler; theophylline capsules; or placebo twice daily for 12 weeks. Only inhaled albuterol was permitted as needed for acute symptoms. RESULTS: Both fluticasone propionate groups had a significantly greater probability of remaining in the study (ie, meeting asthma stability criteria) than did either the theophylline or placebo group (P < or = .008); 39% and 51% in the theophylline and placebo groups, respectively, were withdrawn due to lack of treatment efficacy compared with 14% and 21% in the fluticasone propionate, 50 micrograms, and fluticasone propionate, 100 micrograms, groups. Both fluticasone propionate groups experienced significantly greater improvement in FEV1 and PEF compared with patients in the theophylline or placebo group (P < or = .004). The incidence of potentially drug-related adverse events was significantly greater in the theophylline group (25%) than in the placebo group (11%) (P = .031), while there were no differences between placebo and fluticasone propionate, 50 micrograms, (18%) or fluticasone propionate 100 micrograms, (22%). CONCLUSION: Twice daily treatment with inhaled fluticasone propionate 50 micrograms or 100 micrograms was significantly more effective than theophylline in the treatment of mild-to-moderate asthma.
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Androstadienos/uso terapéutico , Antiasmáticos/uso terapéutico , Asma/tratamiento farmacológico , Teofilina/uso terapéutico , Administración por Inhalación , Administración Oral , Adolescente , Adulto , Anciano , Albuterol/uso terapéutico , Androstadienos/administración & dosificación , Antiasmáticos/administración & dosificación , Asma/fisiopatología , Ritmo Circadiano , Método Doble Ciego , Femenino , Fluticasona , Volumen Espiratorio Forzado , Humanos , Masculino , Persona de Mediana Edad , Estudios Multicéntricos como Asunto , Teofilina/administración & dosificación , Resultado del TratamientoRESUMEN
In an effort to evaluate conformity with published guidelines for diagnostic allergy skin testing in their locality, a committee of members of the Orange County (California) Society of Allergy and Clinical Immunology surveyed their membership for the number, identity, and rates of sensitization of aeroallergens in a selected patient population. Test data were analyzed on patients who were judged appropriate to undergo immunotherapy. Complete test results of 271 patients were obtained from one third of local allergy specialists. A total of 115 different aeroallergen extracts were identified. By category, tree pollen allergens (32) were followed in declining order by weed pollens (28), molds (22), environmentals (18), and grass pollen extracts (15), for the total of 115. The average number of aeroallergens used by a practice in a comprehensive evaluation was 77 (range, 47-114). When only unequivocally positive reactions were considered (3+ equivalent or greater), Bermuda grass pollen extracts elicited the highest rate, 85%, and the environmental, rat dander, was the lowest at 1.8%. At least 20% of the patients reacted strongly on skin tests to 97% of the extracts. The disparity between the recommendations of a maximum of 30 aeroallergens for a comprehensive evaluation and actual practice procedures merits efforts at resolution.
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Alérgenos , Contaminantes Ambientales , Hongos , Hipersensibilidad/diagnóstico , Polen , Pruebas Cutáneas , Adulto , Anciano , Alérgenos/inmunología , California , Humanos , Hipersensibilidad/inmunología , Persona de Mediana Edad , Reproducibilidad de los ResultadosAsunto(s)
Asma , Ruidos Respiratorios , Asma/diagnóstico , Asma/fisiopatología , Asma/terapia , Enfermedad Crónica , Humanos , LactanteRESUMEN
Presented are the results of trials with hydrogel inserts received by radiation method and applied into the conjunctival sac of rabbits. In the future they can serve for incorporation of some definite drugs.