RESUMO
BACKGROUND: More than a million visits/year characterize acute asthma morbidity at Venezuela's (24 million inhabitants) Ministry of Health ambulatory services, caring for 80% or more of the population; acute morbidity from asthma is second to "viral syndrome" but ahead of diarrhea and other diseases. These acute episodes are the only contact of a poor asthmatic child with this health care system and portray the prevailing approach focused around acute care: to be reversed, a simple cost/effective program ought to be implemented during these acute asthma visits. Since convenience of administration is a key factor in compliance, a pilot study to explore the efficacy of budesonide CFC 400 microg administered on a once-a-day basis for adherence was carried out within a naturalistic real-world design. METHODS: Thirty persistent asthmatic patients attending the Allergology Unit of the Hospital Pediátrico San Juan de Dios in Caracas were enrolled, and their asthma signs/symptoms quantified and registered on diary cards (0-3 scale) as well as peak flow measurements in am/pm for a period of 2 weeks prior to budesonide administration (control data) and until completion of study. Only 12 (mean age: 9 years) of the initial patients were able to properly keep a diary and scheduled visits for a period of 15 weeks. RESULTS: Data allowed comparison between pre- and post-treatment symptoms/signs scores and PF values. After 3 weeks treatment with budesonide, statistically significant improvements were shown for all parameters, except for PF, whose minor improvements did not reach statistical significance. CONCLUSIONS: Budesonide CFC 400 microg administered once a day seems effective in control of asthma signs/symptoms within study design. Confirmation of the above findings in larger groups of patients, treated similarly and for longer periods of time, seems justified. A simple cost-effective intervention, analogous conceptually to the proven successful oral rehydration therapies for diarrhea in public health, should be considered in third world countries with high urban asthma prevalence.
Assuntos
Antiasmáticos/administração & dosagem , Asma/tratamento farmacológico , Budesonida/administração & dosagem , Países em Desenvolvimento , Adolescente , Albuterol/uso terapêutico , Asma/economia , Asma/fisiopatologia , Criança , Serviços de Saúde da Criança , Pré-Escolar , Esquema de Medicação , Humanos , Lactente , Recém-Nascido , Pico do Fluxo Expiratório , Projetos Piloto , Testes Cutâneos/métodos , Resultado do Tratamento , VenezuelaRESUMO
To study the possible effects of Furosemide at the lung level, two groups of isolated rabbit lung preparation were studied. An experimental group underwent a pulmonary hydrostatic oedema when the pressure of the left auricle (PAI) was increased from 0.45 +/- 0.74 t0 11.8 +/- 2.9 cm of H2O, with that increase in PAI we obtained an increase of 0.457 +/- 0.51 g/min in FFR (Fluid Filtration Rate), during this stable and sustained oedema, a 2 mg/Kg dosis of Furosemide was injected every 10 minutes and the possible changes in PAP, PAI, PVA, TFL, PaO2, PaCO2 and pH was observed, but no changes were observed in these parameters during the Furosemide infusion, and the same effect was observed in the control group were the preparations were maintained in basal conditions and without oedema. These results suggests that the Furosemide hat not a direct cardio-pulmonary effects, and the only possible effects could be by increasing diuresis at renal level.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Furosemida/administração & dosagem , Pulmão/efeitos dos fármacos , Artéria Pulmonar/fisiologia , Animais , Pressão Sanguínea/fisiologia , Pulmão/fisiologia , CoelhosRESUMO
Para la terapia de las afecciones respiratorias unos pocos medicamentos se expenden sin la prescripción facultativa (s.p.f). Podría extenderse esta condición a otros madicamentos? A expensas de cuáles requerimientos? Las Autoridades Sanitarias han establecido requisitos relacionados con el medicamento, con el paciente y con el producto. Además, consideramos que es indispensable que el fármaco no produzca efectos adversos como toxicidad, alergia, anafilaxia, acumulación, idiosincrasia y tolerancia, en las formas de taquifilaxia, resistencia o dependencia. Entre los broncodilatadores incluimos los simpaticomiméticos, los inhibidores de la fosfodiesterasa y los anticolinérgicos: su uso impone multiples precauciones que impiden su expendio s.p.f. Entre las drogas antiasmáticas consideramos los glucocorticoides, el cromoglicato disódico y el ketotifeno: los efectos colaterales de estos medicamentos no permiten su expendio s.p.f. Como expectorales orales se usan varias soluciones salinas de posible expendio s.p.f; después de evaluar la asociación medicamentosa de la cual forman parte, como los antihistamínicos (expendio s.p.f. reducido a los de muy bajo efecto sobre S.N.C.) y otros agentes actualmente en revisión por su cuestionada eficacia terapéutica. se consideran susceptibles de expendio s.p.f. agentes mucolíticos como la bromhexina y la S-carboximetilcisteina, dotados de marcada eficacia terapéutica y amplio margen de seguridad. De los antitusígenos no-narcóticos de acción central, algunos son expendidos s.p.f. (ej.: dextrometorfano).Esta condición puede ser extendida a la codeina..