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Tamiya H, Mitani A, Abe M, Nagase T. Putative Bidirectionality of Chronic Obstructive Pulmonary Disease and Periodontal Disease: A Review of the Literature. J Clin Med 2023; 12:5935. [PMID: 37762876 PMCID: PMC10531527 DOI: 10.3390/jcm12185935] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/24/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
The prevalence of chronic obstructive pulmonary disease (COPD) is increasing worldwide and is currently the third leading cause of death globally. The long-term inhalation of toxic substances, mainly cigarette smoke, deteriorates pulmonary function over time, resulting in the development of COPD in adulthood. Periodontal disease is an inflammatory condition that affects most adults and is caused by the bacteria within dental plaque. These bacteria dissolve the gums around the teeth and the bone that supports them, ultimately leading to tooth loss. Periodontal disease and COPD share common risk factors, such as aging and smoking. Other similarities include local chronic inflammation and links with the onset and progression of systemic diseases such as ischemic heart disease and diabetes mellitus. Understanding whether interventions for periodontal disease improve the disease trajectory of COPD (and vice versa) is important, given our rapidly aging society. This review focuses on the putative relationship between COPD and periodontal disease while exploring current evidence and future research directions.
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Affiliation(s)
- Hiroyuki Tamiya
- Division for Health Service Promotion, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- The Department of Respiratory Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Akihisa Mitani
- The Department of Respiratory Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Masanobu Abe
- Department of Sensory and Motor System Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo 113-8654, Japan
| | - Takahide Nagase
- The Department of Respiratory Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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2
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Sanchez A, Mahe E, Miquel J, Abasq C, Phan A, Mazereeuw‐Hautier J, Lemille J, Maruani A, Bonniaud B, Plantin P, Mallet S, Martin H, Hubiche T, Chiaverini C, Lacour J. Perialar intertrigo in children and adolescents: A multicenter prospective study of 41 cases. Pediatr Dermatol 2022; 39:702-707. [PMID: 35699273 PMCID: PMC9796429 DOI: 10.1111/pde.15036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 05/01/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/OBJECTIVES We observed isolated cases of perialar intertrigo in children and teenagers that did not appear to correspond to any known clinical entity. The objective of this study was to describe the clinical features of this dermatosis and the clinical characteristics of the patients. METHODS We conducted a prospective, multicenter cohort study in France from August 2017 to November 2019. All the patients under 18 years of age with chronic perinasal intertrigo were included. A standardized questionnaire detailing the clinical characteristics of the patients and the description of the intertrigo. If possible, a Wood's lamp examination of the intertrigo was done. RESULTS Forty-one patients were included (25 boys and 16 girls, average age: 12.1 years). Intertrigo was bilateral in 38 patients (93%). The majority of patients had no symptoms (54%). Pruritus was present in 39% of cases. Orange red follicular fluorescence was present in the perialar region on Wood's light examination in 78% of cases with active fluorescence. The presumptive diagnoses suggested by the investigators were acne (24.4%), seborrheic dermatitis (19.5%), rosacea (9.8%), psoriasis (9.8%) and perioral dermatitis (7.3%). No diagnosis was proposed in 22% of the cases. CONCLUSIONS We describe a previously undescribed clinical sign which is characterized by a chronic bilateral erythematous intertrigo located in the perialar region. It can be isolated or associated with various facial dermatoses.
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Affiliation(s)
- Adrien Sanchez
- Department of Dermatology‐VenereologyHôpital Archet 2, CHU de NiceNiceFrance
| | - Emmanuel Mahe
- Department of Dermatology‐VenereologyCentre Hospitalier d'ArgenteuilArgenteuilFrance
| | - Juliette Miquel
- Pediatric Dermatology UnitHôpital de Saint Pierre, CHU de la RéunionSaint PierreFrance
| | - Claire Abasq
- Department of Dermatology‐VenereologyHôpital Morvan, CHU de BrestBrestFrance
| | - Alice Phan
- Pediatric Dermatology UnitHôpital Femme‐Mère‐Enfant, Hospices Civils de LyonBronFrance
| | | | - Juliette Lemille
- General Medicine, Hôpital Saint‐Jacques, CHU de NantesNantesFrance
| | - Annabel Maruani
- Department of Dermatology, Unit of Paediatric DermatologyUniversity of Tours, CHU de ToursToursFrance
| | | | - Patrice Plantin
- Department of Dermatology‐VenereologyCentre Hospitalier de QuimperQuimperFrance
| | - Stéphanie Mallet
- Department of Dermatology‐VenereologyHôpital de la Timone, Assistance Publique Hôpitaux de MarseilleMarseilleFrance
| | - Hélène Martin
- Department of Dermatology‐VenereologyHôpital Archet 2, CHU de NiceNiceFrance
| | - Thomas Hubiche
- Department of Dermatology‐VenereologyHôpital Archet 2, CHU de NiceNiceFrance
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3
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Vidal M, Calvão J, Ramos L. Not everything in dermatology is treated with corticosteroids. J Paediatr Child Health 2022; 58:213-214. [PMID: 34796575 DOI: 10.1111/jpc.15833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 10/29/2021] [Accepted: 11/08/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Marta Vidal
- Pediatric Dermatology Service, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Joana Calvão
- Pediatric Dermatology Service, Hospital and University Centre of Coimbra, Coimbra, Portugal
| | - Leonor Ramos
- Pediatric Dermatology Service, Hospital and University Centre of Coimbra, Coimbra, Portugal
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Hollis AN, Ghodke A, Farquhar D, Buckmire RA, Shah RN. Postoperative Inhaled Steroids Following Glottic Airway Surgery Reduces Granulation Tissue Formation. Ann Otol Rhinol Laryngol 2021; 131:1267-1273. [PMID: 34965742 DOI: 10.1177/00034894211065805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Transoral laser surgery for glottic stenosis (transverse cordotomy and anteromedial arytenoidectomy (TCAMA)) is often complicated by granulation tissue (GT) formation. GT can cause dyspnea and may require surgical removal to alleviate airway obstruction. Inhaled corticosteroids (ICS) have been shown to reduce benign vocal fold granulomas, however its use to prevent GT formation has not been described. We aimed to analyze the effect of immediate postoperative ICS on GT formation in patients undergoing transoral laser surgery for glottic stenosis. METHODS A retrospective analysis of patients that had transoral laser surgery for glottic stenosis from 2000 to 2019 was conducted. Surgical instances were grouped into those that received postoperative ICS and those that did not. Demographics, diagnosis, comorbidities, intraoperative adjuvant therapy, and perioperative medications were collected. Differences in GT formation and need for surgical removal were compared between groups. A multivariate exact logistic regression model was performed. RESULTS Forty-four patients were included; 16 required 2 glottic airway surgeries (60 surgical instances). Of the 23 instances where patients received immediate postoperative ICS, 0 patients developed GT; and of the 37 instances that did not receive postoperative ICS, 15 (40.5%) developed GT (P < .0001). Eight (53.3%) of these cases returned to the OR for GT removal. ICS use was solely associated with the absence of GT formation (P = .042) in the multivariate analysis. CONCLUSIONS Immediate postoperative use of ICS seems to be a safe and effective method to prevent granulation tissue formation and subsequent surgery in patients following transoral laser airway surgery for glottic stenosis.
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Affiliation(s)
- Alison N Hollis
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Ameer Ghodke
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Douglas Farquhar
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Robert A Buckmire
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Rupali N Shah
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina School of Medicine, Chapel Hill, NC, USA
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5
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Damiański P, Kardas G, Panek M, Kuna P, Kupczyk M. Improving the risk-to-benefit ratio of inhaled corticosteroids through delivery and dose: current progress and future directions. Expert Opin Drug Saf 2021; 21:499-515. [PMID: 34720035 DOI: 10.1080/14740338.2022.1999926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Inhaled corticosteroids (ICS) are known to increase the risk of systemic and local adverse effects, especially with high doses and long-term use. Hence, considerable resources are invested to improve pharmacokinetic/pharmacodynamic (PK/PD) properties of ICS, effective delivery systems and novel combination therapies to enhance the risk-to-benefit ratio of ICS. AREAS COVERED There is an unmet need for new solutions to achieve optimal clinical outcomes with minimal dose of ICS. This paper gives an overview of novel treatment strategies regarding the safety of ICS therapy on the basis of the three most recent molecules introduced to our everyday clinical practice - ciclesonide, mometasone furoate, and fluticasone furoate. Advances in aerosol devices and new areas of inhalation therapy are also discussed. EXPERT OPINION Current progress in improving the risk-to-benefit ratio of ICS through dose and delivery probably established pathways for further developments. This applies both to the improvement of the PK/PD properties of ICS molecules but also includes technical aspects that lead to simplified applicability of the device with simultaneous optimal drug deposition in the lungs. Indubitably, the future of medicine lies not only in the development of new molecules but also in technology and digital revolution.
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Affiliation(s)
- Piotr Damiański
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Grzegorz Kardas
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Michał Panek
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Piotr Kuna
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Maciej Kupczyk
- Clinical Department of Internal Medicine, Asthma and Allergy, Medical University of Lodz, Lodz, Poland
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Searle T, Ali FR, Al-Niaimi F. Perioral dermatitis: diagnosis, proposed etiologies and management. J Cosmet Dermatol 2021; 20:3839-3848. [PMID: 33751778 DOI: 10.1111/jocd.14060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/05/2021] [Indexed: 11/29/2022]
Abstract
Perioral dermatitis is a common cutaneous condition characterized by acneiform facial eruptions often with an eczematous appearance. A granulomatous subtype exists in addition to the classic variant. Whilst topical corticosteroids have been largely implicated in this condition, its etiology is not completely understood. Using the keywords "corticosteroids," "dermatology," "fusobacteria," "perioral dermatitis", and "periorificial dermatitis" we searched the databases PubMed, MEDLINE and EMBASE to find the relevant literature. Only articles in English were chosen. The level of evidence was evaluated and selected according to the highest level working our way downwards using the Oxford Centre of Evidence-Based Medicine 2011 guidance. This systematic review found the strongest evidence to support topical corticosteroid misuse as the principal causative factor in the pathogenesis of perioral dermatitis. In terms of treatment, further research is required to robustly investigate promising treatment options including tetracyclines, topical metronidazole, topical azelaic acid, adapalene gel and oral isotretinoin.
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Affiliation(s)
- Tamara Searle
- University of Birmingham Medical School, Birmingham, UK
| | - Faisal R Ali
- Dermatological Surgery & Laser Unit, St John's Institute of Dermatology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Firas Al-Niaimi
- Department of Dermatology, Aalborg University Hospital, Aalborg, Denmark
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Langarizadeh MA, Ranjbar Tavakoli M, Abiri A, Ghasempour A, Rezaei M, Ameri A. A review on function and side effects of systemic corticosteroids used in high-grade COVID-19 to prevent cytokine storms. EXCLI JOURNAL 2021; 20:339-365. [PMID: 33746666 PMCID: PMC7975631 DOI: 10.17179/excli2020-3196] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/09/2021] [Indexed: 12/13/2022]
Abstract
In December 2019, a cluster of pneumonia caused by a novel coronavirus (2019-nCoV), officially known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, Hubei province, China. Cytokine storm is an uncontrolled systemic inflammatory response resulting from the release of large amounts of pro-inflammatory cytokines and chemokines that occurs at phase 3 of viral infection. Such emergence led to the development of many clinical trials to discover efficient drugs and therapeutic protocols to fight with this single-stranded RNA virus. Corticosteroids suppress inflammation of the lungs during the cytokine storm, weaken immune responses, and inhibit the elimination of pathogen. For this reason, in COVID-19 corticosteroid therapy, systemic inhibition of inflammation is observed with a wide range of side effects. The present review discusses the effectiveness of the corticosteroid application in COVID-19 infection and the related side effects of these agents. In summary, a number of corticosteroids, including and especially methylprednisolone and dexamethasone, have demonstrated remarkable efficacy, particularly for COVID-19 patients who underwent mechanical ventilation.
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Affiliation(s)
- Mohammad Amin Langarizadeh
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | | | - Ardavan Abiri
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
- Department of Medicinal Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Ghasempour
- Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Masoud Rezaei
- Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
| | - Alieh Ameri
- Department of Medicinal Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
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8
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Melhem O, Savage E, Lehane E. Symptom burden in patients with chronic obstructive pulmonary disease. Appl Nurs Res 2021; 57:151389. [PMID: 33549292 DOI: 10.1016/j.apnr.2020.151389] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/15/2020] [Accepted: 11/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is now a growing body of evidence to suggest that patients with chronic disease experience their symptoms as a burden. Although symptoms are a principal focus for diagnosis and treatment of chronic obstructive pulmonary disease (COPD), there has been little research to date on symptom burden with reference to frequency, severity, and distress of symptoms. METHODS A descriptive, cross-sectional survey design was used. Symptom burden was measured using the Memorial Symptom Assessment Scale (MSAS). A sample of 214 patients with COPD, recruited from one of the major teaching hospitals in Ireland. RESULTS Patients experienced a median of 13 symptoms. Patients with 'very severe' COPD experienced the greatest number, with a median of 15 symptoms, followed by those with 'severe' COPD, with a median of 14 symptoms. Patients with 'mild' and 'moderate' COPD reported a median of 10 symptoms each. The most burdensome symptoms were shortness of breath, lack of energy, difficulty sleeping, worrying, dry mouth, feeling nervous, and feeling irritable. Total symptom burden was found to be low. Patients with 'very severe' COPD had the greatest symptom burden, followed by those with 'severe', 'moderate', and 'mild' COPD. Symptom burden was higher for psychological symptoms, with a mean score of 1.60 compared to the physical symptoms (mean = 0.87). CONCLUSION Patients with COPD experience a remarkably high number of symptoms, and significant symptom burden of both physical and psychological symptoms. There is a need for early assessment and management of both physical and psychological symptoms in all patients with COPD.
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Affiliation(s)
- Omar Melhem
- Nursing Department, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates.
| | - Eileen Savage
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
| | - Elaine Lehane
- School of Nursing & Midwifery, University College Cork, Cork, Ireland
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9
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Shahabadi N, Razlansari M, Zhaleh H. In vitro cytotoxicity studies of smart pH-sensitive lamivudine-loaded CaAl-LDH magnetic nanoparticles against Mel-Rm and A-549 cancer cells. J Biomol Struct Dyn 2020; 40:213-225. [PMID: 32873158 DOI: 10.1080/07391102.2020.1812431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In this study, an effective nano-drug delivery system was prepared by the co-precipitation method via two steps; the preparation of Fe3O4 magnetic nanoparticles and its surface modification with layered double hydroxide (LDH) and loading lamivudine on this nanocarrier (Fe3O4@CaAl-LDH@Lamivudine). The developed nanoparticles (NPs) were characterized by X-ray powder diffraction, scanning electron microscopy, transmission electron microscopy, energy dispersive X-ray analysis, Fourier-transformed infrared spectroscopy, vibrating-sample magnetometry, thermogravimetric analysis, X-ray photoelectron spectroscopy and Brunauer-Emmett-Teller. The prepared system demonstrated an average size of 130 nm. Also, the drug entrapment efficiency was estimated at ∼70%. In vitro, drug release investigations showed a controlled and pH-dependent lamivudine release over 300 min. The in vitro cytotoxic activity of Fe3O4@CaAl-LDH@Lamivudine NPs was explored against Mel-Rm and A-549 cancer cell lines in comparison with lamivudine and nanocarrier using lactate dehydrogenase colorimetric and MTT assay. The results of the MTT assay revealed that the Fe3O4@CaAl-LDH@Lamivudine NPs significantly inhibited the proliferation of Mel-Rm and A-549 cells in a dose-dependent manner. The influences of Fe3O4@CaAl-LDH@Lamivudine on the cancer cell lines by different therapeutic investigation illustrated the remarkable effect in comparison with free drug. Finally, the achieved consequences confirm the anticancer properties of Fe3O4@CaAl-LDH@Lamivudine and indicate that they may be a cost-effective substitute in the treatment of lung and skin cancer.Communicated by Ramaswamy H. Sarma.
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Affiliation(s)
- Nahid Shahabadi
- Inorganic Chemistry Department, Faculty of Chemistry, Razi University, Kermanshah, Iran.,Medical Biology Research Center (MBRC), University of Medical Sciences, Kermanshah, Iran
| | - Mahtab Razlansari
- Inorganic Chemistry Department, Faculty of Chemistry, Razi University, Kermanshah, Iran
| | - Hossein Zhaleh
- Substance Abuse Prevention Research Center, University of Medical Sciences, Kermanshah, Iran
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Abumossalam AM, Ahmed HA, Ibrahim OM, Algreisy TMS, Al-Shenqiti AM. Vocal cordopathy consequent to bronchial asthma inhalation therapy. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2020. [DOI: 10.1186/s43168-020-00010-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Vocal cords signify an imperative lane for air flow in and out of the respiratory tract along with a phonetic role. So, the aim of this work is to assess the impact of habitual versus occasional utilization of inhalation therapy of patients with bronchial asthma on their vocal cords regarding visual endoscopic pathological changes in addition to phonetic dysfunction. This study was conducted on 112 diagnosed bronchial asthma patients (66 male and 46 females). They were classified into the following: group A (habitual user), 65 patients with severe persistent asthma with regular frequent intake of inhalation therapy, and group B (occasional user), 47 patients with intermittent asthma with alternating intake of inhalation therapy. They were submitted to clinical, vocal assessment plus laryngoscopic examination.
Results
The habitual users group demonstrated that laryngeal edema and hyperemia attained the higher percentage in the adult than children age group (60%, 40–67.3%, 50%) respectively together after 6 and 9 months of study followed by laryngeal nodules (5.4%, 0–9%, 10%). Occasional users presented the same findings comparable to the habitual group (27%, 10–32.4%, 20%). Cord paresis, cord dysfunction, and fungal plaques were in the second frequencies in both age groups with the same percentage (3.6%) at the end of the study; however, in occasional users, fungal plaques illustrated low percentage (2.7%, 5.4–0, 10%, respectively).
Conclusion
Inhalation therapy as a form of asthma medication correlated with major counter effects on vocal cords with well-recorded laryngeal hyperemia, edema, and vocal nodules in addition to fungal plaques moreover phonetic dysfunction.
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11
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Sahakijpijarn S, Smyth HD, Miller DP, Weers JG. Post-inhalation cough with therapeutic aerosols: Formulation considerations. Adv Drug Deliv Rev 2020; 165-166:127-141. [PMID: 32417367 DOI: 10.1016/j.addr.2020.05.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 01/20/2023]
Abstract
This review provides an assessment of post-inhalation cough with therapeutic aerosols. Factors that increase cough may be mitigated through design of the drug, formulation, and device. The incidence of cough is typically less than 5% for drugs with a nominal dose less than 1 mg, including asthma and COPD therapeutics. Cough increases markedly as the dose approaches 100 mg. This is due to changes in the composition of epithelial lining fluid (e.g., increases in osmolality, proton concentration). Whether an individual exhibits cough depends on their degree of sensitization to mechanical and chemical stimuli. Hypersensitivity is increased when the drug, formulation or disease result in increases in lung inflammation. Cough related to changes in epithelial lining fluid composition can be limited by using insoluble neutral forms of drugs and excipients.
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13
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Ollech A, Yousif R, Kruse L, Wagner A, Kenner-Bell B, Chamlin S, Yun D, Shen L, Vivar K, Reynolds M, Paller AS, Mancini AJ. Topical calcineurin inhibitors for pediatric periorificial dermatitis. J Am Acad Dermatol 2020; 82:1409-1414. [PMID: 32032693 DOI: 10.1016/j.jaad.2020.01.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 01/18/2020] [Accepted: 01/29/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Data regarding the treatment of periorificial dermatitis with topical calcineurin inhibitors (TCI) in the pediatric population are limited. OBJECTIVE To assess the clinical utility of TCI in pediatric patients with periorificial dermatitis. METHODS A retrospective medical record review of all pediatric patients with periorificial dermatitis treated with TCIs was performed. Follow-up via telephone was performed to capture missing data. RESULTS A total of 132 patients met the inclusion criteria. The median age at diagnosis was 4.2 years (interquartile range, 2.3-8.2). The median follow-up was 5.2 months (interquartile range, 2.1-11.7). Seventy-two patients had evaluable follow-up data. Of these, 48 (67%) patients were treated with TCI alone, 12 (16.7%) were treated with a combination of TCI and topical metronidazole, and 9 (12.5%) were treated with a combination of TCI and a systemic antibiotic. Complete response was noted in 68.8% of patients treated with TCI alone, in 75% of patients treated with TCI and metronidazole, and in 77.8% of patients treated with TCI and a systemic antibiotic. Adverse events were rare and mild in severity. CONCLUSION Topical calcineurin inhibitors are an effective therapeutic option for pediatric patients with periorificial dermatitis and were well tolerated in this cohort.
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Affiliation(s)
- Ayelet Ollech
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
| | - Rame Yousif
- Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lacey Kruse
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Annette Wagner
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Brandi Kenner-Bell
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah Chamlin
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Duri Yun
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lisa Shen
- Department of Dermatology, School of Medicine, Boston University, Boston, Massachusetts
| | - Karina Vivar
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Megan Reynolds
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Amy S Paller
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Anthony J Mancini
- Division of Dermatology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Department of Dermatology, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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14
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Surgical and therapeutic advances in the management of voice problems in children and young people. Curr Opin Otolaryngol Head Neck Surg 2019; 27:178-184. [PMID: 30920984 DOI: 10.1097/moo.0000000000000533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The current article reviews advances in both the assessment of paediatric voice disorders, as well as surgical, medical and therapeutic treatments. RECENT FINDINGS It is important to evaluate the impact of a voice disorder from both the parent and child perspective. Outpatient laryngoscopy with stroboscopy is very possible even in young children; however, high-speed ultrasound is a plausible alternative. High-speed videolaryngoscopy, videokymography and dynamic computed tomography, offer potential for augmenting the assessment of vocal fold vibratory characteristics in children. The evidence to support the efficacy of both indirect and direct voice therapy interventions is growing. The management of vocal fold palsy has advanced to include laryngeal reinnervation. Intubation injury with/without surgical intervention offers challenge and gives rise to voice disorders that may be lifelong. SUMMARY Although assessment and management practices of paediatric voice disorders closely follow those applied to adults, there are important differences and a developmental approach is required when considering both surgical and therapeutic management. Children can benefit from both indirect and direct therapy treatments following an ear, nose and throat assessment which utilizes paediatric instrumentation and considers the health of the entire airway. Underlying medical contributory factors should be explored and treated. Voice disorders due to congenital and acquired changes of the vocal tract may be amenable to surgery.
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Nirmal G, Awasthi S, Gupta S, Aggarwal J. Effect of Different Doses of Inhaled Corticosteroids on the Isolation of Nasopharyngeal Flora in Children with Asthma. Indian Pediatr 2019. [DOI: 10.1007/s13312-019-1646-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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16
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Okauchi S, Kinoshita K, Sato S, Osawa H, Yamada H, Miyazaki K, Satoh H, Hizawa N, Kobayashi H. Rinsing of oropharynx and storage place of respiratory medicine inhaler: A cross-sectional audit. J Gen Fam Med 2019; 20:101-106. [PMID: 31065474 PMCID: PMC6498108 DOI: 10.1002/jgf2.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 02/21/2019] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In patients with bronchial asthma and those with chronic obstructive pulmonary disease (COPD), inhalation therapy and rinsing of the mouth and the oropharynx by gargling ("RMOG") after inhalation are recommended. We performed a cross-sectional audit aimed at investigating (a) the proportion of patients performing "RMOG" after inhalation and (b) storage place of patients' inhaler. METHODS Patients with bronchial asthma and those with COPD were asked by medical aids at outpatient visits whether they did "RMOG every time," "RMOG sometimes," or "no RMOG" after inhalation, and where they stored their inhaler. RESULTS During a six month study period up to September 2017, 330 consecutive patients with asthma and those with COPD were included in the study. Two hundred and thirty-two (70.3%) of the 330 patients answered "RMOG every time" and 98 (29.7%) of them did "RMOG sometimes" and did "no RMOG." There was a difference in the proportion of patients performing RMOG after inhalation with patient age. With regard to the storage location of inhaler, we found the proportion of patients performing RMOG was higher in those who stored inhalers in a room with running water than in those who stored inhalers at other places. This difference was found in patients with both bronchial asthma and those with COPD. CONCLUSIONS Further implementation of "patient education" on performing RMOG after inhalation for patients receiving inhaled medication is still necessary. Our results suggest that it is better to store inhalers in places where there is easy access to tap water used for RMOG.
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Affiliation(s)
- Shinichiro Okauchi
- Division of Respiratory MedicineMito Medical CenterUniversity of TsukubaMitoJapan
| | - Kensuke Kinoshita
- Division of General MedicineMito Medical CenterUniversity of TsukubaMitoJapan
| | - Shinya Sato
- Division of Respiratory MedicineRyugasaki Saiseikai HospitalRyugasakiJapan
| | - Hajime Osawa
- Division of Respiratory MedicineMito Medical CenterUniversity of TsukubaMitoJapan
| | - Hideyasu Yamada
- Division of Respiratory MedicineHitachinaka General HospitalHitachinakaHitachinaka
| | - Kunihiko Miyazaki
- Division of Respiratory MedicineRyugasaki Saiseikai HospitalRyugasakiJapan
| | - Hiroaki Satoh
- Division of Respiratory MedicineMito Medical CenterUniversity of TsukubaMitoJapan
| | - Nobuyuki Hizawa
- Division of Respiratory MedicineFaculty of MedicineUniversity of TsukubaTsukubaJapan
| | - Hiroyuki Kobayashi
- Division of General MedicineMito Medical CenterUniversity of TsukubaMitoJapan
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Comparison of adverse events associated with different spacers used with non-extrafine beclometasone dipropionate for asthma. NPJ Prim Care Respir Med 2019; 29:3. [PMID: 30737400 PMCID: PMC6368625 DOI: 10.1038/s41533-019-0115-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 12/05/2018] [Indexed: 11/30/2022] Open
Abstract
Co-prescription of Aerochamber® spacer with non-extrafine beclometasone diproprionate (non-EF BDP) is common but unlicensed. We report a comparison of inhaled corticosteroid (ICS)-related adverse events between patients co-prescribed Aerochamber compared to the licensed Volumatic® spacer. We utilised two historical cohorts: questionnaire-based and electronic medical record (EMR)-based, to assess patient-reported and EMR-recorded adverse events in patients with asthma prescribed non-EF BDP. Marginal effect estimate (MEE) was calculated to determine non-inferiority of Aerochamber compared to Volumatic in terms of patient-reported oral thrush and hoarseness with margin of 0.13. Other patient-reported adverse events (sore throat, bruising, weight gain, and coughing), and EMR-recorded adverse events were also assessed. Rate of patient-reported oral adverse events were non-inferior in 385 patients prescribed Aerochamber compared to 155 patients prescribed Volumatic (27.7 vs 29.9%; MEE, −0.043; 95% CI, −0.133 to 0.047). Total patient-reported adverse events did not differ significantly between Aerochamber and Volumatic (53.3 vs 49.7% with ≥1 adverse event). The EMR-based study of 1471 matched pairs of subjects did not show significantly different number of EMR-recorded adverse events between Aerochamber and Volumatic (12.5 vs 12.8% with ≥1 adverse events). Co-prescribing Aerochamber with non-EF BDP does not increase the risk for patient-reported and EMR-recorded ICS-related adverse events compared to co-prescribing Volumatic. A study of spacer devices for use with asthma inhalers shows no significant difference in the incidence of side-effects between licensed and unlicensed spacers. Spacers offer a way of improving the dose inhaled, particularly in children and those adults who struggle to use asthma inhalers correctly. However, non-extrafine beclomethasone dipropionate (like Clenil Modulite) inhalers are frequently co-prescribed with unlicensed Aerochamber spacers rather than the Volumatic spacer which is licensed for this drug. David Price at the University of Aberdeen, UK, and co-workers analysed data from two historical studies to verify whether Aerochamber use enhanced the risk of unpleasant side effects for patients, such as oral thrush or hoarseness. They found no significant difference between licensed and unlicensed spacers and the chances of adverse events, suggesting both are suitable for use with non-extrafine beclomethasone dipropionate inhalers.
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Kaplan A, Hardjojo A, Yu S, Price D. Asthma Across Age: Insights From Primary Care. Front Pediatr 2019; 7:162. [PMID: 31131265 PMCID: PMC6510260 DOI: 10.3389/fped.2019.00162] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 04/08/2019] [Indexed: 11/16/2022] Open
Abstract
Asthma is a heterogeneous disease comprising of multiple phenotypes and affects patients from childhood up to old age. In this review, we summarize the current knowledge on the similarities and differences in asthma across different age-groups, with emphasis on the perspective from primary care. Despite the similar disease presentation, phenotyping studies showed that there are differences in the distribution of phenotypes of asthma presenting in childhood compared to that in adulthood. Whereas, asthma with early age of onset tends to be of the atopic phenotype, the disease shifts toward the non-atopic phenotypes at later ages. Studies within primary care patients aiming to elucidate risk factors for future asthma exacerbation have shown pediatric and elderly patients to be at higher risk for future asthma attacks compared to other adult patients. Regardless, both pediatric and adult studies demonstrated previous asthma episodes and severity, along with high blood eosinophil to predict subsequent asthma attacks. Differences in childhood and adult asthma are not limited to the underlying phenotypes but also extends to the challenges in the diagnosis, treatment, and management of the disease. Diagnosis of asthma is complicated by age-specific differential diagnoses such as infectious wheezing and nasal obstruction in children, and aging-related problems such as heart disease and obesity in the elderly. There are also age-related issues leading to decreased disease control such as non-adherence, tobacco use, difficulty in using inhalers and corticosteroid-related side effects which hinder asthma control at different patient age-groups. Several clinical guidelines are available to guide the diagnosis and drug prescription of asthma in pediatric patients. However, there are conflicting recommendations for the diagnostic tools and treatment for pediatric patients, posing additional challenges for primary care physicians in working with multiple guidelines. While tools such as spirometry and peak flow variability are often available in primary care, their usage in preschool patients is not consistently recommended. FeNO measurement may be a valuable non-invasive tool which can be adopted by primary physicians to assist asthma diagnosis in preschool-age patients.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Antony Hardjojo
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Shaylynn Yu
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.,Optimum Patient Care, Cambridge, United Kingdom
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19
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George C, Walsh S. Periocular rash. BMJ 2018; 363:k5098. [PMID: 30578243 DOI: 10.1136/bmj.k5098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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20
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Lee SH, Heng D, Xavier VJ, Chan KP, Ng WK, Zhao Y, Chan HK, Tan RB. Inhaled non-steroidal polyphenolic alternatives for anti-inflammatory combination therapy. POWDER TECHNOL 2018. [DOI: 10.1016/j.powtec.2018.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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21
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Maarouf M, Saberian C, Lio PA, Shi VY. Head-and-neck dermatitis: Diagnostic difficulties and management pearls. Pediatr Dermatol 2018; 35:748-753. [PMID: 30152560 DOI: 10.1111/pde.13642] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Head-and-neck dermatitis is a variant of atopic dermatitis (AD) often seen in children and is challenging to diagnose, as it frequently overlaps with other eczematous dermatoses. Successful head-and-neck dermatitis (HND) treatment requires identification of common triggers and clinical mimickers, such as airborne dermatitis, periorificial dermatitis, and steroid-induced rosacea. Head-and-neck involvement negatively impacts quality of life and is often harder to treat than other body parts, as long-term topical corticosteroid use carries higher risks for skin atrophy on the face. Heating and flushing associated with HND further exacerbate the itch-and-scratch-cycle and disrupt sleep. We aim to address diagnostic gaps, identify clinical mimickers, and share clinical pearls in managing HND, including cooling pillows, thermal water sprays, rice starch paper facial masks, and tips to minimize food and saliva-induced facial irritation.
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Affiliation(s)
- Melody Maarouf
- College of Medicine, University of Arizona, Tucson, Arizona
| | | | - Peter A Lio
- Medical Dermatology Associates of Chicago, Chicago, Illinois
| | - Vivian Y Shi
- Division of Dermatology, Department of Medicine, University of Arizona, Tucson, Arizona
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22
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Kaur S, Singh V. Asthma and Medicines - Long-Term Side-Effects, Monitoring and Dose Titration. Indian J Pediatr 2018; 85:748-756. [PMID: 29306991 DOI: 10.1007/s12098-017-2553-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 11/22/2017] [Indexed: 01/30/2023]
Abstract
Asthma is a major pediatric respiratory morbidity requiring long-term management. A thorough knowledge of long-term medication side-effects in children is, thus, essential for every physician dealing with childhood asthma. Establishing diagnosis and initiating treatment is just a beginning of the journey. Ongoing monitoring is an essential component of comprehensive asthma management programme. Monitoring includes not only assessment of asthma control but also checking for adherence to treatment, technique of inhaler device use, associated co-morbities, if any, and potential environmental exposure. Various tools - both subjective and objective - are available for assessment of asthma control. However, evidence for their optimum use in different settings and patient groups is lacking and monitoring has to be customized depending on available resources and individual patient characteristics. Patient education is an important component of long-term asthma therapy. The ultimate aim is to achieve optimum asthma control i.e., achieve and maintain control of clinical symptoms, decrease future risk to patients (risk of exacerbations, progressive loss of lung function and development of fixed airflow obstruction, adverse effects of medications) and enabling the child to lead a life without restrictions, at lowest possible dose of drugs. This article reviews the side-effects of medications used for long-term management of asthma and discusses current literature on asthma monitoring and dose titration in pediatric population to help the asthma therapist not only prescribe the drugs rationally but also help the family make right choices for treatment.
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Affiliation(s)
- Satnam Kaur
- Department of Pediatrics, Vardhman Mahavir Medical College and Associated Safdarjung Hospital, New Delhi, India
| | - Varinder Singh
- Department of Pediatrics, Lady Hardinge Medical College and Associated Kalawati Saran Children's Hospital, New Delhi, India.
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23
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Alves MF, Ferreira LAMP, Gadelha FAAF, Ferreira LKDP, Felix MB, Scotti MT, Scotti L, de Oliveira KM, dos Santos SG, Diniz MDFFM. Toxicological evaluation in silico and in vivo of secondary metabolites of Cissampelos sympodialis in Mus musculus mice following inhalation. Nat Prod Res 2017; 33:789-795. [DOI: 10.1080/14786419.2017.1410805] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mateus Feitosa Alves
- Postgraduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba , João Pessoa, Brazil
| | | | | | | | - Mayara Barbalho Felix
- Postgraduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba , João Pessoa, Brazil
| | - Marcus Tullius Scotti
- Postgraduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba , João Pessoa, Brazil
| | - Luciana Scotti
- Postgraduate Program in Natural and Synthetic Bioactive Products, Federal University of Paraíba , João Pessoa, Brazil
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Leung JS, Johnson DW, Sperou AJ, Crotts J, Saude E, Hartling L, Stang A. A systematic review of adverse drug events associated with administration of common asthma medications in children. PLoS One 2017; 12:e0182738. [PMID: 28793336 PMCID: PMC5549998 DOI: 10.1371/journal.pone.0182738] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 07/24/2017] [Indexed: 12/16/2022] Open
Abstract
Objective To systematically review the literature and determine frequencies of adverse drug events (ADE) associated with pediatric asthma medications. Methods Following PRISMA guidelines, we systematically searched six bibliographic databases between January 1991 and January 2017. Study eligibility, data extraction and quality assessment were independently completed and verified by two reviewers. We included randomized control trials (RCT), case-control, cohort, or quasi-experimental studies where the primary objective was identifying ADE in children 1 month– 18 years old exposed to commercial asthma medications. The primary outcome was ADE frequency. Findings Our search identified 14,540 citations. 46 studies were included: 24 RCT, 15 cohort, 4 RCT pooled analyses, 1 case-control, 1 open-label trial and 1 quasi-experimental study. Studies examined the following drug classes: inhaled corticosteroids (ICS) (n = 24), short-acting beta-agonists (n = 10), long-acting beta-agonists (LABA) (n = 3), ICS + LABA (n = 3), Leukotriene Receptor Antagonists (n = 3) and others (n = 3). 29 studies occurred in North America, and 29 were industry funded. We report a detailed index of 406 ADE descriptions and frequencies organized by drug class. The majority of data focuses on ICS, with 174 ADE affecting 13 organ systems including adrenal and growth suppression. We observed serious ADE, although they were rare, with frequency ranging between 0.9–6% per drug. There were no confirmed deaths, except for 13 potential deaths in a LABA study including combined adult and pediatric participants. We identified substantial methodological concerns, particularly with identifying ADE and determining severity. No studies utilized available standardized causality, severity or preventability assessments. Conclusion The majority of studies focus on ICS, with adrenal and growth suppression described. Serious ADE are relatively uncommon, with no confirmed pediatric deaths. We identify substantial methodological concerns, highlighting need for standardization with future research examining pediatric asthma medication safety.
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Affiliation(s)
- James S. Leung
- Division of Pediatric Emergency Medicine, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
- * E-mail:
| | - David W. Johnson
- Departments of Pediatrics, Emergency Medicine, and Physiology and Pharmacology, University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
| | - Arissa J. Sperou
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jennifer Crotts
- Departments of Pediatrics, Emergency Medicine, Pediatric Emergency Research Institute, Calgary, Alberta, Canada
| | - Erik Saude
- Departments of Emergency Medicine and Pediatric Emergency Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lisa Hartling
- Alberta Research Center for Health Evidence, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Antonia Stang
- Departments of Pediatrics, Emergency Medicine, and Community Health Sciences, University of Calgary, Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada
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Abstract
BACKGROUND Asthma is a common chronic disease in both adults and children. Inhaled corticosteroids (ICS) and β2-agonists are the major medications treating asthma with many side effects. Acupuncture has been used in many diseases including asthma. We aim to assess the efficacy and safety of acupuncture for asthma. METHODS The following electronical databases will be searched from inception to January 1, 2017: Medline, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), SinoMed, the China National Knowledge Infrastructure Database (CNKI), the Chinese Scientific Journal Database (VIP database), and the Wanfang database. We will also search reference lists of identified studies, potential gray literatures, relevant conference abstracts, and registers of clinical trials. Two reviewers will independently undertake study selection, data extraction, and quality assessment. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. Changes in lung function will be assessed as the primary outcome. The level of control, medication usage, quality of life, exacerbations, symptoms, adverse events will be evaluated as the secondary outcomes. The RevMan V.5.3.5 will be employed for meta-analysis. Continuous outcomes will be presented as mean difference or standard mean difference, while dichotomous data will be expressed as relative risk. RESULTS This study will provide a high-quality synthesis of current evidence of acupuncture for asthma from several aspects including lung function, the level of control, medication usage, quality of life, exacerbations, symptoms and adverse events. CONCLUSION The conclusion of our study will provide updated evidence to judge whether acupuncture is an effective intervention for children with asthma. ETHICS AND DISSEMINATION It is not necessary for ethical approval because individuals cannot be identified. The protocol will be disseminated in a peer-reviewed journal or presented at a relevant conference. PROSPERO REGISTRATION NUMBER PROSPERO CRD42017054562.
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Affiliation(s)
- Meng Li
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Xing Zhang
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Haipeng Bao
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Chunlei Li
- School of Graduates, Beijing University of Chinese Medicine, Beijing, China
| | - Peitong Zhang
- Department of Oncology, Guang’anmen Hospital, China Academy of Chinese Medical Sciences
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26
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Incidence of oral thrush in patients with COPD prescribed inhaled corticosteroids: Effect of drug, dose, and device. Respir Med 2016; 120:54-63. [DOI: 10.1016/j.rmed.2016.09.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Revised: 09/20/2016] [Accepted: 09/21/2016] [Indexed: 11/19/2022]
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Spantideas N, Drosou E, Bougea A, Assimakopoulos D. Inhaled Corticosteroids and Voice Problems. What Is New? J Voice 2016; 31:384.e1-384.e7. [PMID: 27742496 DOI: 10.1016/j.jvoice.2016.09.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 09/05/2016] [Accepted: 09/08/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Voice problems are the most common and most annoying local side effect of inhaled corticosteroids (ICS), affecting not only patients' treatment compliance but also their quality of life. The literature is very poor regarding prevalence, mechanism, prevention, and management of voice problems attributed to ICS use and especially for the new ICS, ciclesonide. Prevalence of dysphonia seems to be less common with the use of ciclesonide and beclomethasone dipropionate. METHOD We conducted a bibliography review based on recently published data, including data from the recently introduced ICS, ciclesonide, which are lacking in previous reviews. RESULTS Very little improvement, based on limited number of new papers published during previous years without any direct comparison between available ICS, has been made in our understanding of ICS local side effects. CONCLUSION Our understanding concerning basic information of ICS effects on voice still remains poor, and further investigation is needed to have a better understanding on epidemiology, predisposing factors, mechanisms, prevention, and treatment of voice problems attributed to ICS.
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Affiliation(s)
- Nikolaos Spantideas
- Athens Speech, Language and Swallowing Institute, 10 Lontou Street, Glyfada, Athens 16675, Greece.
| | - Eirini Drosou
- Athens Speech, Language and Swallowing Institute, 37 Oinois Street, Glyfada, Athens 16674, Greece
| | - Anastasia Bougea
- Athens Speech, Language and Swallowing Institute, 10 Lontou Street, Glyfada, Athens 16675, Greece
| | - Dimitrios Assimakopoulos
- ENT Department in University Hospital of Ioannina, Medical School of the University of Ioannina, 51 Napoleontos Zerva Street, Ioannina 45332, Greece
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28
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Khodaei H, Alizadeh M. Inhibition of IL-4 but not IFN-γ production by splenocytes of mice immunized with ovalbumin after oral administration of 5-hydroxymethylfurfural. FOOD AGR IMMUNOL 2016. [DOI: 10.1080/09540105.2016.1202208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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29
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Navarrete BA, Palacios PJR, Aguilar-Salvatierra A, Guardia J, Gómez-Moreno G. Effect of inhaled corticosteroids on salival composition: a cross-sectional study in patients with bronchial asthma. Clin Drug Investig 2016; 35:569-74. [PMID: 26271244 DOI: 10.1007/s40261-015-0313-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To date, no evidence exists in the literature as to the effects of inhaled corticosteroids (ICs) on salivary composition in patients with bronchial asthma. OBJECTIVE The aim of this study was to assess the effect of ICs on salival composition. METHODS Adult patients attending an outpatient respiratory clinic who were classified into two groups (controls and patients with bronchial asthma receiving ICs), were recruited in this cross-sectional study. For each participant, data of clinical records, baseline history of asthma, and regular IC dose were recorded. A sample of stimulated saliva was collected and processed for investigation of mucin 5B (MUC5B), lipoxygenase (LPO), total antioxidant capacity, and 8-hydroxydeoxyguanosine (8-OHdG) levels. RESULTS Overall, 103 patients (49 controls and 54 patients receiving regular treatment with ICs) were recruited. No differences in comorbidities or smoking habits were observed. Patients treated with high-doses of ICs showed lower levels of salival MUC5B compared with those treated with medium IC doses or those not treated with ICs (1.60 vs. 2.20 vs. 2.53 ng/mL; p = 0.042). CONCLUSION In patients with asthma, treatment with high-doses of ICs is associated with reduced levels of salivary MUC5B. This effect can explain some of the effects of ICs on oral health.
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Hu Y, Cantarero-Arévalo L. Ethnic differences in adverse drug reactions to asthma medications: a systematic review. J Asthma 2015; 53:69-75. [PMID: 26365429 DOI: 10.3109/02770903.2015.1058395] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Information on ethnic diversity of adverse drug reactions (ADRs) to asthma medications is rare despite evidence suggesting higher risk for African Americans when using β2-adrenergic receptor agonists. The objectives are to investigate how ethnic background was involved in ADR assessment and to examine the relationship between ethnic background and ADRs to asthma medications. METHODS MEDLINE was searched until March 2014. All types of studies reporting ADRs to asthma medications involving more than one ethnic group were included. Extracted information includes study designs, ethnic backgrounds, intervention, and types and severities of ADRs. RESULTS Among the selected 15 randomised clinical trials, six pooled analyses of randomized clinical trials, and five prospective observational studies, only six studies compared ADRs across different ethnic groups. The majority of the comparisons were either statistically insignificant or inconclusive. CONCLUSIONS Ethnicity was largely overlooked. Most studies neglected to report ADRs by ethnicity. Lack of consistency in defining ethnicities complicated further pooled analyses. Despite the higher prevalence of asthma among specific ethnic minority groups, few studies disaggregated information by ethnic background, and reports of ADRs to asthma medications in different ethnic groups were rare. We suggest that the inclusion of ADR analysis by different ethnic backgrounds is desirable.
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Affiliation(s)
- Yusun Hu
- a Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Lourdes Cantarero-Arévalo
- a Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
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31
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Visser R, Wind M, de Graaf BJ, de Jongh FHC, van der Palen J, Thio BJ. The effect of body posture during medication inhalation on exercise induced bronchoconstriction in asthmatic children. Respir Med 2015; 109:1257-61. [PMID: 26341547 DOI: 10.1016/j.rmed.2015.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 08/01/2015] [Accepted: 08/15/2015] [Indexed: 10/23/2022]
Abstract
RATIONALE Inhaling medication in a standard body posture leads to impaction of particles in the sharp angle of the upper airway. Stretching the upper airway by extending the neck in a forward leaning body posture may improve pulmonary deposition. A single dose of inhaled corticosteroids (ICS) offers acute, but moderate protection against exercise induced bronchoconstriction (EIB). This study investigated whether inhaling a single dose of ICS in a forward leaning posture improves this protection against EIB. METHODS 32 Asthmatic children, 5-16 years, with EIB (Median fall in FEV1 or FEV0.5 30.9%) performed two exercise challenge tests (ECT's) with spirometry in a single blinded cross-over trial design. Children inhaled a single dose of 200 μg beclomethasone dipropionate (BDP) 4 h before the ECT, once in the standard posture and once with the neck extended in a forward leaning posture. Spirometry was also performed before the inhalation of the single dose of BDP. RESULTS Inhalation of BDP in both body postures provided similar protection against EIB (fall in FEV1 or FEV0.1 in standard posture 16.7%; in forward leaning posture 15.1%, p = 0.83). Inhaling ICS in a forward leaning posture significantly delayed EIB compared to inhaling in the standard posture (respectively 2.5 min ± 1.0 min vs. 1.6 min ± 0.8 min; difference 0.9 min (95CI 0.25; 1.44 min); p = 0.01). CONCLUSION Inhalation of a single dose BDP in both the forward leaning posture and the standard posture provided effective and similar protection against EIB in asthmatic children, but the forward leaning posture resulted in a delay of EIB. REGISTER NTR3432 (www.trialregister.nl).
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Affiliation(s)
- Reina Visser
- Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands.
| | - Mariet Wind
- Department of Emergency, Röpcke-Zweers Hospital, Hardenberg, The Netherlands
| | - Beike J de Graaf
- Department of Psychiatry, Ziekenhuisgroep Twente, Almelo, The Netherlands
| | - Frans H C de Jongh
- Department of Pulmonary Function, Medisch Spectrum Twente, Enschede, The Netherlands
| | - Job van der Palen
- Medical School Twente, Medisch Spectrum Twente, Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, Enschede, The Netherlands
| | - Bernard J Thio
- Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA, Enschede, The Netherlands
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Brigic A, Kobaslija S, Zukanovic A. Cariogenic Potential of Inhaled Antiasthmatic Drugs. Med Arch 2015; 69:247-50. [PMID: 26543312 PMCID: PMC4610653 DOI: 10.5455/medarh.2015.69.247-250] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 07/19/2015] [Indexed: 12/01/2022] Open
Abstract
Introduction: The organism of children with asthma is exposed to the effects of the disease but also the drugs for its treatment. Antiasthmatic drugs have different modes that promote the caries formation which varies according to their basic pharmacological composition. Namely, these drugs have a relatively low pH (5.5), can contain sweeteners such as lactose monohydrate in order to improve the drug taste or both. Frequent consumption of these inhalers in combination with reduced secretion of saliva increases the risk of caries. Material and methods: The study sample consisted of 200 patients, age from 7-14 years, divided into two groups: control group (n1 = 100) consisted of healthy children and the experimental group consisted of children suffering from asthma (n2 = 100). In both groups of respondents are determined the DMFT index, plaque index value and hygienic-dietary habits using the questionnaire. The subjects in the control group had significantly higher DMFT index than subjects in the experimental group (p = 0.004). It is determined that there are no significant differences in the values of plaque index (p>0.05). Conclusion: The effect of different diseases or medications from their treatment, diet and fermentable carbohydrates in the etiology of dental caries cannot be observed outside the living conditions of subjects, their social epidemiologic status, age, habits, oral hygiene, fluoride use, etc.
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Affiliation(s)
- Amela Brigic
- Pediatric Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Sedin Kobaslija
- Pediatric Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - Amila Zukanovic
- Pediatric Clinic, University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
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Visser R, van der Palen J, de Jongh FHC, Thio BJ. Reversibility after inhaling salbutamol in different body postures in asthmatic children: a pilot study. Respir Med 2015; 109:459-62. [PMID: 25727243 DOI: 10.1016/j.rmed.2015.02.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 02/04/2015] [Accepted: 02/06/2015] [Indexed: 10/24/2022]
Abstract
RATIONALE Pulmonary medication is mostly delivered in the form of medical aerosols to minimize systemic side effects. A major drawback of inhaled medication is that the majority of inhaled particles impacts in the oropharynx at the sharp bend of the airway. Stretching the airway by a forward leaning body posture with the neck extended ("sniffing position") may improve pulmonary deposition and clinical effects. METHODS 41 asthmatic children who were planned for standard reversibility testing at the pulmonary function lab, alternately inhaled 200 μgr salbutamol with an Autohaler(®) in the standard or in the forward leaning body posture. Forced Expiratory Volume in 1 s (FEV1), Forced Vital Capacity (FVC), Peak Expiratory Flow (PEF), Mean Expiratory Flow at 25% of vital capacity (MEF25) and Mean Expiratory Flow at 75% of vital capacity (MEF75) were analysed. RESULTS The children in the forward leaning body posture group showed a significantly higher mean FEV1 reversibility than the control group after inhalation of 200 μgr salbutamol (10.2% versus 4.1%, p = 0.019). Additionally, mean MEF75 was significantly more reversible in the forward leaning body posture group versus the standard body posture group (32.2% resp. 8.9%, p = 0.013). CONCLUSION This pilot study showed a higher reversibility of FEV1 and MEF75 after inhaling salbutamol in a forward leaning body posture compared to the standard body posture in asthmatic children. This suggests that pulmonary effects of salbutamol can be improved by inhaling in a forward leaning body posture with the neck extended. This effect is possibly due to a higher pulmonary deposition of salbutamol and should be confirmed in a randomized controlled trial.
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Affiliation(s)
- R Visser
- Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands.
| | - J van der Palen
- Medical School Twente, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands; Department of Research Methodology, Measurement and Data Analysis, University of Twente, P.O. Box 217, 7500 AE Enschede, The Netherlands.
| | - F H C de Jongh
- Department of Pulmonary Function, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands.
| | - B J Thio
- Department of Pediatrics, Medisch Spectrum Twente, P.O. Box 50 000, 7500 KA Enschede, The Netherlands.
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Khalifa MAAA, Abouelkheir HM, Khodiar SEF, Mohamed GAM. Salivary composition and dental caries among children controlled asthmatics. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Alcázar Navarrete B, Gómez-Moreno G, Aguilar-Salvatierra A, Guardia J, Romero Palacios PJ. Xerostomia relates to the degree of asthma control. J Oral Pathol Med 2014; 44:273-7. [PMID: 25154765 DOI: 10.1111/jop.12228] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2014] [Indexed: 11/27/2022]
Abstract
Few studies have assessed the relationships between xerostomia and the use of inhaled corticosteroids (ICS). The main objective of this study was to investigate the prevalence of xerostomia in a respiratory outpatient clinic and its relationship with bronchial asthma and ICS use. A cross-sectional observational study of patients recruited in an outpatient setting divided them according to previous diagnoses of bronchial asthma. Data about pulmonary function, concomitant medication, medical comorbidities, Xerostomia Inventory test (XI test), and the degree of asthma control by ACT (asthma control test) were collected for each patient. A linear regression model was applied, using the XI score as dependent variable and the ACT score as independent variable. The 57 patients were divided into asthmatics (40 patients, 70.2%) and control group without asthma (17, 29.8%). The prevalence of xerostomia was 87.7% (50 patients), with no differences between the study groups or current dose of ICS. In the asthmatic group, patients with uncontrolled asthma had worse XI scores than those with partially or totally controlled asthma (30.43 ± 8.71 vs. 24.92 ± 8.08; P < 0.05). In a logistic regression model, the XI test was significantly associated to ACT scores with a moderately strong correlation (r = 0.55; P = 0.005) after adjusting for the current daily dose of ICS. Xerostomia is a common symptom in the ambulatory setting. There is a moderate relationship between the degree of asthma control and the severity of xerostomia.
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Affiliation(s)
- Bernardino Alcázar Navarrete
- Pneumology Department, AIG of Medicine, Hospital de Alta Resolución de Loja, Granada, Spain; Department of Medicine, School of Medicine, University of Granada, Granada, Spain
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Voice changes in patients with chronic obstructive pulmonary disease. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.03.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Pinto CR, Almeida NR, Marques TS, Yamamura LLL, Costa LA, Souza-Machado A. Local adverse effects associated with the use of inhaled corticosteroids in patients with moderate or severe asthma. J Bras Pneumol 2014; 39:409-17. [PMID: 24068261 PMCID: PMC4075864 DOI: 10.1590/s1806-37132013000400003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 05/23/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE: To describe and characterize local adverse effects (in the oral cavity,
pharynx, and larynx) associated with the use of inhaled corticosteroids
(ICSs) in patients with moderate or severe asthma. METHODS: This was a cross-sectional study involving a convenience sample of 200
asthma patients followed in the Department of Pharmaceutical Care of the
Bahia State Asthma and Allergic Rhinitis Control Program Referral Center,
located in the city of Salvador, Brazil. The patients were ≥ 18 years of age
and had been using ICSs regularly for at least 6 months. Local adverse
effects (irritation, pain, dry throat, throat clearing, hoarseness, reduced
vocal intensity, loss of voice, sensation of thirst, cough during ICS use,
altered sense of taste, and presence of oral candidiasis) were assessed
using a 30-day recall questionnaire. RESULTS: Of the 200 patients studied, 159 (79.5%) were women. The mean age was 50.7 ±
14.4 years. In this sample, 55 patients (27.5%) were using high doses of
ICS, with a median treatment duration of 38 months. Regarding the symptoms,
163 patients (81.5%) reported at least one adverse effect, and 131 (65.5%)
had a daily perception of at least one symptom. Vocal and pharyngeal
symptoms were identified in 57 (28.5%) and 154 (77.0%) of the patients,
respectively. The most commonly reported adverse effects were dry throat,
throat clearing, sensation of thirst, and hoarseness. CONCLUSIONS: Self-reported adverse effects related to ICS use were common among the asthma
patients evaluated here.
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Tempark T, Shwayder TA. Perioral dermatitis: a review of the condition with special attention to treatment options. Am J Clin Dermatol 2014; 15:101-13. [PMID: 24623018 DOI: 10.1007/s40257-014-0067-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Perioral dermatitis is a common acneiform facial eruption found in both adults and children. Its variants are periorificial and granulomatous periorificial dermatitis. The etiology of perioral dermatitis remains unknown; however, topical corticosteroid use on the face commonly precedes the manifestation of this condition. There are an overwhelming number of treatment options for perioral dermatitis, and the options in children are slightly different from those in adults for both systemic medications and topical treatment. This article provides a literature review of the various applicable treatments available based on the level and quality of the evidence by the US Preventive Service Task Force. Oral tetracycline reveals the best valid evidence. However, if the patient is less than 8 years old, then this oral therapy may not be suitable. Topical metronidazole, erythromycin, and pimecrolimus also represent effective treatment choices with good evidence. Topical corticosteroid use is common in these cases and the question of whether it is a good treatment or a cause remains unanswered. Corticosteroid cream can improve the clinical picture, but there is a risk of rebound when treatment is stopped. We propose a treatment algorithm to assist dermatologists, pediatric dermatologists, and general practitioners encountering this condition.
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Teodorescu M, Xie A, Sorkness CA, Robbins J, Reeder S, Gong Y, Fedie JE, Sexton A, Miller B, Huard T, Hind J, Bioty N, Peterson E, Kunselman SJ, Chinchilli VM, Soler X, Ramsdell J, Loredo J, Israel E, Eckert DJ, Malhotra A. Effects of inhaled fluticasone on upper airway during sleep and wakefulness in asthma: a pilot study. J Clin Sleep Med 2014; 10:183-93. [PMID: 24533002 DOI: 10.5664/jcsm.3450] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
STUDY OBJECTIVE Obstructive sleep apnea is prevalent among people with asthma, but underlying mechanisms remain unknown. Inhaled corticosteroids may contribute. We tested the effects of orally inhaled fluticasone propionate (FP) on upper airway (UAW) during sleep and wakefulness. STUDY DESIGN 16-week single-arm study. PARTICIPANTS 18 (14 females, mean [ ± SD] age 26 ± 6 years) corticosteroid-naïve subjects with mild asthma (FEV1 89 ± 8% predicted). INTERVENTIONS High dose (1,760 mcg/day) inhaled FP. MEASUREMENTS (1) UAW collapsibility (passive critical closing pressure [Pcrit]); (2) tongue strength (maximum isometric pressure-Pmax, in KPa) and endurance-time (in seconds) able to maintain 50% Pmax across 3 trials (Ttot)-at anterior and posterior locations; (3) fat fraction and volume around UAW, measured by magnetic resonance imaging in three subjects. RESULTS Pcrit overall improved (became more negative) (mean ± SE) (-8.2 ± 1.1 vs. -12.2 ± 2.2 cm H2O, p = 0.04); the response was dependent upon baseline characteristics, with older, male gender, and worse asthma control predicting Pcrit deterioration (less negative). Overall, Pmax increased (anterior p = 0.02; posterior p = 0.002), but Ttot generally subsided (anterior p = 0.0007; posterior p = 0.06), unrelated to Pcrit response. In subjects studied with MRI, fat fraction and volume increased by 20.6% and 15.4%, respectively, without Pcrit changes, while asthma control appeared improved. CONCLUSIONS In this study of young, predominantly female, otherwise healthy subjects with well-controlled asthma and stiff upper airways, 16-week high dose FP treatment elicited Pcrit changes which may be dependent upon baseline characteristics, and determined by synchronous and reciprocally counteracting local and lower airway effects. The long-term implications of these changes on sleep disordered breathing severity remain to be determined.
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Affiliation(s)
- Mihaela Teodorescu
- James B. Skatrud Pulmonary/Sleep Research Laboratory, Medical Service, William S. Middleton Memorial Veteran's Hospital, Madison, WI ; Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI ; Center for Sleep Medicine and Sleep Research/Wisconsin Sleep, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ailiang Xie
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Christine A Sorkness
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI ; University of Wisconsin School of Pharmacy, Madison, WI
| | - Joanne Robbins
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI ; William S. Middleton Memorial Veterans Hospital, Geriatric Research, Education and Clinical Center (GRECC)
| | - Scott Reeder
- Departments of Radiology, Medical Physics and Biomedical Engineering, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Yuanshen Gong
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica E Fedie
- Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ann Sexton
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Barb Miller
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Tiffany Huard
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jaqueline Hind
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI ; William S. Middleton Memorial Veterans Hospital, Geriatric Research, Education and Clinical Center (GRECC)
| | - Nora Bioty
- Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Emily Peterson
- Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Susan J Kunselman
- Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Vernon M Chinchilli
- Public Health Sciences, Pennsylvania State University, College of Medicine, Hershey, PA
| | - Xavier Soler
- Department of Medicine, University of California at San Diego, San Diego, CA
| | - Joe Ramsdell
- Department of Medicine, University of California at San Diego, San Diego, CA
| | - Jose Loredo
- Department of Medicine, University of California at San Diego, San Diego, CA
| | - Elliott Israel
- Department of Medicine, Brigham and Womens Hospital, Harvard University, Boston, MA
| | - Danny J Eckert
- Department of Medicine, Brigham and Womens Hospital, Harvard University, Boston, MA ; Neuroscience Research Australia, Sydney, Australia
| | - Atul Malhotra
- Department of Medicine, University of California at San Diego, San Diego, CA ; Department of Medicine, Brigham and Womens Hospital, Harvard University, Boston, MA
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Admani S, Barrio VR. Evaluation and treatment of acne from infancy to preadolescence. Dermatol Ther 2013; 26:462-6. [DOI: 10.1111/dth.12108] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Shehla Admani
- Rady Children's Hospital; San Diego California
- University of California, San Diego; La Jolla California
| | - Victoria R. Barrio
- Rady Children's Hospital; San Diego California
- University of California, San Diego; La Jolla California
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Glavey SV, Keane N, Power M, O'Regan AW. Posterior pharyngeal candidiasis in the absence of clinically overt oral involvement: a cross-sectional study. Lung 2013; 191:663-8. [PMID: 24030864 DOI: 10.1007/s00408-013-9503-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 08/17/2013] [Indexed: 11/30/2022]
Abstract
PURPOSE Although oropharyngeal candidiasis is associated with inhaled corticosteroid (ICS) usage, there is sparse data on the prevalence of posterior pharyngeal candidiasis in those without any detectable oral candidiasis on clinical examination. We systematically investigated the relationship between oral candidiasis on clinical examination and the presence of posterior pharyngeal candidiasis at bronchoscopy. METHODS We conducted a cross-sectional study on a convenience sample of 100 patients undergoing bronchoscopy at our institution. Patients were assessed for symptoms of and risk factors for candida infection and had an examination of their oropharynx for evidence of candidiasis before bronchoscopy. They subsequently had a detailed assessment for posterior candidiasis at bronchoscopy. We performed a posteriori subgroup analysis, which focused solely on those patients on ICS maintenance therapy. RESULTS Median age was 54.7 (27-84) years, and 55 patients were male; 47 % of patients were on ICS, and 20 % of this cohort received recent oral corticosteroids. Twenty-eight percent of this convenience sample had posterior pharyngeal candidiasis; however, only 10.7 % (3/28) of these patients had clinically detectable oral candidiasis on clinical examination before bronchoscopy. Factors that were independently associated with the presence of pharyngeal candidiasis at bronchoscopy were OR (95 % CI) ICS usage 6.9 (2.5-19.2), particularly fluticasone usage 6.8 (2.62-17.9) and the presence of dysphonia 3.2 (1.3-8.0). In the subgroup analysis of ICS usage, posterior pharyngeal candidiasis was correlated with the presence of dysphonia but was not independently associated with fluticasone or budesonide dosage. CONCLUSIONS This study demonstrates that posterior pharyngeal candidiasis in the absence of clinically overt oral candidiasis is frequent amongst ICS users. A history of ICS use, particularly fluticasone usage, as well as the presence of dysphonia are associated with posterior pharyngeal candidiasis at bronchoscopy, even in the absence of clinically overt oral involvement.
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Affiliation(s)
- Siobhan V Glavey
- Department of Respiratory Medicine, Galway University Hospital, National University of Ireland Galway, Galway, Ireland,
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van Boven JFM, de Jong-van den Berg LTW, Vegter S. Inhaled corticosteroids and the occurrence of oral candidiasis: a prescription sequence symmetry analysis. Drug Saf 2013; 36:231-6. [PMID: 23516006 DOI: 10.1007/s40264-013-0029-7] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The primary aim of the study was to gain insight into the relative risk of clinically relevant oral candidiasis following inhaled corticosteroid (ICS) initiation over time. A secondary aim was to analyse the influence of patient characteristics and co-medication on the occurrence of this adverse effect. METHODS Drug prescription data from 1994 to 2011 were retrieved from the IADB.nl database. To study the influence of ICS use on occurrence of oral candidiasis, a prescription symmetry analysis was used, including patients using medication for oral candidiasis up to 1 year before or after ICS initiation. The relative risk was calculated by dividing the number of patients receiving medication for oral candidiasis after ICS initiation by the number of patients receiving the same medication before ICS initiation. Sub-analyses were conducted to compare the relative risks at several time points after ICS initiation and to account for therapy persistence by only including chronic users of ICS. A multivariate logistic regression model was used to identify predictive factors. RESULTS A total of 52,279 incident users of ICS therapy were identified, of which 1,081 received medication for oral candidiasis up to 1 year before or after ICS initiation. A total of 701 patients received medication for oral candidiasis after ICS initiation, while 361 received these medications in the reversed sequence, resulting in a sequence ratio (SR) of 1.94 (95 % CI 1.71-2.21). In the first 3 months after ICS initiation, the SR was 2.72 (95 % CI 2.19-3.38) and then decreased to 1.47 (95 % CI 1.11-1.95) 9-12 months after ICS initiation. Predictive factors were higher daily dose of ICS and concomitant use of oral corticosteroids. CONCLUSIONS This study found a significant and clinically relevant increased number of patients receiving medication for oral candidiasis in the first year after therapy initiation with ICS. Relative risk is highest in the first 3 months, but remains increased up to at least 1 year after ICS initiation. This study stresses the need for patient education and inhalation instruction.
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Affiliation(s)
- Job F M van Boven
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, The Netherlands.
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Lee MK, Lee WY, Yong SJ, Shin KC, Kim CW, Lee JH, Jung S, Jung YR, Kim HS, Yu TS, Kim SH. The efficacy of immediate diet for reducing local adverse events of inhaled corticosteroid: a pilot study. Tuberc Respir Dis (Seoul) 2012; 73:93-9. [PMID: 23166541 PMCID: PMC3492379 DOI: 10.4046/trd.2012.73.2.93] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2012] [Revised: 04/13/2012] [Accepted: 06/26/2012] [Indexed: 11/24/2022] Open
Abstract
Background Local adverse events associated with inhaled corticosteroid use, including dysphonia, pharyngitis and oral candidiasis, can affect adherence for treatment. 'Mouth rinsing method' has been used for reducing local adverse events, but it cannot ensure complete prevention. The goal of this pilot study was to identify whether the 'immediate diet method' can reduce local adverse events in a limited number of patients. Methods The study was conducted in a total of 98 patients, who had been prescribed a medium-dose fluticasone propionate for the first time, from January to October in 2010. One training nurse had performed the education on how to use the inhaler, including the mouth rinsing method. And with follow-ups at one month intervals, any patient who experienced such adverse events were educated on the immediate diet method, having a meal within 5 minutes after using an inhaler and they were checked on any incurrence of adverse events with one month intervals for 2 months. Results The mean age of patients was 65.9 years old. The local adverse events had incurred from 18.4% of the study subjects. When performed the follow-up observation in 18 patients with local adverse events after education on the immediate diet method, 14 patients (77.8%) had shown symptomatic improvements. Three of 4 patients did not show any improvement, in spite of implementing the immediate diet method. The other 1 patient did not practice the immediate diet method properly. Conclusion The immediate diet method may be useful in reducing the local adverse events, caused by the use of inhaled corticosteroid.
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Affiliation(s)
- Myoung Kyu Lee
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
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Santos N, Jamelli S, Costa L, Baracho Filho C, Medeiros D, Rizzo J, Sarinho E. Assessing caries, dental plaque and salivary flow in asthmatic adolescents using inhaled corticosteroids. Allergol Immunopathol (Madr) 2012; 40:220-4. [PMID: 21862197 DOI: 10.1016/j.aller.2011.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 03/31/2011] [Accepted: 04/06/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND A number of studies have reported that inhaled corticosteroids may cause a greater incidence of caries, reduced salivary flow, changes in saliva composition and an increased frequency of dental plaque, probably through alterations in the oral microbiota. The objective was to compare the frequency of caries, dental plaque and non-stimulated salivary flow rate among asthmatic adolescents using inhaled corticosteroids and non-asthmatic adolescents, as well as the salivary biochemical parameters (pH and leucocytes) in both groups. METHODS This research has a descriptive cross-sectional design to compare dental health of 40 asthmatics on inhaled corticosteroids and 40 non-asthmatic adolescents (median age 13 years). RESULTS The findings were a higher number of tooth surfaces affected by dental caries (median 4 versus 1.5), and more dental plaques (median 70.5 versus 60.7) among asthmatic adolescents. They also had a significantly higher frequency of salivary leucocytes. The non-stimulated salivary flow was similar in both groups. CONCLUSIONS The results suggest an association between the use of inhaled corticosteroids and an increased risk of dental caries and bacterial plaque, which calls for special attention of these patients by doctors and dental health professionals.
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46
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Ferré A, Dres M, Roche N, Antignac M, Becquemin MH, Trosini V, Vecellio L, Chantrel G, Dubus JC. [Inhalation devices: characteristics, modeling, regulation and use in routine practice. GAT Aerosolstorming, Paris 2011]. Rev Mal Respir 2012; 29:191-204. [PMID: 22405113 DOI: 10.1016/j.rmr.2011.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2011] [Accepted: 12/27/2011] [Indexed: 10/14/2022]
Abstract
Aerosoltherapy is a first-line treatment for chronic obstructive respiratory diseases such as asthma and COPD. Treatment modalities and devices are varied and the choice of the device must be adapted to and optimized for every patient. Spacers can be used for some categories of patients for whom the use of other devices turns out to be complicated. The improvement of these treatments requires the optimization of the lung deposition of inhaled particles; lung modeling plays an essential role in the understanding of the mechanisms of flow in the airways. Regulations must frame prescription of inhaled treatments to optimize its quality and, thus, the care for these chronic diseases. Many generally-accepted ideas concerning these treatments turn out to be false. Inhaled treatments are constantly evolving, both pharmacologically and technologically.
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Affiliation(s)
- A Ferré
- Service de pneumologie et réanimation, université Paris Descartes, Hôtel-Dieu, Paris, France
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Abstract
Inhalation therapy has been employed as the mainstay of the treatment in chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease (COPD). Beta-2 agonists, anticholinergic bronchodilators, inhaled corticosteroids, and sodium cromoglycate are often used alone or in combination in an inhaled form. Studies have shown that inhaled drugs used in the treatment have some adverse effects on the oral health based on their dosage, frequency, and duration of use. Several oral conditions such as xerostomia, dental caries, candidiasis, ulceration, gingivitis, periodontitis, and taste changes have been associated with inhalation therapy. Since the prevalence of chronic respiratory diseases is rising, it is important to provide optimal oral care to the individuals receiving inhalation therapy. This article will review the influence of inhaled drugs on the oral health of individuals and adequate management and prevention of the same.
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Affiliation(s)
- Navneet Godara
- Department of Conservative Dentistry and Endodontics, Jaipur Dental College, Dhand, Jaipur, Rajasthan, India
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48
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Baba K, Tanaka H, Nishimura M, Yokoe N, Takahashi D, Yagi T, Yamaguchi E, Maeda Y, Muto T, Hasegawa T. Age-dependent deterioration of peak inspiratory flow with two kinds of dry powder corticosteroid inhalers (Diskus and Turbuhaler) and relationships with asthma control. J Aerosol Med Pulm Drug Deliv 2011; 24:293-301. [PMID: 22047450 DOI: 10.1089/jamp.2010.0868] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Inhaled corticosteroid (ICS) therapy has improved the quality of life (QOL) for many asthmatics and reduced mortality rates associated with asthma. However, some patients do not obtain therapeutic benefit despite satisfactory adherence. OBJECTIVES To determine whether asthmatic patients were using ICS devices appropriately, and to clarify relationships between these results and QOL. SUBJECTS AND METHODS We studied 100 adult asthmatics, divided into two groups: 50 patients consecutively registered as using Diskus (fluticasone; D-group) and 50 consecutively registered as using Turbuhaler (budesonide; T-group). We measured peak inspiratory flows (PIFs) using the In-Check Dial device. Subjects also completed the Asthma Control Test for evaluation of QOL. RESULTS In the D-group, no patients showed PIF below the optimal range (30-90 L/min), whereas 52% of patients had PIF≥91 L/min. In the T-group, 6% of patients showed PIF over the optimal range (60-90 L/min), and 44% had PIF≤59 L/min. When patients in the T-group were required to deliberately make a maximal inhalation, 14% still had PIF≤59 L/min. The proportion of patients with poor control was significantly greater in the T-group than in the D-group. According to univariate logistic regression analyses, low PIF tended to be associated with poor asthma control in the T-group. No significant correlation was found between PIF and age in the D-group, but PIF decreased significantly with age in the T-group. CONCLUSIONS Appropriate measures for patients in whom PIF has been judged as lower than optimal include adequate education for inhalation and/or changing to a different inhalation device. These measures should be kept in mind for elderly asthma patients in particular, where appropriate selection of a corticosteroid inhalation device in the early stages of therapy would also be important.
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Affiliation(s)
- Kenji Baba
- Division of Respiratory Medicine and Allergology, Department of Internal Medicine, Aichi Medical University School of Medicine, and Department of Pharmacy, Aichi Medical University Hospital, Aichi, Japan.
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Henningsen E, Bygum A. Budesonide-induced periorificial dermatitis presenting as chalazion and blepharitis. Pediatr Dermatol 2011; 28:596-7. [PMID: 21895758 DOI: 10.1111/j.1525-1470.2011.01516.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
We report a case of periorificial dermatitis caused by suboptimal inhalation of budesonide for asthma. The initial skin lesions presented in the eye surroundings, leading to diagnostic difficulties and treatment of presumed chalazion and staphylococcal folliculitis. After several months, the patient developed perioral papules and pustules and was diagnosed with periorificial dermatitis. He was efficiently treated with topical metronidazole and oral erythromycin.
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Affiliation(s)
- Emil Henningsen
- Department of Dermatology, Odense University Hospital, Odense, Denmark.
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