Management of asthma in the child aged under 6 years

Correlation of breath sounds with diagnoses of lung dysfunction: experimental observations

An investigation has been undertaken to determine whether there is any correlation between the spectral analyses of breath sounds at the mouth and the diagnosis of lung dysfunction in a small number of patients. The results of the investigation have shown that it is possible to differentiate between the spectral characteristics of the breath sounds of people who are: (a) normal; (b) asthmatic adult, both before and after the administration of a bronchodilator drug; (c) asthmatic adult, treated with an inhaled steroid, both before and after the administration of a bronchodilator drug; (d) asthmatic child, both before and after the administration of a bronchodilator drug. The possible applications of the technique are discussed.

Treatment of asthma in pre-school children with inhalation of terbutaline in Turbuhaler compared with Nebuhaler

The aim of this study was to evaluate the efficacy, safety and preference of pre-school children with regard to two different devices for treatment of bronchial asthma with terbutaline. Turbuhaler, a powder inhaler preloaded with pure terbutaline for inhalation, was compared with a pressurized metered dose inhaler, attached to a Nebuhaler. The study had an open, cross-over randomized design. Each treatment period consisted of 2 weeks. Diary cards were filled in every morning and evening by the parents regarding PEF, asthma symptoms, extra inhalations of terbutaline, and side effects. Twenty-one children (mean age 3.9 years) were included in the study. A highly significant (P less than 0.001) increase in peak expiratory flow (PEF) was obtained after inhalation with both devices. The PEF values in the mornings after inhalation of terbutaline with Turbuhaler were significantly higher (P = 0.046) than those with Nebuhaler. Further, the PEF baseline values in the evenings before inhalation were also significantly higher (P = 0.03) with Turbuhaler. No difference was found in asthma symptoms and extra medication between the two devices. Side effects were mild and few with both devices. The parents found Turbuhaler easier to handle and 19 of 21 preferred this device for future use.

Current therapeutic practice in the management of acute severe asthma

In a prospective study we have documented the treatment administered to patients before and during attacks of acute severe asthma, including cases managed at home by the general practitioner and those treated in hospital. In the course of 1 year, 261 consecutive episodes were studied. Five patients required artificial ventilation but there were no fatalities. In 28 patients (11.8%) no regular maintenance therapy was being taken before the index attack, and in 72 (30.3%) no regular treatment with a beta 2-adrenergic bronchodilator. Childhood asthmatics were receiving less maintenance therapy than adults, with the exception of cromoglycate. An increased dose of a beta 2-adrenergic bronchodilator was taken prior to medical consultation in 64.7% as the attack developed, but an increased dose of oral steroids in only 19.3%. The general practitioners gave intravenous steroids in 53 cases (61.6%), but rarely combined this with a bronchodilator. However, when a combination of a bronchodilator and intravenous steroids was given, there was a significant reduction in the need for hospital admission. In hospital the majority of patients received intravenous steroids as well as a nebulized beta 2-adrenergic bronchodilator and an intravenous xanthine bronchodilator, but one-third were not given oxygen. Sedatives were rarely used. Differing treatment patterns emerged when contrasting childhood with adult episodes, whether managed inside or outside hospital. Comparisons are made between the treatment observed in practice and that currently recommended for optimal treatment, and the implications are discussed.