Pill swallowing ability and training in children 6 to 11 years of age

Despite the widespread view that children have difficulty swallowing pills, data are limited. In an observational cohort study, pill swallowing ability (small oral tablet) was assessed in children age 6 to 11 years. A total of 113 of 124 subjects (91%) swallowed a tablet using an ordinary cup or a patented pill cup. All 57 subjects who initially said they could swallow a pill were capable. Forty-seven learned with an ordinary cup and nine with the pill cup. Eleven did not learn. The majority of children (91%) age 6 to 11 years were able to successfully swallow a small oral tablet.

The leukotriene D4-receptor antagonist zafirlukast attenuates exercise-induced bronchoconstriction in children

OBJECTIVE

To determine the effects of zafirlukast on exercise-induced bronchoconstriction in children.

STUDY DESIGN

Exercise challenges were done 4 hours after single oral doses of zafirlukast or placebo were administered in asthmatic children (6 to 14 years) treated with beta 2-agonists alone. Subjects randomized to treatment had a >/=20% decrease in forced expiratory volume in 1 second (FEV1 ) after a screening challenge. In a randomized, double-blind, 3-way, crossover design, group 1 (n = 20) received placebo and 5 and 20 mg zafirlukast, and group 2 (n = 19) received placebo and 10 and 40 mg zafirlukast. Maximal percentage fall in FEV1, area under the curve, and time to recovery of FEV1 to within 5% of baseline after the challenge were compared with analysis of variance.

RESULTS

Mean values for maximal fall in FEV1 ranged from -8.7% +/- 1.7% to -11.1% +/- 1.9% after zafirlukast compared with -17.1% +/- 1.8% and -16.3% +/- 1.9% after placebo. Differences from placebo for fall in FEV1 and area under the curve were significant (P </=.05) after 5, 20, and 40 mg zafirlukast and approached significance (P </=.08) after 10 mg zafirlukast. After all zafirlukast doses, recovery times (means of 5 to 7 minutes) decreased significantly (P </=.05) and by approximately half compared with placebo (11 and 14 minutes). Safety assessments did not differ among treatments.

CONCLUSION

Four hours after dosing, zafirlukast attenuated exercise-induced bronchoconstriction in children.

Pilot study of bronchodilator response to inhaled albuterol delivered by metered-dose inhaler and a novel dry powder inhaler

BACKGROUND

The metered-dose inhaler is currently one of the most prescribed methods of delivering drugs to the lungs. In the United States, most currently marketed metered dose inhalers use chlorofluorocarbons as the system propellant and require patient breath coordination. These factors lead to the need for a delivery system that is independent of propellants and patient coordination.

OBJECTIVE

To compare the magnitude and time course of bronchodilation between albuterol delivered by Ventolin metered dose inhaler and albuterol sulfate powder (Rotacaps) delivered by a novel dry powder inhaler that generates a respirable drug aerosol over a range of inspiratory flow rates.

METHODS

A single-center, single-dose, randomized, placebo-controlled, partial-blind, 3-way crossover study was conducted in an outpatient asthma Clinical Research Center. Twelve mild to moderate asthmatic patients 12 to 36 years of age participated in this study that involved three treatments, each separated by three to eight days, consisting of 2 puffs (90 micrograms/puff) albuterol by Ventolin metered-dose inhaler, two inhalations (100 micrograms/puff) albuterol sulfate powder (Rotacaps) by dry powder inhaler, and two inhalations (12.5 mg/inhalation) lactose powder by dry powder inhaler. Spirometry, blood pressure, and heart rate were measured at 30 minutes, 15 minutes, and immediately before treatment and then at 15, 30, 45, 60, 90, 120, 180, 240, and 300 minutes after each treatment. Serum potassium and glucose, and electrocardiograms were measured at 30 minutes before, and 30, 60, 90, and 180 minutes after each treatment. Endpoints were compared with analysis of variance.

RESULTS

Five patients (one metered-dose inhaler and four dry powder inhaler) did not respond with > 15% FEV1 increase over baseline within 30 minutes. Metered-dose inhaler and dry powder inhaler mean FEV1 results, respectively, for 11 and 8 responders were 15 minutes in onset, 202.9 and 185.4 minutes in duration, 24.8% and 25.1% maximum change, and 18.6 and 18.2 area-under-FEV1-bronchodilation-curve. Statistical analysis of all patients and responders-only revealed both active treatments to be different from placebo (P = .0018), but not different from each other (P = .1291). No safety endpoints were significantly different among all three treatments (P > .10 for all safety endpoints).

CONCLUSIONS

In this study, the dry powder inhaler safely and effectively delivered a commercially available albuterol sulfate powder (Rotacaps) into human lungs with bronchodilation comparable to Ventolin metered-dose inhaler.

Comparison of intranasal cromolyn sodium, 4%, and oral terfenadine for allergic rhinitis: symptoms, nasal cytology, nasal ciliary clearance, and rhinomanometry

Topical intranasal cromolyn sodium, 4% solution, and oral terfenadine, 60 mg tablets, both relieve symptoms of allergic rhinitis with few or no adverse effects, but no comparison of their relative efficacy has been reported. In this double-blind, double-dummy study, 79 patients, ages 12-56 years with symptoms of allergic rhinitis, were randomized to receive either active cromolyn sodium, 1 spray in each nostril QID, or active terfenadine BID along with the appropriate placebo spray or tablet for 4 weeks following a 1-week baseline qualification period. Patients' daily symptom scores were reviewed weekly and constituted the primary efficacy measures. Changes in nasal cytology, nasal ciliary clearance, and rhinomanometry were also assessed. The presence of adverse effects and the overall score of medication efficacy at the end of each week was recorded. The cromolyn sodium and terfenadine groups had comparable baseline scores for severity of allergic rhinitis symptoms and both treatments resulted in significant improvement (P less than .0001) with no statistical difference between them for total symptom scores at the end of 4 weeks. Eosinophils in nasal samples were decreased significantly in the cromolyn treated group with no significant change in the terfenadine-treated group. There were no significant differences between treatment groups in ciliary clearance or rhinomanometry. Adverse effects were uncommon and mild. We conclude that cromolyn sodium and terfenadine are comparably effective and well-accepted treatments for allergic rhinitis.

Vocal cord dysfunction in a child with asthma

Vocal cord dysfunction is uncommon in children. We present the case of a 12-year-old boy with a history of mild, intermittent asthma from 7 to 10 years of age. Subsequently, severe, rapid-onset attacks of respiratory distress occurred with increasing frequency. After a life-threatening attack of airway obstruction with 3 minutes of apnea, he was hospitalized for diagnostic studies. Although pulmonary function tests were normal, laryngoscopy under general anesthesia revealed extremely severe vocal cord spasm induced by minimal contact of the laryngoscope. It required intravenous lidocaine and muscle relaxant to reverse. Spasm was not demonstrable one week later on repeat laryngoscopy and bronchoscopy. No structural abnormalities were seen. There was considerable family stress exacerbated by anxiety about the patient's illness. Parents were told that the condition was different from asthma and probably functional in origin. There have been no further episodes, possibly due to counseling and education in relaxation techniques as well as oral pharmacotherapy for asthma with avoidance of inhaled medications.

Exercise cardiorespiratory function in adolescents with pectus excavatum. Observations before and after operation

We studied 12 children with pectus excavatum (mean age, 13.8 years) using pulmonary function and exercise testing. Eight patients had surgical repair and were studied before and after repair. Four patients did not have repair and were tested twice. The degree of chest wall deformity in the two groups was similar. All patients reached 86% or more of their maximal predicted heart rate with exercise. Total lung capacity decreased 8% (p less than 0.01) after operation. In the nonoperated control group, total lung capacity was similar during both studies. The ratio of ventilation at maximal exercise to maximal voluntary ventilation was 68% +/- 12% before and 66% +/- 9% after operation in the operated group and 69% +/- 18% and 79% +/- 30% at two studies in the nonoperated group (nonsignificant changes). Maximal oxygen uptake was 36.1 +/- 4.4 ml/kg/min preoperatively and 38.1 +/- 8.1 postoperatively and 41.2 +/- 7.3 ml/kg/min and 43.0 +/- 6.9 on two studies in the nonoperated group (nonsignificant changes). Cardiac output and stroke volume increased appropriately with exercise both before and after operation. Operation had no physiologically significant effect on the cardiorespiratory response to exercise. Slight changes in cardiorespiratory function occurred in both operated and nonoperated subjects. These results emphasize the importance of studying patients before and after operation and of using a control group.

Occupational allergy to honeybee-body dust in a honey-processing plant

We studied a honey-plant employee who developed severe asthma coincident with the seasonal honey-packing process. Symptoms correlated with duration of exposure inside the plant during the honey pack and improved in other environments during that season. The patient was asymptomatic inside the plant at other times of the year. Skin tests to seasonal outdoor aeroallergens were negative, as were inhalation challenges with two insecticides used inside the building during the honey pack. Skin test, RAST, and bronchial provocation test with honeybee whole body extract were positive. We used high-volume air samplers to collect ambient airborne particles on filter sheets outside the patient's home and inside the honey plant, both during and after the honey pack. Skin tests, RASTs, and bronchial provocation tests with eluates from these filters were positive only to eluate from the filter exposed inside the plant during the honey pack. The patient's positive honeybee whole body RAST could be inhibited by preincubation of her serum with this filter eluate but not by preincubation with eluate from a filter exposed outside the patient's home. Collectively, these data support an IgE-mediated, seasonal, occupational sensitivity to honeybee-body dust.