pulmicort and Bronchial-Diseases

Formoterol has a fast onset of action and can therefore be used to relieve symptoms of asthma. A combination inhaler can deliver formoterol with different doses of inhaled corticosteroid; when used as a reliever both drugs will be delivered more frequently when asthma symptoms increase. This has the potential to treat both bronchoconstriction and inflammation in the early stages of exacerbations.. To assess the efficacy and safety of combined inhalers containing both formoterol and an inhaled corticosteroid when used for reliever therapy in adults and children with chronic asthma.. We last searched the Cochrane Airways Group trials register in April 2008.. Randomised trials in adults and children with chronic asthma, where a combination inhaler containing formoterol and inhaled corticosteroid is compared with fast-acting beta2-agonist alone for the relief of asthma symptoms. This should be the only planned difference between the trial arms.. Two review authors independently extracted the characteristics and results of each study. Authors or manufacturers were asked to supply unpublished data in relation to primary outcomes.. Three trials involving 5905 participants were included. In patients with mild asthma who do not need maintenance treatment, no clinically important advantages of budesonide/formoterol as reliever were found in comparison to formoterol as reliever.Two studies enrolled patients with more severe asthma who were not controlled on high doses of inhaled corticosteroids (around 700 mcg/day in adults), and had suffered a clinically important asthma exacerbation in the past year. Hospitalisations related to asthma in the two studies comparing budesonide/formoterol for maintenance and relief with the same dose of budesonide/formoterol for maintenance with terbutaline for relief yielded an odds ratio of 0.68 (95% CI 0.40 to 1.16), which was not a statistically significant reduction. One adult study found a reduction in exacerbations requiring oral corticosteroids compared to terbutaline, odds ratio 0.56 (95% CI 0.42 to 0.74) and the study in children found less serious adverse events with budesonide/formoterol used for maintenance and relief. There was no significant difference in annual growth in children using budesonide/formoterol reliever in comparison to terbutaline.. In mild asthma it is not yet known whether patients who use a budesonide/formoterol inhaler for relief of asthma symptoms derive any clinically important benefits. In more severe asthma, one study that enrolled patients who were not controlled on quite high doses of inhaled corticosteroids, and had suffered an exacerbation in the previous year, demonstrated a reduction in the risk of exacerbations that require oral corticosteroids with budesonide/formoterol for maintenance and relief in comparison with budesonide/formoterol for maintenance and terbutaline or formoterol for relief. The incidence of serious adverse events in children was also less using budesonide/formoterol for maintenance and relief in one study, which similarly enrolled children who were not controlled on medium to high doses of inhaled corticosteroids, and compared to terbutaline relief with an explorative maintenance dose of budesonide/formoterol that is not approved for treatment.

Topics: Administration, Inhalation; Adolescent; Adult; Anti-Asthmatic Agents; Asthma; Bronchial Diseases; Bronchodilator Agents; Budesonide; Child; Chronic Disease; Constriction, Pathologic; Drug Combinations; Ethanolamines; Formoterol Fumarate; Humans; Randomized Controlled Trials as Topic; Terbutaline

Although continuous or frequent stimuli in tracheostomized patients may cause tracheal granulomas, little is known about management of patients with translaryngeal intubation.. A 1-month-old Japanese boy, weighing 3.5kg, was admitted to our hospital owing to cardiac failure caused by an atrial septal defect and intractable arrhythmia. To treat his unstable cardiovascular status, surgery was performed to close his atrial septal defect. After the operation, stenosis was detected by auscultation and flow limitation worsened. A bronchoscopy revealed granulomas completely obstructing his right bronchus and partially obstructing his left bronchus. Dexamethasone infusion partially reduced the mass, after which removal by yttrium aluminium garnet laser was tried. The airway obstruction was not resolved, however, because of granuloma reproliferation. Budesonide (aerosol liquid) inhalation was started, and tissue was reduced using an yttrium aluminium garnet laser and physically removed using forceps. After continued budesonide inhalation, he was successfully liberated from the ventilator.. Life-threatening airway obstruction by granulomas developed in a translaryngeally intubated paediatric patient. The granuloma was detected after a couple of weeks of intubation. A bronchial granuloma is rare in paediatric patients. It should be suspected with evidence of bronchial obstruction. Treatment with corticosteroids and surgery using a laser maybe indicated.

Topics: Administration, Inhalation; Airway Obstruction; Anti-Inflammatory Agents; Bronchial Diseases; Bronchoscopy; Budesonide; Combined Modality Therapy; Granuloma; Humans; Infant; Intubation, Intratracheal; Lasers, Solid-State; Male

The drug-drug interaction of two pMDI (pressure metered dose inhaler) combination products budesonide-formoterol fumarate dihydrate and salmeterol xinafoate-fluticasone propionate were investigated using in situ atomic force microscopy (AFM), equipped with a liquid cell filled with model a propellant, and Raman spectroscopy. Electron microscopy images of the budesonide-formoterol formulation suggested discrete particulates while the salmeterol-fluticasone formulation appeared agglomerated. Based on the analysis of the AFM curves, it is proposed that interactions in the budesonide-formoterol system (cohesion and adhesion) are dominated by van der Waals forces while interactions between salmeterol and fluticasone are of a chemical nature. Such observations are further substantiated by analysis of the Raman maps produced from pMDI actuations deposited on Andersen cascade impactor plates. The relevance of such synergy between particulates of different chemical nature is discussed. In particular, it is anticipated that strong interactions between particles could lead to heteroflocculation, increase aerosol particle size and consequently reduction of the respirable fine particle fraction.

Topics: Administration, Inhalation; Aerosols; Albuterol; Androstadienes; Bronchial Diseases; Bronchodilator Agents; Budesonide; Chemistry, Pharmaceutical; Drug Combinations; Ethanolamines; Fluticasone; Formoterol Fumarate; Humans; Hydrocarbons, Fluorinated; Metered Dose Inhalers; Microscopy, Atomic Force; Microscopy, Electron, Scanning; Particle Size; Salmeterol Xinafoate; Spectrum Analysis, Raman

A 78-year-old man was referred to our hospital complaining of chronic productive cough. Physical examination revealed yellowish, thin nails and pretibial edema. A chest computed tomograph showed bilateral bronchiectasis. A sinus radiograph showed the findings of chronic sinusitis. From these findings, yellow nail syndrome was diagnosed. Long-term low-dose macrolide therapy with 400 mg/day clarithromycin was started and his symptoms began to gradually improve. However, complete resolution of his symptoms was not achieved and fiberoptic bronchoscopy was performed. Transbronchial biopsy specimen obtained from the right second carina showed bronchial asthma-like findings such as eosinophilic infiltration, thickening of the basement membrane, mucosal edema and goblet cell hyperplasia. Airflow reversibility was not detected. Thus a diagnosis of coexistence of yellow nail syndrome and eosinohilic bronchial disease was established. Further improvement of his symptoms was achieved by additional therapy with 800 microg/day budesonide and 100 microg/day salmeterol. To the best of our knowledge, this is the first report of a case of yellow nail syndrome associated with eosinophilic bronchial disease successfully treated with long-term low-dose macrolides and inhaled corticosteroids.

Topics: Aged; Anti-Bacterial Agents; Anti-Inflammatory Agents; Bronchial Diseases; Bronchiectasis; Budesonide; Clarithromycin; Drug Therapy, Combination; Eosinophilia; Humans; Lymphedema; Male; Nail Diseases; Sinusitis; Syndrome

We examined the effects of glucocorticosteroids (GCS) on antigen-induced bronchial anaphylactic reactions (BAR) in SD rats immunized with ovalbumin (OA) and alum. The animals were treated with vehicle, budesonide (BUD), dexamethasone (DEX), or hydrocortisone (HC) at various times before intravenous (i.v.) antigen challenge. The drugs were administered either intraperitoneally (i.p.) or intratracheally (i.t.); the BAR was elicited by a low or by a high challenge dose of antigen. A BAR elicited by a low challenge dose of antigen was reduced in a dose-dependent way by all GCS after i.p. administration; at 1 mg/kg, BUD and DEX significantly reduced BAR and at 50 mg/kg all three of the examined compounds inhibited the BAR by 50% or more. For BUD, maximum effect was recorded when it was given 12 h before test. There was only a slight variation in the inhibitory effects of the GCS with immunization conditions of test animals. I.t. instillation of the drugs did not markedly increase their inhibitory capacity as compared to i.p. administration. BAR elicited by a high antigen dose was at best marginally affected by the GCS when given either i.p. or i.t. Thus, antigen-induced airway reactivity in rats can be reduced by GCS treatment provided that this is performed sufficiently long before the test and that the challenge dose of antigen is not too high.

Topics: Acetophenones; Administration, Topical; Alum Compounds; Aluminum; Anaphylaxis; Animals; Antigens; Bronchial Diseases; Budesonide; Cromolyn Sodium; Dexamethasone; Dose-Response Relationship, Drug; Drug Interactions; Glucocorticoids; Immunization; Injections, Intraperitoneal; Injections, Intravenous; Male; Ovalbumin; Pregnenediones; Quinacrine; Rats; Rats, Inbred Strains; Respiration; Sulfates; Time Factors

Topics: Adult; Aerosols; Asthma; Beclomethasone; Bronchial Diseases; Budesonide; Constriction, Pathologic; Female; Humans; Pregnenediones

The influence on the immediate and late bronchial allergic reaction after pretreatment with budesonide was investigated in 10 asthmatic patients with dual bronchial responses to bronchial provocation tests. Pretreatment was given in daily doses of 1 mg inhaled budesonide from a pressurized aerosol. In the first study pretreatment was given for 12 h and one week and in the second study for one week and one month. The late allergic reaction decreased markedly after 12 h pretreatment but additional effect was obtained after extended pretreatment. The immediate allergic reaction decreased less after pretreatment for 12 h and one week than did the late allergic reaction. Pretreatment for one month decreased also the immediate reaction substantially.

Topics: Adult; Aerosols; Bronchial Diseases; Budesonide; Female; Humans; Hypersensitivity, Delayed; Hypersensitivity, Immediate; Male; Pregnenediones; Time Factors