pulmicort and Bronchiolitis

Topics: Adenoviridae Infections; Adenoviruses, Human; Administration, Topical; Animals; Anti-Inflammatory Agents; Asthma; Bronchiolitis; Budesonide; Disease Models, Animal; Drug Resistance; Glucocorticoids; Humans; Respiratory Tract Infections; Virus Diseases

Budesonide, a topically active corticosteroid, has a broad spectrum of clinically significant local anti-inflammatory effects in patients with inflammatory lung diseases including persistent asthma. In infants and young children with persistent asthma, day- and night-time symptom scores, and the number of days in which beta2-agonist bronchodilators were required, were significantly lower during randomised, double-blind treatment with budesonide inhalation suspension 0.5 to 2 mg/day than placebo in 3 multicentre trials. Significantly fewer children discontinued therapy with budesonide inhalation suspension than with placebo because of worsening asthma symptoms in a study that included children who were receiving inhaled corticosteroids at baseline. Recent evidence indicates that budesonide inhalation suspension is significantly more effective than nebulised sodium cromoglycate in improving control of asthma in young children with persistent asthma. At a dosage of 2 mg/day, budesonide inhalation suspension significantly reduced the number of asthma exacerbations and requirements for systemic corticosteroids in preschool children with severe persistent asthma. In children with acute asthma or wheezing, the preparation was as effective as, or more effective than oral prednisolone in improving symptoms. In children with croup, single 2 or 4mg dosages of budesonide inhalation suspension were significantly more effective than placebo and as effective as oral dexamethasone 0.6 mg/kg or nebulised L-epinephrine (adrenaline) 4mg in alleviating croup symptoms and preventing or reducing the duration of hospitalisation. Early initiation of therapy with budesonide inhalation suspension 1 mg/day appears to reduce the need for mechanical ventilation and decrease overall corticosteroid usage in preterm very low birthweight infants at risk for chronic lung disease. In adults with persistent asthma, budesonide inhalation suspension < or =8 mg/day has been compared with inhaled budesonide 1.6 mg/day and fluticasone propionate 2 mg/day administered by metered dose inhaler. Greater improvements in asthma control occurred in patients during treatment with budesonide inhalation suspension than with budesonide via metered dose inhaler, whereas fluticasone propionate produced greater increases in morning peak expiratory flow rates than nebulised budesonide. Several small studies suggest that the preparation has an oral corticosteroid-sparing effect in adults with persistent asthma

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Asthma; Bronchiolitis; Bronchodilator Agents; Budesonide; Child; Child, Preschool; Clinical Trials as Topic; Croup; Drug Delivery Systems; Female; Humans; Infant; Infant, Newborn; Lung Diseases, Obstructive; Male; Middle Aged

To investigate the efficacy of fluticasone propionate aerosol (flixotide) versus budesonide suspension in the treatment of recurrent wheezing caused by bronchiolitis.. A total of 214 infants with newly diagnosed bronchiolitis were randomly divided into flixotide treatment (106 infants) and budesonide treatment groups (108 infants), and were given aerosol inhalation of flixotide or budesonide for 3 months after achieving remission of clinical symptoms. Another 136 infants with bronchiolitis who did not receive regular inhalation of corticosteroid after achieving remission of clinical symptoms were enrolled as the control group. The follow-up visits were performed for 1 year, and the effects of the two therapeutic methods on recurrent wheezing were evaluated.. Compared with the control group, both the flixotide and budesonide treatment groups had significantly fewer times of wheezing episodes within 1 year and a significantly lower recurrence rate of wheezing within the first 3 months after regular inhalation of corticosteroid, but no significant differences were observed between the two treatment groups. The amount of corticosteroid inhaled and hospital costs in the budesonide treatment group were significantly higher than in the flixotide treatment group (P<0.01).. Continuous inhalation of flixotide or budesonide after remission of clinical symptoms in children with bronchiolitis can reduce wheezing episodes and the recurrence of wheezing, and flixotide treatment is superior to budesonide treatment in the aspects of hospital costs and the amount of corticosteroid used.

Topics: Aerosols; Bronchiolitis; Budesonide; Female; Fluticasone; Humans; Infant; Male; Recurrence; Respiratory Sounds; Suspensions

To assess the efficacy and safety of inhaled nebulized hypertonic saline (HS) solution in infants with acute bronchiolitis.. Totally 129 patients with acute bronchiolitis (clinical severity score ≥ 4, aged 2-18 months) admitted to the Capital Institute of Pediatrics from November 2012 to January 2013 were enrolled. All the subjects were assigned to receive 1.5 ml compound ipratropium bromide solution for inhalation and 1 ml budesonide firstly, twice a day. Then, the subjects were randomized to receive 2 ml doses of nebulized 5% HS (Group A), 3% HS (Group B) or 0.9% NS (Group C), twice a day. The treatment lasted for 3 days. Clinical severity scores before treatment and 24, 48, 72 h after treatment were documented. Bronchospasm, nausea and emesis were recorded to assess safety.. A total of 124 patients completed this research.Group A included 40 cases, Group B included 42 cases, Group C included 42 cases. Demographic characteristics, pre-treatment duration and clinical severity score before treatment were similar among the 3 group.Seventy-two hours after treatment, the clinical severity score of Group A, B, and C were 3.5 (1.0) , 4.0 (1.0) and 5.0 (0) . At 24, 48, and 72 h after treatment, the clinical severity score were significantly different among the three groups (χ(2) = 36.000, 51.200, 50.800, P < 0.05) .One patient in Group A got paroxysmal cough everytime as soon as he received 5% HS (6 times).Other 3 patients in Group A got paroxysmal cough once. The incidence of adverse effect of Group A was 3.75% (9/240); no adverse event occurred in other group. The incidence of adverse effect among this three group was significantly different (χ(2) = 19.13, P < 0.01).. Inhalation of nebulized 5% and 3% hypertonic saline could decrease clinical symptoms of patient with acute bronchiolitis; 5% HS was superior to 3% HS. But 2 ml dose of 5% HS may induce paroxysmal cough.

Topics: Administration, Inhalation; Bronchiolitis; Bronchodilator Agents; Budesonide; Cough; Female; Humans; Infant; Ipratropium; Male; Saline Solution, Hypertonic; Severity of Illness Index; Treatment Outcome

Respiratory syncytial virus (RSV) bronchiolitis in infancy can lead to bronchial hyper-reactivity or recurrent obstructive bronchitis. The aim of the present study was to determine whether the type of treatment has an influence on respiratory status after RSV bronchiolitis. The study involved 117 infants (mean age 2.6 months), who needed hospital treatment because of RSV bronchiolitis. The patients were divided randomly into three groups. All received the same symptomatic treatment. Group I children received symptomatic treatment only, group II children were treated for 7 days with inhaled budesonide, 500 microg three times per day, administered via a nebulizer. Group III children received nebulized budesonide, 500 microg twice per day for two months. Follow-up consisted of out-patient check-ups 2 and 6 months after the infection, and telephone contact two years after the infection. Statistically significant differences were seen between the groups. In group I 37% of the children had asthma, in group II 18%, and in group III 12%. According to the present study it seems that inhaled corticosteroid treatment during and after the acute phase of infant RSV bronchiolitis may have a beneficial effect on subsequent bronchial wheezing tendency.

Topics: Administration, Inhalation; Adrenal Cortex Hormones; Asthma; Bronchiolitis; Bronchodilator Agents; Budesonide; Disease Management; Female; Humans; Infant; Infant, Newborn; Male; Outcome Assessment, Health Care; Respiratory Syncytial Virus Infections

To determine the effectiveness of nebulized budesonide in the treatment of acute bronchiolitis and in the prevention of postbronchiolitic wheezing.. A randomized, double-blind, placebo-controlled trial was performed.. Forty infants with bronchiolitis (83% RSV), mean age 13.5 weeks (range 4 to 41 weeks), were admitted to the Royal Alexandra Children's Hospital, Brighton, UK.. Twenty-one infants received nebulized budesonide 1 mg every 12 hours for 5 days, then 500 micrograms every 12 hours continuing to a total of 6 weeks. Nineteen received nebulized placebo (0.9% saline) for 6 weeks. A clinical scoring system was used to rate acute symptoms, and diary cards were used to assess persistent respiratory symptoms over a 6-month follow-up period.. No significant differences were found between the budesonide and placebo groups in change in clinical score 48 hours after trial entry, mean oxygen requirements, or length of hospital stay during the acute illness. At 6-month follow-up, the two groups did not differ significantly in prevalence of wheeze, respiratory symptom scores, or proportion requiring bronchodilators or steroids.. This study did not demonstrate that a 6-week course of nebulized budesonide reduced the symptoms of acute bronchiolitis or prevented postbronchiolitic wheezing.

Topics: Acute Disease; Bronchiolitis; Bronchodilator Agents; Budesonide; Double-Blind Method; Female; Humans; Infant; Infant, Newborn; Length of Stay; Male; Nebulizers and Vaporizers; Respiratory Sounds; Treatment Outcome

We have evaluated the role of eosinophil cationic protein (ECP) concentrations in serum in predicting wheezing after bronchiolitis, during infancy and early childhood. A prospective study at a university hospital serving all pediatric patients in a defined area was designed. Serum ECP concentrations were measured in 92 infants under the age of 2 years on admission for acute bronchiolitis, and 6 and 16 weeks after hospitalization. Nebulized anti-inflammatory therapy was initiated during hospitalization: 32 patients received cromolyn sodium and 32 patients received budesonide for 16 weeks; 30 control patients received no maintenance therapy. The numbers of subsequent physician-diagnosed wheezing episodes and hospital admissions for obstructive airway disease were recorded during 16 weeks of follow-up. At entry, 14 of 92 (15%) children had high (> or = 16 micrograms/L) levels of ECP in their serum. During the 16-week follow-up period, this group of patients had significantly more physician-diagnosed episodes of wheezing (86% vs. 43%, P < 0.01) and hospital admissions for wheezing (64% vs. 19%, P = 0.001) than those with serum levels of ECP < 16 micrograms/L. The number of patients with serum ECP > or = 8 micrograms/L was 25 (27%); 76% of this group developed physician-diagnosed wheezing (P < 0.01), and 48% had hospital admissions for wheezing (P < 0.01). Serum ECP levels decreased significantly with respect to time after bronchiolitis and did not differ among the three intervention groups. We conclude that a high serum ECP concentration during the acute phase of bronchiolitis is a specific but insensitive predictor of wheezing after bronchiolitis.

Topics: Acute Disease; Analysis of Variance; Anti-Asthmatic Agents; Biomarkers; Blood Proteins; Bronchiolitis; Bronchodilator Agents; Budesonide; Child, Preschool; Cromolyn Sodium; Eosinophil Granule Proteins; Female; Follow-Up Studies; Humans; Infant; Inflammation Mediators; Male; Predictive Value of Tests; Pregnenediones; Prospective Studies; Respiratory Sounds; Ribonucleases; Sensitivity and Specificity

To evaluate whether early anti-inflammatory therapy with nebulized cromolyn sodium or budesonide reduces wheezing after bronchiolitis.. A randomized, controlled study in a university hospital that provides primary hospital care for all pediatric patients in a defined area.. One hundred consecutive infants younger than 24 months treated in the hospital for acute bronchiolitis.. Thirty-four patients received cromolyn sodium, 20 mg four times a day for 8 weeks and 20 mg three times a day for 8 weeks, and 34 patients received budesonide, 500 micrograms twice a day for 8 weeks and 250 micrograms twice a day for 8 weeks, by a foot pump with a face mask; 32 patients in the control group received no therapy.. Numbers of physician-diagnosed wheezing episodes, hospital admissions for bronchial obstructions, and symptomatic days recorded by the parents.. Children in the cromolyn sodium (19%) and budesonide (16%) groups had significantly fewer physician-diagnosed wheezing episodes than those in the control group (47%) during the second 8-week period (P < .05). A significant reduction in hospital admissions for bronchial obstructions was seen in the budesonide group and in the children with atopy in both treatment groups (P < .05). The children with atopy had significantly more subsequent wheezing episodes and hospital admissions than those without atopy (P < .05). The numbers of symptomatic days did not differ significantly among the three groups.. Early anti-inflammatory therapy with nebulized cromolyn sodium or budesonide reduces the number of wheezing episodes and hospital admissions after bronchiolitis. Children with atopy are at high risk of subsequent wheezing episodes, and they particularly benefit from anti-inflammatory therapy.

Topics: Administration, Inhalation; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Bronchiolitis; Bronchodilator Agents; Budesonide; Cromolyn Sodium; Humans; Infant; Pregnenediones; Prospective Studies; Respiratory Sounds; Risk Factors; Treatment Outcome

Topics: Acute Disease; Bronchiolitis; Budesonide; Humans; Infant; Pregnenediones; Randomized Controlled Trials as Topic

A 39-year-old white woman with longstanding Crohn's disease presented with the rare complication of granulomatous bronchiolitis. Rapid resolution after inhaled budesonide is highlighted, as this is the first case described in the literature successfully treated without the need for systemic therapy. This less toxic approach to therapy is warranted in granulomatous bronchiolitis of Crohn's disease to avoid unwanted side effects of steroids and infliximab.

Topics: Adult; Anti-Inflammatory Agents; Bronchiolitis; Bronchodilator Agents; Budesonide; Crohn Disease; Female; Glucocorticoids; Granuloma, Respiratory Tract; Humans; Tomography, X-Ray Computed

Topics: Administration, Inhalation; Asthma; Bronchiolitis; Bronchodilator Agents; Budesonide; Humans; Infant; Respiratory Sounds; Respiratory Syncytial Virus Infections

Topics: Administration, Inhalation; Bronchiolitis; Bronchodilator Agents; Budesonide; Female; Humans; Infant; Male; Poly I-C

Airway rejection after lung transplantation is recognized histologically as lymphocytic bronchiolitis (LB). We hypothesized that inhaled steroids could control LB and that changes in exhaled nitric oxide (eNO) would correlate with the development of LB and also have a role in monitoring response to treatment. A cohort of 120 lung transplant (LT) recipients attending for review and biopsy had eNO measurements, FEV1, lavage microbiology, and biopsy histology performed prospectively. Wilcoxon signed-rank test was used to assess the significance of changes in eNO and FEV1. The coefficient of reproducibility of eNO measurement in stable recipients was 2.36 ppb. Fourteen developed graft dysfunction owing to isolated LB and were treated with inhaled budesonide 800 microg twice daily. They showed significant increases in eNO at diagnosis, median (range) 10.9 ppb (4.6 to 48) ppb compared with baseline, 4.33 (1.0 to 10.76), p = 0.008, and a decrease in FEV1. After inhaled treatment, both eNO and FEV1 returned to baseline values. Seven developed acute vascular rejection (with or without LB) and were treated with oral corticosteroids; no changes in eNO occurred at diagnosis or after treatment. Serial eNO measurements provide a useful noninvasive method of identifying airway inflammation in LT recipients. Inhaled budesonide may be a useful addition to systemic immunosuppressants in controlling airway inflammation posttransplant.

Topics: Administration, Inhalation; Anti-Inflammatory Agents; Bronchiolitis; Budesonide; Humans; Lung Transplantation; Lymphocytes; Nitric Oxide; Prospective Studies; Respiration

Steroid-resistant asthma develops after adenoviral bronchiolitis.. We sought to determine the effect of steroids on allergic lung inflammation in the presence of latent adenoviral infection.. Guinea pigs with latent adenoviral (n = 12) or sham (n = 12) infections were sensitized and challenged with ovalbumin (OA) or sham sensitized and challenged with saline solution. The effect of steroids (20 mg/kg administered intraperitoneally) on OA-induced lung inflammation was examined by using quantitative histology as the outcome measure.. Latent adenoviral infection increased CD8(+) cells in the airway wall and CD8(+) cells, macrophages, B cells, and CD4(+) cells in the lung parenchyma. Ovalbumin challenge, on the other hand, increased eosinophils, macrophages, B cells, and CD4(+) cells in both the airway wall and lung parenchyma independent of the effect of latent adenoviral infection. In the sham-infected groups steroid treatment caused the expected reduction in the eosinophilic infiltrate induced by OA challenge in the airways without affecting the other cells. In the presence of both latent adenoviral infection and OA challenge, steroid treatment had no effect on allergen-induced eosinophilia but reduced CD8(+) cells in the airways and CD8(+) cells, CD4(+) cells, and B cells in the parenchyma.. Latent adenoviral infection and OA challenge result in different types of lung inflammation, and the presence of latent adenoviral infection causes OA-induced eosinophilic airway inflammation to become steroid resistant.

Topics: Adenoviridae Infections; Adenoviruses, Human; Administration, Topical; Allergens; Animals; Anti-Inflammatory Agents; Asthma; Bronchiolitis; Budesonide; Cell Line; Female; Glucocorticoids; Guinea Pigs; Humans; Lung; Ovalbumin; Pneumonia; Virus Latency

Topics: Anti-Asthmatic Agents; Anti-Inflammatory Agents; Bronchiolitis; Bronchodilator Agents; Budesonide; Cromolyn Sodium; Humans; Infant; Pregnenediones; Respiratory Sounds

Inflammatory bowel disease (IBD) only occasionally affects the lung. Noteworthy among the various pulmonary entities related to IBD are chronic bronchitis and bronchiectasis, though reports of bronchiolitis, obliterants bronchiolitis with organizing pneumonia and other interstitial diseases have also been published. Given the rarity of such pneumopathy, we report a case of bronchiolitis in a patient with a prior diagnosis of ulcerative colitis. We discuss the radiological findings and the results of lung function testing, emphasizin the utility of corticosteroid treatment, which usually leads to a good outcome in pneumopathy secondary to IBD.

Topics: Administration, Oral; Administration, Topical; Adult; Aerosols; Anti-Inflammatory Agents; Bronchiolitis; Bronchodilator Agents; Budesonide; Colitis, Ulcerative; Female; Glucocorticoids; Humans; Prednisone; Pregnenediones; Radiography, Thoracic; Tomography, X-Ray Computed

Topics: Anti-Inflammatory Agents; Bronchiolitis; Budesonide; Drug Evaluation; Humans; Infant, Newborn; Nebulizers and Vaporizers; Pilot Projects; Pregnenediones; Recurrence; Respiratory Sounds