pulmicort and Constriction--Pathologic

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 Authors or manufacturers were asked to supply unpublished data in relation to primary outcomes..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

Topics: Adrenal Cortex Hormones; Anastomosis, Surgical; Anti-Inflammatory Agents; Antibodies, Monoclonal; Budesonide; Colon; Constriction, Pathologic; Crohn Disease; Dilatation; Endoscopy; Gastrointestinal Agents; Glucocorticoids; Humans; Ileal Diseases; Ileum; Infliximab; Intestinal Obstruction; Magnetic Resonance Imaging; Prosthesis Implantation; Randomized Controlled Trials as Topic; Recurrence; Risk Factors; Time Factors

In normal humans in vivo, maximal airway narrowing to LTD4 is more severe than to methacholine. Moreover, LTD4 heightens the maximal response to methacholine for several days. To investigate whether or not this is due to inflammatory changes in the airway wall, we studied the effects of the corticosteroid budesonide on the dose-response curves to inhaled LTD4 and to methacholine. In a two-period, double-blind, placebo-controlled design, budesonide (400 micrograms twice a day) or placebo was inhaled by eight normal subjects on six consecutive days, with a 3-wk washout. Complete dose-response curves to LTD4 (0.36 to 43 nmol) were performed on Day 5, and to methacholine (1.28 to 655 mumol) on Days 4 and 6 of each period using a validated method. The response was measured by FEV1 and standardized partial expiratory flow-volume curves (V40p), and was expressed as the percent fall from baseline. A maximal response plateau was considered if more than two doses fell within a 5% response range. All subjects reached plateaus to methacholine and to LTD4. Budesonide reduced the maximal response to LTD4 (mean difference with placebo, 7.9% fall for FEV1, and 8.4% fall for V40p; p less than 0.05). During placebo the maximal response to methacholine 24 h after LTD4 was higher than 24 h before (mean change, 2.7% fall in FEV1 and 5.5% fall in V40p; p less than 0.05), but not during budesonide (mean change, -2.5% fall in FEV1 and -0.1% fall in V40p; p greater than 0.2), the changes being significantly different between the two periods (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Administration, Inhalation; Adult; Aerosols; Anti-Inflammatory Agents; Budesonide; Constriction, Pathologic; Dose-Response Relationship, Drug; Double-Blind Method; Drug Interactions; Female; Humans; Lung; Male; Methacholine Chloride; Methacholine Compounds; Middle Aged; Pregnenediones; Research Design; SRS-A; Time Factors

Central airway stenosis (CAS) in infants is characterized by dysphonia, dyspnea, cyanosis, repeated apnea, and infection. This case series study aimed to evaluate the safety and efficacy of holmium laser, cryoablation and budesonide inhalation in treating infants with severe CAS.. This retrospective study reviewed medical records data of 28 infants with severe CAS who underwent holmium laser treatment with cryoablation and/or balloon dilatation and budesonide inhalation therapy at Shanghai Children's Medical Center between June 2014 and May 2020. Outcomes were defined as treatment success when the stenotic area was <25% for the normal age group with stable reopening diameter at one-year follow-up.. Patients' mean age was 12.8 ± 8.8 months and 17 (60%) were male. Sixteen cases had web-like stenosis and 12 had scar contracture stenosis. Among 16 patients with web-like stenosis, 8 (50%) underwent balloon dilation with cryotherapy and 8 (50%) underwent balloon dilation only; treatment success was achieved in 10 (62.5%) cases and after revised treatments in 5 (31.25%) cases. Among 12 patients with scar contracture stenosis, 6 (50%) underwent balloon dilation with cryotherapy, 4 (33.3%) underwent cryotherapy and 2 (16.7%) underwent balloon dilation only; treatment success was achieved in 3 (23.1%) cases and after 1-4 revised treatments in 8 (61.5%) cases. Symptoms of the 2 unsuccessful (7.1%) cases were relieved after tracheal stent insertion. Neither severe adverse events nor complications were observed during follow-up.. Holmium laser with cryoablation followed by budesonide inhalation therapy safely and effectively cleans stenotic tissues and maintains airway reopening. Balloon dilation after holmium laser is recommended for treating web-like stenosis.

Topics: Budesonide; Child; China; Cicatrix; Constriction, Pathologic; Contracture; Cryosurgery; Female; Humans; Infant; Lasers, Solid-State; Male; Retrospective Studies

 Endoscopic resection is the treatment of choice for early esophageal cancers. However, resections comprising more than 70-80 % of the circumference are associated with a high risk of stricture formation. Currently, repetitive local injections and/or systemic steroids are given for prevention..  We present here the case of a 78-year-old male patient who had a near circumferential endoscopic submucosal dissection for a pT1a mm, L0, V0, R0, G2 esophageal squamous cell cancer. At the end of endoscopic resection, 80 mg of triamcinolone was injected locally. The patient was then treated with oro-dispersible budesonide tablets (2 × 1 mg/day) and nystatin (4 × 100 000 I.E.) for 8 weeks. This treatment resulted in complete healing without any stricture formation and did not result in any complications..  Treatment with orodispersible budesonide tablets could help prevent strictures after large endoscopic resections in the esophagus..  Die endoskopische Resektion von Ösophagusfrühkarzinomen ist der aktuelle Therapiestandard. Allerdings sind Resektionen von mehr als 70–80 % der Zirkumferenz mit einem sehr hohen Strukturrisiko behaftet. Aktuell werden zur Prävention wiederholte lokale Steroidinjektionen und/oder systemische Steroide eingesetzt..  Wir berichten über einen 78-jährigen Mann, bei dem wegen eines Plattenepithelfrühkarzinoms (pT1a mm, L0, V0, R0, G2) eine subtotal zirkumferentielle endoskopische Submukosadissektion durchgeführt worden war. Am Ende der Resektion wurde einmalig 80 mg Triamcinolon lokal injiziert. Anschließend wurde über 8 Wochen mit oro-dispersiblen Budesonid Tabletten (2 × 1 mg) und Nystatin (4 × 100 000 I.E.) behandelt. Diese Therapie führte zu einer kompletten Ausheilung ohne Ausbildung einer Striktur. Komplikationen wurden nicht beobachtet..  Die Therapie mit orodispersiblen Budesonid Tabletten könnte zur Prävention von Strikturen nach ausgedehnten endoskopischen Resektionen im Ösophagus hilfreich sein.

Topics: Aged; Budesonide; Carcinoma, Squamous Cell; Constriction, Pathologic; Esophageal Neoplasms; Esophageal Stenosis; Esophagoscopy; Humans; Male; Postoperative Complications; Tablets

Topics: Adalimumab; Anti-Bacterial Agents; Anti-Inflammatory Agents; Budesonide; Colonoscopy; Colostomy; Constriction, Pathologic; Crohn Disease; Disease Management; Embolization, Therapeutic; Endoscopy, Digestive System; Esophageal Diseases; Esophagitis; Female; Gastric Artery; Gastrointestinal Hemorrhage; Hematemesis; Humans; Infliximab; Magnetic Resonance Imaging; Middle Aged; Omeprazole; Proton Pump Inhibitors; Rectovaginal Fistula; Recurrence; Sigmoid Diseases; Tumor Necrosis Factor Inhibitors

Topics: Adenoma, Villous; Aged; Budesonide; Constriction, Pathologic; Endoscopic Mucosal Resection; Enema; Female; Humans; Postoperative Complications; Rectal Diseases; Rectal Neoplasms

Outcomes of medical treatment in patients with stricturing and penetrating Crohn's disease (CD) are not well characterized.. Adults with stricturing and penetrating CD who underwent medical treatment from 2004 to 2008 were evaluated. We assessed response rates to medical treatment, time to relapse or surgery, and postoperative complications.. In all, 53 patients underwent medical therapy. 60% had stricturing disease, 11% had penetrating, and 28% had both. Disease location was ileal in 38%, colonic in 2%, and ileocolonic in 60%. At 30, 60, and 90 days, 54%, 60%, and 64% experienced a response to medical therapy, respectively. At 30 days, 75% of patients with ileal CD responded to therapy compared to 38% of patients with ileocolonic CD (P = 0.026). Overall, 64% of patients required surgery. Patients with ileocolonic disease required surgery at 0.55 years versus 1.07 years in patients with ileal disease (P = 0.023). 24% of patients experienced an anastomotic leak, fistula, or abscess (IASC). 29% of patients with penetrating disease developed IASC compared to 6% of patients with stricturing disease (P = 0.047). 32% of patients on biologic therapy had IASC compared to 0% of those not on biologics (P = 0.059).. The outcomes of medical treatment of stricturing or penetrating CD are poor, as 64% ultimately require surgery. Important factors that seem to be associated with either failed therapy include ileocolonic or colonic disease location. We report a high rate of IASC, especially in patients with penetrating disease and those treated with biologic therapy. This should be considered prior to attempted medical therapy.

Topics: Adult; Anti-Bacterial Agents; Budesonide; Cohort Studies; Constriction, Pathologic; Crohn Disease; Female; Glucocorticoids; Humans; Immunologic Factors; Male; Phenotype; Postoperative Complications; Prednisone; Retrospective Studies; Treatment Outcome

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

Topics: Aerosols; Asthma; Bronchi; Budesonide; Constriction, Pathologic; Humans; Male; Middle Aged; Pregnenediones; Pulmonary Ventilation; Vital Capacity