Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Rizzo, Maria Cândida; Solé, Dírceu

doi:10.2223/jped.1549

Cited by 27 publications

(28 citation statements)

References 50 publications

(50 reference statements)

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“…Em relação aos estudos sobre a utilização de CI para o tratamento da sibilância em lactentes, existem diferenças nos critérios de seleção das crianças, nas estratégias de tratamento, na coleta dos dados e nos desfechos considerados 8,[13][14][15][16][17][18][19][20][21][22][23][24][25] . Apesar disso, é possível concluir que a utilização de CI em lactentes pode, em algumas situações, possibilitar um melhor controle dos sintomas que, porém, não se sustenta após a suspensão do mesmo, ou seja, não interfere A principal limitação do presente estudo compreende o fato de as frequências de uso de CO e CI serem estimadas pelo relato dos pais ou responsáveis pela criança e não através de registros médicos, o que seria mais confiável.…”

Section: Características N (%)unclassified

Oral and inhaled corticoid treatment for wheezing in the first year of life

Alvim¹,

Nunes²,

Fernandes³

et al. 2011

J Pediatr (Rio J)

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Objective: To evaluate the prevalence of corticoid utilization for the treatment of wheezing in infants less than 12 months old and to analyze factors associated with this practice.Methods: This was a cross-sectional study that administered the validated questionnaire from the International Study on the Prevalence of Wheezing in Infants to 1,261 infants aged 12 to 15 months in Belo Horizonte, Brazil. Proportions and 95% confidence intervals were calculated and the chi-square test was used to detect associations between variables.Results: Six hundred and fifty-six (52%) infants, 53% male and 48.2% white, exhibited wheezing during the first year of life. Mean age at first episode was 5.11±2.89 months. There was a high rate of morbidity, with many emergency visits (71%) and hospitalizations (27.8%). Also common were a family history of asthma and atopic disease (32.2 to 71%) and exposure to passive smoking (41.5%) and to mould (47.3%). The prevalence rates for corticoid use, whether via oral route (48.7%) or inhaled (51.3%), were elevated and were higher in the group that suffered three or more episodes. Children suffering greater morbidity were more likely to be prescribed a corticoid (p < 0.05). Conclusion:The high frequency of corticoid use highlights the need to establish specific criteria for the treatment of wheezing in the first years of life in order to avoid extrapolation of asthma treatments to other conditions that are transitory and self-limiting and in which using corticoids could involve more risk than benefit. J Pediatr (Rio J). 2011;87(4):314-318: Infant, asthma, treatment, morbidity. ResumoObjetivo: Avaliar a frequência e os fatores associados ao uso de corticoides para o tratamento de sibilância em lactentes no 1º ano de vida.Método: Estudo transversal, realizado com o questionário validado do Estudio Internacional de Sibilancias en Lactantes, com 1.261 lactentes entre 12 e 15 meses em Belo Horizonte (MG). Foi realizado o cálculo das proporções e intervalo de confiança de 95% e teste de qui-quadrado para estudo da associação entre as variáveis.Resultados: Seiscentos e cinquenta e seis (52%) manifestaram sibilância no 1º ano de vida, sendo 53% do sexo masculino e 48,2% brancos. A média de idade do primeiro episódio foi 5,11±2,89 meses. Verificou-se elevada morbidade, com frequentes idas à emergência (71%) e hospitalizações (27,8%). Foram frequentes a história familiar de asma e atopia (32,2 a 71%), exposição a tabagismo passivo (41,5%) e mofo (47,3%). As prevalências da utilização de corticoides, tanto por via oral (48,7%) quanto inalatória (51,3%), foram elevadas e maiores no grupo com três ou mais episódios. Crianças com maior morbidade tiveram maior chance de receber uma prescrição de corticoide (p < 0,05). Conclusão:A elevada frequência de utilização de corticoides aponta para a necessidade de estabelecerem-se critérios específicos para o tratamento da sibilância nos primeiro anos de vida, para evitar a extrapolação do tratamento da asma para outras condições transitórias e autolimitada...

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Section: Características N (%)unclassified

Oral and inhaled corticoid treatment for wheezing in the first year of life

Alvim¹,

Nunes²,

Fernandes³

et al. 2011

J Pediatr (Rio J)

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“…Current strategies for the management of asthma focus on suppressing airway inflammation [2]. Inhaled glucocorticoids are currently the mainstay of asthma therapy although several side effects may arise when they are used at high doses or for a prolonged time [3]. Airway remodeling consists of progressive structural changes in the composition, content, and organization of the cellular and molecular constituents of the airway wall [4].…”

Section: Introductionmentioning

confidence: 99%

Mesenchymal stem cells ameliorate the histopathological changes in a murine model of chronic asthma

Fırıncı

Karaman

Baran

et al. 2011

International Immunopharmacology

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Asthma therapies are effective in reducing inflammation but airway remodeling is poorly responsive to these agents. New therapeutic options that have fewer side effects and reverse chronic changes in the lungs are essential. Mesenchymal stem cells (MSCs) are promising for the development of novel therapies in regenerative medicine. This study aimed to examine the efficacy of MSCs on lung histopathology in a murine model of chronic asthma. BALB/c mice were divided into four groups: Group 1 (control group, n = 6), Group 2 (ovalbumin induced asthma only, n = 10), Group 3 (ovalbumin induced asthma + MSCs, n = 10), and Group 4 (MSCs only, n = 10). Histological findings (basement membrane, epithelium, subepithelial smooth muscle thickness, numbers of goblet and mast cells) of the airways and MSC migration were evaluated by light, electron, and confocal microscopes. In Group 3, all early histopathological changes except epithelial thickness and all of the chronic changes were significantly ameliorated when compared with Group 2. Evaluation with confocal microscopy showed that no noteworthy amount of MSCs were present in the lung tissues of Group 4 while significant amount of MSCs was detected in Group 3. Serum NO levels in Group 3, were significantly lower than Group 2. The results of this study revealed that MSCs migrated to lung tissue and ameliorated bronchial asthma in murine model. Further studies are needed to evaluate the efficacy of MSCs for the treatment of asthma.

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“…Os corticóides inalatórios são reconhecidamente eficazes e seguros no controle do processo inflamatório da asma 1,2 .…”

Section: Introductionunclassified

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

Lasmar

Camargos²,

Costa³

et al. 2007

J Pediatr (Rio J)

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Objetivo: A morbidade associada à asma é elevada, principalmente nos países em desenvolvimento, e as falhas na adesão ao uso de corticóide inalatório contribuem para esta elevação. Este estudo objetiva comparar as taxas de adesão ao uso de beclometasona relatadas pelos responsáveis e as mensuradas pelos registros de dispensação farmacêutica do medicamento. Métodos:Foi realizado um estudo de coorte concorrente com duração de 12 meses, do qual participaram 106 crianças e adolescentes asmáticos, selecionados aleatoriamente. Através da regressão linear, as taxas de adesão relatadas pelos responsáveis e pelos registros de dispensação da farmácia do serviço foram correlacionadas, quadrimestralmente, a partir da admissão no estudo.Resultados: As taxas de adesão relatadas pelos pais e/ou responsáveis foram sempre superiores (p < 0,001) e apresentaram fraca correlação com aquelas mensuradas pelos registros de farmácia nos períodos estudados, quarto (r = 0,37) e 12º (r = 0,31) mês do seguimento. Conclusão:As taxas de adesão relatadas pelos pais foram superestimadas em todos os períodos do estudo. Crianças com asma deveriam ter suas taxas de adesão também monitoradas por outros métodos e, neste caso, os registros de farmácia foram efetivos em revelar as falhas na adesão. Dado ao seu baixo custo, esse método está indicado para a verificação dessas taxas.J Pediatr (Rio J). 2007;83(5):471-476:Asma, adesão, corticóide inalatório, beclometasona.Objective: There is elevated morbidity associated with asthma, particularly in developing countries, and failure to comply with inhaled corticosteroid treatment contributes to this morbidity. The objective of this study is to compare rates of compliance with beclomethasone treatment reported by parents or guardians with those measured by pharmacy dispensing records. Methods:A concurrent cohort study of 12 months' duration was carried out, enrolling 106 asthmatic children and adolescents, selected at random. Linear regression was used to compare rates of compliance reported by parents or guardians with the pharmacy dispensing records at the service, every 4 months after enrollment on the study. Results:Compliance rates reported by parents and/or guardians were always higher (p < 0.001) and exhibited a weak correlation with pharmacy records during the period studied; fourth (r = 0.37) and twelfth (r = 0.31) months of follow-up. Conclusions:The rates of compliance reported by parents were overestimated during all study periods. The compliance rates of children with asthma should also be monitored by other methods and, in this case, pharmacy records effectively revealed compliance failures. Given its low cost, this method is indicated for verification of these compliance rates. Artigo submetido em 08.05.07, aceito em 11.07.07. J Pediatr (Rio J)

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Inhaled corticosteroids in the treatment of respiratory allergy: safety vs. efficacy

Cited by 27 publications

References 50 publications

Oral and inhaled corticoid treatment for wheezing in the first year of life

Oral and inhaled corticoid treatment for wheezing in the first year of life

Mesenchymal stem cells ameliorate the histopathological changes in a murine model of chronic asthma

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

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