The bronchoprotective effect of inhaled salmeterol in preschool children: a dose-ranging study

Primhak, R A; Smith, C.M.; Yong, SC; Wach, Richard; Kurian, Midhu; Brown, Randall; Efthimiou, J.

doi:10.1183/09031936.99.13107899

Cited by 18 publications

(8 citation statements)

References 39 publications

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“…Formoterol and salmeterol have shown long-lasting bronchodilatory and bronchoprotective effects in preschool children [99,105]. There are no published double-blind randomised placebo-controlled trials in preschool children on the addition of long-acting inhaled b 2 -adrenergic agents to ICSs.…”

Section: Long-acting Inhaled B 2 -Agonistsmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

752

759

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There is poor agreement on definitions of different phenotypes of preschool wheezing disorders. The present Task Force proposes to use the terms episodic (viral) wheeze to describe children who wheeze intermittently and are well between episodes, and multiple-trigger wheeze for children who wheeze both during and outside discrete episodes. Investigations are only needed when in doubt about the diagnosis.Based on the limited evidence available, inhaled short-acting b 2 -agonists by metered-dose inhaler/spacer combination are recommended for symptomatic relief. Educating parents regarding causative factors and treatment is useful. Exposure to tobacco smoke should be avoided; allergen avoidance may be considered when sensitisation has been established. Maintenance treatment with inhaled corticosteroids is recommended for multiple-trigger wheeze; benefits are often small. Montelukast is recommended for the treatment of episodic (viral) wheeze and can be started when symptoms of a viral cold develop.Given the large overlap in phenotypes, and the fact that patients can move from one phenotype to another, inhaled corticosteroids and montelukast may be considered on a trial basis in almost any preschool child with recurrent wheeze, but should be discontinued if there is no clear clinical benefit.Large well-designed randomised controlled trials with clear descriptions of patients are needed to improve the present recommendations on the treatment of these common syndromes.

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Section: Long-acting Inhaled B 2 -Agonistsmentioning

confidence: 99%

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Brand¹,

Baraldi²,

Bisgaard³

et al. 2008

Eur Respir J

752

759

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“…Other authors have favoured measuring the transcutaneous oxygen tension (tcPO 2 ), arguing that it is effort independent, reliable and repeatable and is superior to tracheal auscultation [3±5]. The methodology of the study by WILSON et al [4] involved cessation of challenge when tcPO 2 fell by 20%, which may have censored the PCW data.As part of a dose-ranging study of inhaled salmeterol in preschool children [6], the current study set out to reevaluate these two challenge endpoints. The aim of the study was to compare the sensitivity and safety of using audible wheeze and tcPO 2 in a methacholine challenge in children <4 yrs of age.…”

mentioning

confidence: 99%

“…As part of a dose-ranging study of inhaled salmeterol in preschool children [6], the current study set out to reevaluate these two challenge endpoints. The aim of the study was to compare the sensitivity and safety of using audible wheeze and tcPO 2 in a methacholine challenge in children <4 yrs of age.…”

mentioning

confidence: 99%

Methacholine challenge in preschool children: methacholine-induced wheeze versus transcutaneous oximetry

Yong¹,

Smith²,

Wach³

et al. 1999

Eur Respir J

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Methacholine challenge in preschool children: methacholine-induced wheeze versus transcutaneous oximetry. S.C. Yong, C.M. Smith, R. Wach, M. Kurian, R.A. Primhak. # ERS Journals Ltd 1999. ABSTRACT: Tracheal/chest auscultation for wheeze and transcutaneous oximetry have both been suggested as measures of outcome in bronchial provocation tests in young children. This study aimed to compare the sensitivity and safety of these two techniques as end-points for methacholine challenge in children aged <4 yrs.Seventy-two methacholine challenges were performed in 39 children aged <4 yrs with recurrent wheeze. Arterial oxygen saturation (Sa,O 2 ) and transcutaneous oxygen pressure tcPO 2 continuously, and the test was terminated when wheeze was heard or at Sa,O 2 <91%. tcPO 2 was not used as an end-point.Wheeze or desaturation occurred at #8 mg . mL -1 methacholine in every test. One child had transient clinical cyanosis, but no other ill-effects were seen. Fifty-six tests (78%) were terminated for wheeze, seven (10%) for fall in Sa,O 2 and nine (12%) showed simultaneous responses in both parameters. Twenty-eight tests (39%) contained a fall in tcPO 2 >3 kPa but six of these also showed a significant rise. Fifty-three tests (75%) contained a fall in tcPO 2 >15%, but 20 of these also showed a significant rise.Tracheal/chest auscultation with Sa,O 2 monitoring is a sensitive and relatively safe end-point for bronchial challenges in preschool children. The erratic pattern of transcutaneous oxygen pressure response in some children casts doubt on its reliability as a proxy measure of bronchial obstruction. Eur Respir J 1999; 14: 1175±1178. The measurement of bronchial responsiveness in preschool children is a potentially useful clinical and research tool, but it is hampered by the fact that lung function measurement in preschool children is technically difficult without sedation. Several indirect methods have been used to assess bronchial responsiveness to methacholine challenge in this age group. Tracheal or chest auscultation can be used to measure the provocative concentration of methacholine which induces audible wheeze (PCW) [1,2]. This technique does not require full co-operation of the children, and it has been demonstrated in older children that the value for PCW was similar to that causing a 20% fall in forced expiratory volume in one second (FEV1) [2]. Other authors have favoured measuring the transcutaneous oxygen tension (tcPO 2 ), arguing that it is effort independent, reliable and repeatable and is superior to tracheal auscultation [3±5]. The methodology of the study by WILSON et al. [4] involved cessation of challenge when tcPO 2 fell by 20%, which may have censored the PCW data.As part of a dose-ranging study of inhaled salmeterol in preschool children [6], the current study set out to reevaluate these two challenge endpoints. The aim of the study was to compare the sensitivity and safety of using audible wheeze and tcPO 2 in a methacholine challenge in children <4 yrs of age. Methods SubjectsChildren aged <4...

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“…Weinstein et al 18 reported a trend to greater bronchodilatation with 42 µg than with 21 µg salmeterol in 243 children but found no statistically diVerent changes between the two doses. Primhak et al 19 did show additional bronchoprotective eVect against methacholine induced wheeze with an increase in a single salmeterol dose from 25 to 100 µg, but this was in younger children using a mask and spacer. It is diYcult to compare airway deposition with this device and a dry powder device.…”

Section: Discussionmentioning

confidence: 99%

Salmeterol in paediatric asthma

Byrnes

Shrewsbury

Barnes

et al. 2000

Thorax

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Background-The addition of long acting inhaled 2 agonists is recommended at step 3 of the British guidelines on asthma management but a recent study suggested no additional benefit in children with asthma. Methods-The aim of this study was to compare, in a double blind, three way, crossover study, the eVects of the addition of salmeterol 50 µg bd, salmeterol 100 µg bd, and salbutamol 200 µg qds in asthmatic children who were symptomatic despite treatment with inhaled corticosteroids in a dose of at least 400 µg/day over a one month period. Symptom scores, morning and evening peak expiratory flow (PEF) rates, use of rescue medication, spirometric indices, and histamine challenge were measured. Results-Forty five children aged 5-14 years were enrolled. All three treatments improved asthma control, morning and evening PEF rates, and spirometric indices with no change in bronchial hyperreactivity. Mean morning PEF was significantly better during the salmeterol treatment periods than with salbutamol treatment (p<0.05). The analysis of mean morning PEF gave an estimated treatment diVerence of 9.6 l/min for salmeterol 50 µg bd versus salbutamol 200 µg qds (95% confidence interval (CI) 2.1 to 17.1), and an estimated treatment diVerence of 13.8 l/min for salmeterol 100 µg bd versus salbutamol 200 µg qds (95% CI 6.0 to 21.5). There were no significant diVerences between the two doses of salmeterol and all treatments were well tolerated. Conclusions-In this population of moderate to severe asthmatic children on inhaled corticosteroids, salmeterol in a dose of either 50 µg bd or 100 µg bd is significantly more eVective at increasing the morning PEF rate over a one month period than salbutamol 200 µg qds. The data provided no significant evidence of a diVerence in eYcacy between the two doses of salmeterol, 50 µg and 100 µg. A trial of salmeterol 100 µg bd may be worth considering in those still symptomatic on the lower dose. (Thorax 2000;55:780-784)

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The bronchoprotective effect of inhaled salmeterol in preschool children: a dose-ranging study

Cited by 18 publications

References 39 publications

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach

Methacholine challenge in preschool children: methacholine-induced wheeze versus transcutaneous oximetry

Salmeterol in paediatric asthma

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