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[PMID]:28461224
[Au] Autor:Li X; Obeidat M; Zhou G; Leung JM; Tashkin D; Wise R; Connett J; Joubert P; Bossé Y; van den Berge M; Brandsma CA; Nickle DC; Hao K; Paré PD; Sin DD
[Ad] Endereço:UBC Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada.
[Ti] Título:Responsiveness to Ipratropium Bromide in Male and Female Patients with Mild to Moderate Chronic Obstructive Pulmonary Disease.
[So] Source:EBioMedicine;19:139-145, 2017 May.
[Is] ISSN:2352-3964
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Although the prevalence of chronic obstructive pulmonary disease (COPD) is similar between men and women, current evidence used to support bronchodilator therapy has been generated in therapeutic trials that have predominately enrolled male patients. Here, we determined whether there is any significant sex-related differences in FEV responses to ipratropium bromide. METHODS: Data from the Lung Health Study (n=5887; 37% females) were used to determine changes in FEV with ipratropium or placebo in male and female subjects with mild to moderate COPD over 5years. Lung Expression Quantitative Trait Loci (eQTL) dataset was used to determine whether there were any sex-related differences in gene expression for muscarinic (M2 and M3) receptors in lungs of male and female patients. RESULTS: After 4months, ipratropium therapy increased FEV by 6.0% in female and 2.9% in male subjects from baseline values (p=2.42×10 ). This effect was modified by body mass index (BMI) such that the biggest improvements in FEV with ipratropium were observed in thin female subjects (p for BMI∗sex interaction=0.044). The sex-related changes in FEV related to ipratropium persisted for 2years (p=0.0134). Female compared with male lungs had greater gene expression for M3 relative to M2 receptors (p=6.86×10 ). CONCLUSION: Ipratropium induces a larger bronchodilator response in female than in male patients and the benefits are particularly notable in non-obese females. Female lungs have greater gene expression for the M3 muscarinic receptor relative to M2 receptors than male lungs. Female patients are thus more likely to benefit from ipratropium than male COPD patients.
[Mh] Termos MeSH primário: Broncodilatadores/uso terapêutico
Antagonistas Colinérgicos/uso terapêutico
Ipratrópio/uso terapêutico
Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
[Mh] Termos MeSH secundário: Adulto
Índice de Massa Corporal
Feminino
Volume Expiratório Forçado
Expressão Gênica
Seres Humanos
Masculino
Meia-Idade
Doença Pulmonar Obstrutiva Crônica/genética
Doença Pulmonar Obstrutiva Crônica/fisiopatologia
Receptor Muscarínico M2/genética
Receptor Muscarínico M3/genética
Caracteres Sexuais
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Nm] Nome de substância:
0 (Bronchodilator Agents); 0 (Cholinergic Antagonists); 0 (Receptor, Muscarinic M2); 0 (Receptor, Muscarinic M3); GR88G0I6UL (Ipratropium)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180306
[Lr] Data última revisão:
180306
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE


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[PMID]:29449208
[Au] Autor:Keeley D
[Ad] Endereço:Thame OX9 3JF, UK.
[Ti] Título:Everyone with asthma should have a metered dose inhaler and a spacer.
[So] Source:BMJ;360:k648, 2018 02 15.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Asma
Nebulizadores e Vaporizadores
[Mh] Termos MeSH secundário: Administração por Inalação
Albuterol
Broncodilatadores
Seres Humanos
Inaladores Dosimetrados
[Pt] Tipo de publicação:LETTER; COMMENT
[Nm] Nome de substância:
0 (Bronchodilator Agents); QF8SVZ843E (Albuterol)
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180305
[Lr] Data última revisão:
180305
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:180217
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.k648


  3 / 17713 MEDLINE  
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[PMID]:29364929
[Au] Autor:Price DB; Gefen E; Gopalan G; McDonald R; Thomas V; Ming SWY; Davis E
[Ad] Endereço:Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
[Ti] Título:Real-life effectiveness and safety of salbutamol Steri-Neb™ vs. Ventolin Nebules® for exacerbations in patients with COPD: Historical cohort study.
[So] Source:PLoS One;13(1):e0191404, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Ventolin Nebules® (reference product; GlaxoSmithKline) was the first licensed nebulizer solution containing the rapid-onset, short-acting ß2-agonist salbutamol. Salbutamol Steri-Neb™ (comparator; Teva Pharmaceuticals, Inc.) has the same chemical composition as the reference product. This study evaluated whether the effectiveness of the comparator is non-inferior to the reference product alongside concomitant medications during real-life clinical management of COPD exacerbations. Safety in terms of adverse events (AEs) was also examined. METHODS: This matched (1:1) historical cohort study evaluated data from 2 UK primary care databases on patients prescribed the salbutamol comparator or reference. The study included a 1-year baseline period, starting 1 year before the index prescription date, and 1-year outcome period. Cohorts were matched for baseline COPD respiratory medications. The primary outcome was analysis of non-inferiority for the comparator versus reference product for the rate of moderate and severe COPD exacerbations. Non-inferiority was satisfied if the 95% confidence interval (CI) upper limit for mean differences in proportions between treatments was <15%. Secondary outcomes were examined through rate ratios (RR) of severe exacerbations and AEs. RESULTS: After matching, 1191 patients were included in each cohort. Adjusted upper 95% CI for the difference in proportion of patients experiencing moderate or severe exacerbations between comparator and reference groups was 0.032 (3.2%), demonstrating non-inferiority. No significant differences were observed in rates of moderate and severe exacerbations (RR: 1.00; 95% CI: 0.91, 1.10), severe exacerbations (RR: 0.76; 95% CI: 0.49, 1.17), or AEs (RR: 0.98; 95% CI: 0.78, 1.22) after adjusting for baseline confounders. No significant differences across cohorts were observed for rates of any AE or death. CONCLUSION: This matched cohort study of real-life management of COPD patients supports the salbutamol comparator as non-inferior to the reference product, providing an effective treatment alternative for COPD exacerbations. Comparator and reference safety profiles were similar.
[Mh] Termos MeSH primário: Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem
Albuterol/administração & dosagem
Broncodilatadores/administração & dosagem
Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico
[Mh] Termos MeSH secundário: Administração por Inalação
Agonistas de Receptores Adrenérgicos beta 2/efeitos adversos
Adulto
Idoso
Idoso de 80 Anos ou mais
Albuterol/efeitos adversos
Broncodilatadores/efeitos adversos
Estudos de Coortes
Progressão da Doença
Feminino
Seres Humanos
Masculino
Meia-Idade
Nebulizadores e Vaporizadores
Doença Pulmonar Obstrutiva Crônica/fisiopatologia
Resultado do Tratamento
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Adrenergic beta-2 Receptor Agonists); 0 (Bronchodilator Agents); QF8SVZ843E (Albuterol)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191404


  4 / 17713 MEDLINE  
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[PMID]:29395853
[Au] Autor:Fanetti G; Bazzani F; Ferrari A; Alterio D; Donghi SM; Pounou Kamga FA; Orecchia R; Jereczek-Fossa BA
[Ad] Endereço:Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141 Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. Electronic address: giuseppe.fanetti@ieo.it.
[Ti] Título:Bronchiolitis obliterans organizing pneumonia after stereotactic ablative radiation therapy for lung cancer: A case report.
[So] Source:Cancer Radiother;22(1):57-61, 2018 Feb.
[Is] ISSN:1769-6658
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:Bronchiolitis obliterans organizing pneumonia is an interstitial lung disease rarely occurring after radiotherapy probably due to an activation of autoimmune processes. Most cases have been described after postoperative radiotherapy for breast cancer. Corticosteroids represent the main treatment, prognosis is generally favorable. We described a case of bronchiolitis obliterans organizing pneumonia after stereotactic ablative radiation therapy for a recurrent lung cancer. Antibiotics and steroids were administered to solve the clinical picture. After three years, a new lesion at the right lung was found and treated with stereotactic ablative radiation therapy and concomitant long course of steroids with no recurrence of bronchiolitis obliterans organizing pneumonia. Bronchiolitis obliterans organizing pneumonia is a rare event after radiotherapy with undefined risk factors. In our case, steroids played an important role in management and, maybe, in preventing bronchiolitis obliterans organizing pneumonia recurrence after second course of stereotactic ablative radiation therapy.
[Mh] Termos MeSH primário: Pneumonia em Organização Criptogênica/etiologia
Neoplasias Pulmonares/radioterapia
Radiocirurgia/efeitos adversos
[Mh] Termos MeSH secundário: Idoso
Antibacterianos/uso terapêutico
Broncodilatadores/uso terapêutico
Carcinoma Pulmonar de Células não Pequenas/radioterapia
Pneumonia em Organização Criptogênica/tratamento farmacológico
Feminino
Glucocorticoides/uso terapêutico
Seres Humanos
Prednisona/uso terapêutico
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Bronchodilator Agents); 0 (Glucocorticoids); VB0R961HZT (Prednisone)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180220
[Lr] Data última revisão:
180220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180204
[St] Status:MEDLINE


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[PMID]:28465408
[Au] Autor:Hopkinson NS
[Ti] Título:Caring about what happens to people with COPD.
[So] Source:Thorax;72(8):683-685, 2017 08.
[Is] ISSN:1468-3296
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Broncodilatadores
Empatia
[Mh] Termos MeSH secundário: Progressão da Doença
Doença Pulmonar Obstrutiva Crônica
[Pt] Tipo de publicação:EDITORIAL; COMMENT
[Nm] Nome de substância:
0 (Bronchodilator Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170504
[St] Status:MEDLINE
[do] DOI:10.1136/thoraxjnl-2017-210065


  6 / 17713 MEDLINE  
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[PMID]:29320622
[Au] Autor:Tausan D; Ristic A; Zvezdin B
[Ti] Título:Kartagener's syndrome: A case report.
[So] Source:Vojnosanit Pregl;73(9):873-6, 2016 Sep.
[Is] ISSN:0042-8450
[Cp] País de publicação:Serbia
[La] Idioma:eng
[Ab] Resumo:Introduction: Kartagener's syndrome is a recessive autosomal disease which is mainly seen to affect ciliary movement. The symptoms of the syndrome are the consequence of the defective motility of the cilia found in the respiratory tract and that results with recurrent lung infections caused by mucus stasis in the bronchi. Case report: A 37-year-old married, male father of one child, presented with a history of productive cough, wheezing, dispnea, headache, temporary fever. In his 9th year of age, 1986, situs inversus, sinusitis and pectus excavatum were diagnosed. In 1994 he was operated for correction of pectus excavatum. Bronchial asthma was diagnosed in 2008 when he was 31. In the last 2 years he had episodes of breathlessness, wheezing, cough, expectoration, headache, fever and fast declining lung function. The patient was treated with combination of inhaled bronchodilatators (inhaled corticosteroids + long-acting ß-2 agonist), and occasional administration of antibiotics, oral prednisolone, mucolytics in episodes of exacerbations of disease over a period of 7−14 days. Conclusion: Treatment for patients with this syndrome has not been established yet, but it is important to control chronic lung infections and prevent declining of lung function.
[Mh] Termos MeSH primário: Síndrome de Kartagener
Pulmão
[Mh] Termos MeSH secundário: Administração por Inalação
Adulto
Antibacterianos/administração & dosagem
Broncodilatadores/administração & dosagem
Progressão da Doença
Expectorantes/administração & dosagem
Glucocorticoides/administração & dosagem
Seres Humanos
Síndrome de Kartagener/complicações
Síndrome de Kartagener/diagnóstico por imagem
Síndrome de Kartagener/tratamento farmacológico
Síndrome de Kartagener/fisiopatologia
Pulmão/diagnóstico por imagem
Pulmão/efeitos dos fármacos
Pulmão/fisiopatologia
Masculino
Fatores de Tempo
Tomografia Computadorizada por Raios X
Resultado do Tratamento
[Pt] Tipo de publicação:CASE REPORTS; JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents); 0 (Bronchodilator Agents); 0 (Expectorants); 0 (Glucocorticoids)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180111
[St] Status:MEDLINE
[do] DOI:10.2298/VSP141020072T


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[PMID]:29253920
[Au] Autor:Smith S; Edwards CT
[Ad] Endereço:Division of Child Health, Obstetrics & Gynaecology, School of Medicine, The University of Nottingham, 1701 E Floor, East Block Queens Medical Centre, Nottingham, NG7 2UH, UK.
[Ti] Título:Long-acting inhaled bronchodilators for cystic fibrosis.
[So] Source:Cochrane Database Syst Rev;12:CD012102, 2017 Dec 19.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Cystic fibrosis is a life-limiting inherited condition which affects one in 2500 newborns in the UK and 70,000 children and adults worldwide. The condition is multifaceted and affects many systems in the body. The respiratory system is particularly affected due to a build up of thickened secretions and a predisposition to infection. Inhaled bronchodilators are prescribed for 80% of people with cystic fibrosis in order to widen the airways and alleviate symptoms. Both short- and long-acting inhaled bronchodilators are used to improve respiratory symptoms. Short-acting inhaled bronchodilators take effect in minutes and typically last for four to eight hours (muscarinic antagonists). Long-acting inhaled bronchodilators also take effect within minutes but typically last for around 12 hours and sometimes longer. This review is one of two which are replacing a previously published review of both long- and short-acting inhaled bronchodilators. OBJECTIVES: This review aims to evaluate long-acting inhaled bronchodilators in children and adults with cystic fibrosis in terms of clinical outcomes and safety. If possible, we aimed to assess the optimal drug and dosage regimen. SEARCH METHODS: We searched the Cochrane Cystic Fibrosis Trials Register, compiled from electronic database searches and handsearching of journals and conference abstract books.Date of last search: 10 October 2017.We also carried out a separate search of Embase and the reference lists of included trials. We searched clinical trials registries for any ongoing trials and made contact with pharmaceutical companies for any further trials.Date of Embase search: 11 October 2017. SELECTION CRITERIA: Randomised or quasi-randomised parallel trials comparing long-acting inhaled bronchodilators (beta-2 agonists and muscarinic antagonists) with placebo, no treatment or a different long-acting inhaled bronchodilator in adults and children with cystic fibrosis. DATA COLLECTION AND ANALYSIS: Both authors independently assessed trials for inclusion (based on title, abstract and full text). The authors independently assessed the included trials for quality and risk of bias and extracted data. Discrepancies were resolved by a third party. MAIN RESULTS: The searches identified 195 unique references, of which 155 were excluded on title and abstract. We assessed the full texts of the remaining references, excluded 16 trials (28 references) and included four trials (12 references) in the review with 1082 participants.One trial (n = 16) measuring the effect of beta-2 agonists reported an improvement in forced expiratory volume at one second (FEV ) after treatment (at one month), but the trial was small with an unclear risk of bias so we judged the evidence to be very low quality. The trial did not report on participant-reported outcomes, quality of life or adverse events.Three trials (n = 1066) looked at the effects of the muscarinic antagonist tiotropium at doses of 2.5 µg and 5.0 µg in both the short term (up to 28 days) and the longer term (up to three months). Only one of the trials reported the change in FEV (L) after 28 days treatment and showed no significant difference between groups; with 2.5 µg tiotropium, mean difference (MD) -0.02 (95% confidence interval (CI) -0.13 to 0.09), or 5.0 µg tiotropium, MD 0.00 (95% CI -0.10 to 0.10) (moderate-quality evidence). All three trials of muscarinic antagonists provided data on adverse events which were found to differ little from placebo at doses of 2.5 µg, risk ratio (RR) 1.01 (95% CI 0.92 to 1.11) or 5.0 µg, RR 0.98 (95% CI 0.90 to 1.06). Very little participant-reported outcome data or quality of life data were available for analysis. Two of the trials were at low risk of bias overall whilst the remaining trial was at an unclear risk overall. AUTHORS' CONCLUSIONS: Neither long-acting beta-2 agonists nor long-acting muscarinic antagonist bronchodilators demonstrate improvement in our primary outcome of FEV . No difference was observed between intervention and placebo in terms of quality of life or adverse events. The quality of evidence for the use of beta-2 agonists was very low. The use of a long-acting inhaled bronchodilator may help to reduce the burden of treatment for people with cystic fibrosis as it is taken less often than a short-acting inhaled bronchodilator, but future trials would benefit from looking at the effects on our primary outcomes (spirometric changes from baseline, quality of life and adverse effects) in the longer term.
[Mh] Termos MeSH primário: Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico
Broncodilatadores/uso terapêutico
Fibrose Cística/tratamento farmacológico
Antagonistas Muscarínicos/uso terapêutico
Brometo de Tiotrópio/uso terapêutico
[Mh] Termos MeSH secundário: Administração por Inalação
Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem
Broncodilatadores/administração & dosagem
Progressão da Doença
Volume Expiratório Forçado/efeitos dos fármacos
Seres Humanos
Antagonistas Muscarínicos/administração & dosagem
Qualidade de Vida
Ensaios Clínicos Controlados Aleatórios como Assunto
Fatores de Tempo
Brometo de Tiotrópio/administração & dosagem
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Nome de substância:
0 (Adrenergic beta-2 Receptor Agonists); 0 (Bronchodilator Agents); 0 (Muscarinic Antagonists); XX112XZP0J (Tiotropium Bromide)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180129
[Lr] Data última revisão:
180129
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171219
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD012102.pub2


  8 / 17713 MEDLINE  
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[PMID]:29265171
[Au] Autor:Zhang L; Mendoza-Sassi RA; Wainwright C; Klassen TP
[Ad] Endereço:Faculty of Medicine, Federal University of Rio Grande, Rua Visconde Paranaguá 102, Centro, Rio Grande, RS, Brazil, 96201-900.
[Ti] Título:Nebulised hypertonic saline solution for acute bronchiolitis in infants.
[So] Source:Cochrane Database Syst Rev;12:CD006458, 2017 12 21.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (≥ 3%) may reduce these pathological changes and decrease airway obstruction. This is an update of a review first published in 2008, and previously updated in 2010 and 2013. OBJECTIVES: To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute bronchiolitis. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, Embase, CINAHL, LILACS, and Web of Science on 11 August 2017. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 8 April 2017. SELECTION CRITERIA: We included randomised controlled trials and quasi-randomised controlled trials using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline, or standard treatment as a comparator in children under 24 months with acute bronchiolitis. The primary outcome for inpatient trials was length of hospital stay, and the primary outcome for outpatients or emergency department trials was rate of hospitalisation. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, data extraction, and assessment of risk of bias in included studies. We conducted random-effects model meta-analyses using Review Manager 5. We used mean difference (MD), risk ratio (RR), and their 95% confidence intervals (CI) as effect size metrics. MAIN RESULTS: We identified 26 new trials in this update, of which 9 await classification due to insufficient data for eligibility assessment, and 17 trials (N = 3105) met the inclusion criteria. We included a total of 28 trials involving 4195 infants with acute bronchiolitis, of whom 2222 infants received hypertonic saline.Hospitalised infants treated with nebulised hypertonic saline had a statistically significant shorter mean length of hospital stay compared to those treated with nebulised 0.9% saline (MD -0.41 days, 95% CI -0.75 to -0.07; P = 0.02, I² = 79%; 17 trials; 1867 infants) (GRADE quality of evidence: low). Infants who received hypertonic saline also had statistically significant lower post-inhalation clinical scores than infants who received 0.9% saline in the first three days of treatment (day 1: MD -0.77, 95% CI -1.18 to -0.36, P < 0.001; day 2: MD -1.28, 95% CI -1.91 to -0.65, P < 0.001; day 3: MD -1.43, 95% CI -1.82 to -1.04, P < 0.001) (GRADE quality of evidence: low).Nebulised hypertonic saline reduced the risk of hospitalisation by 14% compared with nebulised 0.9% saline among infants who were outpatients and those treated in the emergency department (RR 0.86, 95% CI 0.76 to 0.98; P = 0.02, I² = 7%; 8 trials; 1723 infants) (GRADE quality of evidence: moderate).Twenty-four trials presented safety data: 13 trials (1363 infants, 703 treated with hypertonic saline) did not report any adverse events, and 11 trials (2360 infants, 1265 treated with hypertonic saline) reported at least one adverse event, most of which were mild and resolved spontaneously. AUTHORS' CONCLUSIONS: Nebulised hypertonic saline may modestly reduce length of stay among infants hospitalised with acute bronchiolitis and improve clinical severity score. Treatment with nebulised hypertonic saline may also reduce the risk of hospitalisation among outpatients and emergency department patients. However, we assessed the quality of the evidence as low to moderate.
[Mh] Termos MeSH primário: Bronquiolite Viral/terapia
Solução Salina Hipertônica/administração & dosagem
[Mh] Termos MeSH secundário: Doença Aguda
Obstrução das Vias Respiratórias
Broncodilatadores/administração & dosagem
Seres Humanos
Lactente
Tempo de Internação
Nebulizadores e Vaporizadores
Readmissão do Paciente/estatística & dados numéricos
Ensaios Clínicos Controlados Aleatórios como Assunto
Índice de Gravidade de Doença
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Bronchodilator Agents); 0 (Saline Solution, Hypertonic)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180123
[Lr] Data última revisão:
180123
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171222
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD006458.pub4


  9 / 17713 MEDLINE  
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[PMID]:28743514
[Au] Autor:Herbert J; Thiermann H; Worek F; Wille T
[Ad] Endereço:Bundeswehr Institute of Pharmacology and Toxicology, Neuherbergstrasse 11, 80937 Munich, Germany.
[Ti] Título:Precision cut lung slices as test system for candidate therapeutics in organophosphate poisoning.
[So] Source:Toxicology;389:94-100, 2017 08 15.
[Is] ISSN:1879-3185
[Cp] País de publicação:Ireland
[La] Idioma:eng
[Ab] Resumo:Standard therapeutic options in organophosphate (OP) poisoning are limited to the administration of atropine and oximes, a regimen often lacking in efficacy and applicability. Treatment alternatives are needed, preferably covering a broad spectrum of OP intoxications. Although recent research yielded several promising compounds, e.g. bioscavengers, modulators of the muscarinic acetylcholine (ACh) receptor or bispyridinium non-oximes, these substances still need further evaluation, especially regarding effects on the potentially lethal respiratory symptoms of OP poisoning. Aim of this study was the development of an applicable and easy method to test the therapeutic efficiency of such substances. For this purpose, airway responsiveness in viable precision cut lung slices (PCLS) from rats was analysed. We showed that ACh-induced airway contractions were spontaneously reversible in non-poisoned PCLS, whereas in OP poisoned PCLS, contractions were irreversible. This effect could be antagonized by addition of the standard therapeutic atropine, thereby presenting a clear indication for treatment efficiency. Now, candidate therapeutic compounds can be evaluated, based on their ability to counteract the irreversible airway contraction in OP poisoned PCLS.
[Mh] Termos MeSH primário: Antídotos/farmacologia
Atropina/farmacologia
Broncoconstrição/efeitos dos fármacos
Broncodilatadores/farmacologia
Descoberta de Drogas/métodos
Pulmão/efeitos dos fármacos
Antagonistas Muscarínicos/farmacologia
Contração Muscular/efeitos dos fármacos
Músculo Liso/efeitos dos fármacos
Agentes Neurotóxicos/toxicidade
Intoxicação por Organofosfatos/tratamento farmacológico
Organofosfatos/toxicidade
[Mh] Termos MeSH secundário: Acetilcolina/farmacologia
Animais
Relação Dose-Resposta a Droga
Pulmão/fisiopatologia
Masculino
Músculo Liso/fisiopatologia
Intoxicação por Organofosfatos/fisiopatologia
Ratos Wistar
Fatores de Tempo
Técnicas de Cultura de Tecidos
Sobrevivência de Tecidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Antidotes); 0 (Bronchodilator Agents); 0 (Muscarinic Antagonists); 0 (Nerve Agents); 0 (Organophosphates); 7C0697DR9I (Atropine); N9YNS0M02X (Acetylcholine)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:180122
[Lr] Data última revisão:
180122
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170727
[St] Status:MEDLINE


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[PMID]:29182799
[Au] Autor:Knightly R; Milan SJ; Hughes R; Knopp-Sihota JA; Rowe BH; Normansell R; Powell C
[Ad] Endereço:PHRI, St George's, University of London, London, UK.
[Ti] Título:Inhaled magnesium sulfate in the treatment of acute asthma.
[So] Source:Cochrane Database Syst Rev;11:CD003898, 2017 11 28.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Asthma exacerbations can be frequent and range in severity from mild to life-threatening. The use of magnesium sulfate (MgSO4) is one of numerous treatment options available during acute exacerbations. While the efficacy of intravenous MgSO4 has been demonstrated, the role of inhaled MgSO4 is less clear. OBJECTIVES: To determine the efficacy and safety of inhaled MgSO4 administered in acute asthma. SPECIFIC AIMS: to quantify the effects of inhaled MgSO4 I) in addition to combination treatment with inhaled ß2-agonist and ipratropium bromide; ii) in addition to inhaled ß2-agonist; and iii) in comparison to inhaled ß2-agonist. SEARCH METHODS: We identified randomised controlled trials (RCTs) from the Cochrane Airways Group register of trials and online trials registries in September 2017. We supplemented these with searches of the reference lists of published studies and by contact with trialists. SELECTION CRITERIA: RCTs including adults or children with acute asthma were eligible for inclusion in the review. We included studies if patients were treated with nebulised MgSO4 alone or in combination with ß2-agonist or ipratropium bromide or both, and were compared with the same co-intervention alone or inactive control. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed trial selection, data extraction and risk of bias. We made efforts to collect missing data from authors. We present results, with their 95% confidence intervals (CIs), as mean differences (MDs) or standardised mean differences (SMDs) for pulmonary function, clinical severity scores and vital signs; and risk ratios (RRs) for hospital admission. We used risk differences (RDs) to analyse adverse events because events were rare. MAIN RESULTS: Twenty-five trials (43 references) of varying methodological quality were eligible; they included 2907 randomised patients (2777 patients completed). Nine of the 25 included studies involved adults; four included adult and paediatric patients; eight studies enrolled paediatric patients; and in the remaining four studies the age of participants was not stated. The design, definitions, intervention and outcomes were different in all 25 studies; this heterogeneity made direct comparisons difficult. The quality of the evidence presented ranged from high to very low, with most outcomes graded as low or very low. This was largely due to concerns about the methodological quality of the included studies and imprecision in the pooled effect estimates. Inhaled magnesium sulfate in addition to inhaled ß2-agonist and ipratropiumWe included seven studies in this comparison. Although some individual studies reported improvement in lung function indices favouring the intervention group, results were inconsistent overall and the largest study reporting this outcome found no between-group difference at 60 minutes (MD -0.3 % predicted peak expiratory flow rate (PEFR), 95% CI -2.71% to 2.11%). Admissions to hospital at initial presentation may be reduced by the addition of inhaled magnesium sulfate (RR 0.95, 95% CI 0.91 to 1.00; participants = 1308; studies = 4; I² = 52%) but no difference was detected for re-admissions or escalation of care to ITU/HDU. Serious adverse events during admission were rare. There was no difference between groups for all adverse events during admission (RD 0.01, 95% CI -0.03 to 0.05; participants = 1197; studies = 2). Inhaled magnesium sulfate in addition to inhaled ß2-agonistWe included 13 studies in this comparison. Although some individual studies reported improvement in lung function indices favouring the intervention group, none of the pooled results showed a conclusive benefit as measured by FEV1 or PEFR. Pooled results for hospital admission showed a point estimate that favoured the combination of MgSO4 and ß2-agonist, but the confidence interval includes the possibility of admissions increasing in the intervention group (RR 0.78, 95% CI 0.52 to 1.15; participants = 375; studies = 6; I² = 0%). There were no serious adverse events reported by any of the included studies and no between-group difference for all adverse events (RD -0.01, 95% CI -0.05 to 0.03; participants = 694; studies = 5). Inhaled magnesium sulfate versus inhaled ß2-agonistWe included four studies in this comparison. The evidence for the efficacy of ß2-agonists in acute asthma is well-established and therefore this could be considered a historical comparison. Two studies reported a benefit of ß2-agonist over MgSO4 alone for PEFR and two studies reported no difference; we did not pool these results. Admissions to hospital were only reported by one small study and events were rare, leading to an uncertain result. No serious adverse events were reported in any of the studies in this comparison; one small study reported mild to moderate adverse events but the result is imprecise. AUTHORS' CONCLUSIONS: Treatment with nebulised MgSO4 may result in modest additional benefits for lung function and hospital admission when added to inhaled ß2-agonists and ipratropium bromide, but our confidence in the evidence is low and there remains substantial uncertainty. The recent large, well-designed trials have generally not demonstrated clinically important benefits. Nebulised MgSO4 does not appear to be associated with an increase in serious adverse events. Individual studies suggest that those with more severe attacks and attacks of shorter duration may experience a greater benefit but further research into subgroups is warranted.Despite including 24 trials in this review update we were unable to pool data for all outcomes of interest and this has limited the strength of the conclusions reached. A core outcomes set for studies in acute asthma is needed. This is particularly important in paediatric studies where measuring lung function at the time of an exacerbation may not be possible. Placebo-controlled trials in patients not responding to standard maximal treatment, including inhaled ß2-agonists and ipratropium bromide and systemic steroids, may help establish if nebulised MgSO4 has a role in acute asthma. However, the accumulating evidence suggests that a substantial benefit may be unlikely.
[Mh] Termos MeSH primário: Agonistas Adrenérgicos beta/administração & dosagem
Antiasmáticos/administração & dosagem
Asma/tratamento farmacológico
Sulfato de Magnésio/administração & dosagem
[Mh] Termos MeSH secundário: Doença Aguda
Administração por Inalação
Agonistas Adrenérgicos beta/efeitos adversos
Adulto
Antiasmáticos/efeitos adversos
Broncodilatadores/administração & dosagem
Criança
Progressão da Doença
Quimioterapia Combinada/métodos
Hospitalização/estatística & dados numéricos
Seres Humanos
Ipratrópio/administração & dosagem
Sulfato de Magnésio/efeitos adversos
Readmissão do Paciente/estatística & dados numéricos
Ensaios Clínicos Controlados Aleatórios como Assunto
Testes de Função Respiratória
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Nm] Nome de substância:
0 (Adrenergic beta-Agonists); 0 (Anti-Asthmatic Agents); 0 (Bronchodilator Agents); 7487-88-9 (Magnesium Sulfate); GR88G0I6UL (Ipratropium)
[Em] Mês de entrada:1801
[Cu] Atualização por classe:180116
[Lr] Data última revisão:
180116
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD003898.pub6



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