Navegando por Palavras-chave "inhaled corticosteroids"
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- ItemAcesso aberto (Open Access)Corticosteróides inalados no tratamento da alergia respiratória: segurança versus eficácia(Sociedade Brasileira de Pediatria, 2006-11-01) Rizzo, Maria Cândida V. [UNIFESP]; Solé, Dirceu [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE: Review the molecular mechanisms of action, efficacy, and potential side effects associated with inhaled corticosteroids (ICS) in children with persistent asthma. SOURCES: Articles in English from MEDLINE. The following terms were used: corticosteroids, inhaled corticosteroids, asthma, children, beclomethasone, fluticasone, budesonide, ciclesonide, growth, adrenal insufficiency, bone mineral density, and oral candidiasis. Treatment guidelines, review articles, controlled trials, meta-analyses, and systematic reviews evaluating the efficacy and the adverse events of treatment with ICS were selected. SUMMARY OF THE FINDINGS: In vivo and in vitro studies show that the available ICS have different pharmacokinetic and pharmacodynamic properties that result in different action potentials. ICS also differ as to the systemic and local side effects. The bioavailability of these products is essential in order to determine the incidence of side effects. In general, ICS are capable of controlling asthma, reducing the number of exacerbations, medical consultations, hospitalizations, and the need of oral corticosteroid (applications) bursts. Improvement can also be seen in pulmonary function, especially in patients with recent onset asthma. The most documented adverse effect is transitory decrease of growth rate. CONCLUSIONS: ICS are the main anti-inflammatory agent used to treat persistent asthma. When administered in low doses, they seem to be safe and effective. Patient monitoring allows for early detection of possible side effects associated with ICS.
- ItemSomente MetadadadosCorticosteroids (inhaled and/or intranasal) in the treatment of respiratory allergy in children: safety vs. efficacy(Elsevier B.V., 2007-09-01) Rizzo, Maria Candida Faria Varanda [UNIFESP]; Solé, Dirceu [UNIFESP]; Naspitz, Charles Kirov [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Background: Topical administration of Corticosteroids (CS) can reduce the total dose of CS required to treat the patient and minimize side effects. Topical CS is extremely effective and has an excellent safety profile. Nonetheless, care must be taken when multiple sites such as lungs, nose and skin are being treated. CS mechanisms of action on the inflammatory process are complex. The aim of this study is to review such mechanisms and the adverse events secondary to it.Methods: Review English database (Embase, Pub-Med, Scielo) searching words: CS, adverse events, inhaled CS, intranasal CS, and children.Results: There is a classic mechanism involving a genomic effect of CS and a non-genomic effect, independently of gene transcription process. This mechanism acts by reducing mucosal blood flow in the asthmatic airways. Second-generation topical CS is the treatment of choice in allergic diseases control because of their good anti-inflammatory activity, poor absorption and first-pass hepatic metabolism. When comparing different CS, it is important to compare therapeutically equivalent doses. Although topical CS reduces systemic side effects, local and even systemic side effects can occur. Many factors affect the amount of drug that reaches the lung, including inhaler technique and inhaler type, fine particle dose and particle distribution.Conclusion: Most patients with allergic diseases respond to CS treatment, but there is a small subset of them whose response is unsatisfactory even with high doses of CS. They are classified as corticosteroid-resistant asthmatics. Pro-inflammatory cytokines appear to up regulate the expression of GR beta that has been associated with CS resistance.
- ItemSomente MetadadadosExhaled nitric oxide for monitoring childhood asthma inflammation compared to sputum analysis, serum interleukins and pulmonary function(Wiley-Blackwell, 2008-02-01) Paro-Heitor, Maria Luisa Z.; Bussamra, Maria Helena C. F.; Saraiva-Romanholo, Beatriz M.; Martins, Milton A.; Okay, Thelma Suely; Rodrigues, Joaquim Carlos; Universidade Federal de São Paulo (UNIFESP); Universidade de São Paulo (USP)The level of fractional exhaled nitric oxide (FENO) is significantly elevated in uncontrolled asthma and decreases after anti-inflammatory therapy the aim of this prospective study was to analyze the behavior of FENO in the follow-up and management of the inflammation in asthmatic pediatric patients treated with inhaled corticosteroids (ICS), compared to sputum cellularity, serum interleukins (IL), and pulmonary function. Twenty-six clinically stable asthmatic children aged from 6 to 18 years, previously treated or not with ICS were included. Following an international consensus (GINA), the patients were submitted to standard treatment with inhaled fluticasone for 3 months according to the severity of the disease. During this period, each patient underwent three assessments at intervals of approximately 6 weeks: Each evaluation consisted of the measurement of FENO, determination of serum interleukins IL-5, IL-10, IL-13, and interferon gamma (INF-gamma), spirometry and cytological analysis of spontaneous or induced sputum. A significant reduction in mean FENO and IL-5, without concomitant changes in FEV1, was observed along the study. There was no significant correlation between FeNO and FEV1 in the three assessments. A significant correlation between FeNO and IL-5 levels was only observed in the third assessment (r = 0.499, P=0.025). in most patients, serum IL-10, IL-13, and INF-gamma concentrations were undetectable throughout the study Sputum samples were obtained spontaneously in 11 occasions and in 56 by induction with 3% hypertonic saline solution (success rate: 50.8%), with 39 (69.9%) of them adequate for analysis. Only two of the 26 patients produced adequate samples in the three consecutive evaluations, which impaired the determination of a potential association between sputum cellularity and FeNO levels throughout the study. in conclusion, among the parameters of this study, it was difficult to perform and to interpret the serial analysis of spontaneous or induced sputum. Serum interleukins, which remained at very low or undetectable levels in most patients, were not found to be useful for therapeutic monitoring, except for IL-5 that seems to present some correlation with levels of FeNO exhaled. Monitoring of the mean FEV1 indicated no significant variations during the treatment, demonstrating that functional stability or the absence of obstruction may not reflect the adequate management of asthma. Serial measurement of FeNO seemed to best reflect the progressive anti-inflammatory action of ICS in asthma.
- ItemAcesso aberto (Open Access)Strength and endurance of the respiratory and handgrip muscles after the use of flunisolide in normal subjects(W B Saunders Co Ltd, 2007-07-01) Jardim, José Roberto [UNIFESP]; Camelier, Aquiles Assunção [UNIFESP]; Dal Corso, Simone [UNIFESP]; Rodrigues, José Eduardo; Universidade Federal de São Paulo (UNIFESP); Universidade Federal da Bahia (UFBA); Univ Metropolitana SantosObjective: To evaluate the effects of the inhaled flunisolide upon the strength and endurance of the respiratory and peripheral muscles of normal subjects.Design: A randomized, double blind and placebo-controlled study.Setting: A university-affiliated teaching hospital.Participants: Thirteen normal volunteers selected from a graduation course.Intervention: Subjects were randomly allocated to receive a placebo or corticosteroid (flunisolide) to be inhaled twice a day for 4 weeks. After 2 weeks of a washout period, subjects who were receiving the placebo, received flunisolide and vise versa for another 4-week period.Measurements and results: Spirometry was used to define the volunteers as being normal in terms of pulmonary function. During the study, subjects performed tests of respiratory muscle function (strength and endurance), measurements of handgrip strength and endurance and anthropometric measurements. Muscle strength was measured each week while muscle endurance was measured every 2 weeks. There was no significant difference in the maximal inspiratory and expiratory pressure and handgrip strength during weeks 1-4 when the subjects used either flunisolide or placebo. However, we observed an increase in the endurance time of the respiratory and handgrip muscles in the 4th week of both flunisolide and placebo use, what may be considered due to a learning effect.Conclusion: Inhalation of flunisolide by normal subjects for 1 month does not cause any acute or clinically perceived effect in the peripheral or respiratory muscles. (C) 2007 Published by Elsevier B.V.