Assuntos
Teofilina/administração & dosagem , Humanos , Lactente , Recém-Nascido , Matemática , Teofilina/sangueRESUMO
Chronic cough in childhood has many possible causes. The two most common are asthma and viral upper respiratory infection. Although usually associated with wheezing, dyspnea, or both, cough may be the sole manifestation of asthma ("cough-variant asthma"). Most important to initial evaluation are physical examination, patient history, and chest radiograph. Bronchial provocation testing may also prove helpful but is usually unnecessary. A trial of antiasthma therapy is appropriate when the pattern of symptoms is typical of asthma (excepting the lack of wheezing) and when nothing incompatible with asthma is present in the clinical picture. Drug therapy for cough-variant asthma is the same as that for more typical asthma. A vigorous trial of antiasthma therapy should not be considered complete unless a short course of high oral doses of corticosteroids has been included. The presence of clinical signs or symptoms atypical or incompatible with asthma and the failure of symptoms to respond to aggressive antiasthma therapy both warrant a more aggressive and complete diagnostic study.
Assuntos
Tosse/etiologia , Algoritmos , Asma/complicações , Criança , Pré-Escolar , Doença Crônica , Tosse/tratamento farmacológico , HumanosRESUMO
The effect of high orally administered doses of prednisone for 1 week early in the course of an acute exacerbation of asthma incompletely responsive to bronchodilators was examined in 41 patients randomly assigned to receive either prednisone or an identical appearing placebo. All 22 of the patients who received prednisone improved during the week of treatment, although one had a subsequent exacerbation 5 days after discontinuing the study medication. Of the 19 who received placebo, eight required rescue intervention (P = less than 0.004) in association with continued symptoms, increased frequency of metered-dose inhaler use, and decreased pulmonary function; the other 11 improved at about the same rate as those who received prednisone. Although the mean initial FEV1 was suggestively lower among those who did not improve and required intervention, there was considerable overlap with those who improved spontaneously, and no reliable distinguishing characteristics were found at entry into the study that could serve as predictors of those who would or would not improve spontaneously. There were no clinically important adverse effects from the prednisone. Because continued symptoms of asthma often result in emergency care or hospitalization, these data support early intervention with orally administered prednisone for acute exacerbations that do not respond fully to bronchodilators, at least in those patients with a prior history of a protracted course or emergency care.
Assuntos
Assistência Ambulatorial/métodos , Asma/tratamento farmacológico , Prednisona/uso terapêutico , Adolescente , Adulto , Asma/patologia , Broncodilatadores/uso terapêutico , Criança , Pré-Escolar , Método Duplo-Cego , Emergências , Feminino , Humanos , Masculino , Placebos , Prednisona/efeitos adversos , Estudos Prospectivos , Ventilação Pulmonar , Distribuição Aleatória , Estatística como AssuntoRESUMO
To assess the utility of a dose-titration scheme for determining maintenance theophylline requirements, dose requirements and stability of serum concentrations were examined using 3537 serum determinations from 1073 patients with chronic asthma during a 5-year period. When the dosing scheme was followed, 78% of initial serum concentrations were within the target range of 10 to 20 micrograms/ml; the mean number of measurements to attain this range was 1.3. Among 404 of these patients prospectively questioned, adverse effects were not present in all 41 whose initial serum concentration was less than 10 micrograms/ml, occurred in eight of 296 patients when serum concentrations were between 10 and 20 micrograms/ml, and were present in 21 of 67 when concentrations were greater than 20 micrograms/ml. After final dose adjustment, mean dose requirements among those who attained serum concentrations of 10 to 20 micrograms/ml averaged 22 mg/kg/day in 1- to 9-year-old children, 20 mg/kg/day in 9- to 12-year-old children, 18 mg/kg/day in 12- to 16 year-old children, and 13 mg/kg/day in the 94 patients older than 16 years of age. Repeat serum concentrations after 3 months to 2 years showed 66% remaining within the 10 to 20 micrograms/ml range and another 15% between 7.5 and 10 micrograms/ml; 9% were greater than 20 micrograms/ml, and none greater than 30 micrograms/ml. Thus the dosing scheme produces serum concentrations in the usual therapeutic range with a minimum of samples and few side effects; most patients maintained acceptably stable blood levels.