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Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode.

J Allergy Clin Immunol. 2014 Aug 13;

Authors: Jartti T, Nieminen R, Vuorinen T, Lehtinen P, Vahlberg T, Gern J, Camargo CA, Ruuskanen O

Abstract
BACKGROUND: Rhinovirus-induced wheezing is an important risk factor for recurrent wheezing. There are no randomized controlled trials on the effect of systemic corticosteroids in patients with this disease.
OBJECTIVE: We sought to study the short- and long-term effects of prednisolone treatment of the first acute, moderate-to-severe, rhinovirus-induced wheezing episode in young children.
METHODS: After confirming rhinovirus from nasopharyngeal aspirate by using PCR, 79 children with a first wheezing episode at age 3 to 23 months were randomized to receive oral prednisolone (first dose of 2 mg/kg, followed by 2 mg/kg/d in 2 divided doses for 3 days) or placebo. The trial was double blind throughout the 12-month follow-up. The primary outcomes were long term: new physician-confirmed wheezing episode within 2 months, number of physician-confirmed wheezing episodes within 12 months, and initiation of regular controller medication for asthma symptoms within 12 months. The primary interaction analysis examined rhinovirus load.
RESULTS: Seventy-four patients completed the study (mean age, 13 months; 28% atopic). Long-term outcomes did not differ between groups (all P ≥ .30). For short-term outcomes, the prednisolone group had less cough, rhinitis, noisy breathing, severe breathing difficulties, and nocturnal respiratory symptoms at home within 2 weeks (all P < .05). The 25 children with greater than 7000 rhinovirus copies/mL (most sensitive cutoff) benefitted from prednisolone in terms of less risk of physician-confirmed recurrence within 2 and 12 months compared with placebo (both P < .05).
CONCLUSIONS: Prednisolone cannot be routinely recommended for all young children experiencing their first acute, moderate-to-severe, rhinovirus-induced wheezing episode. Prednisolone might be beneficial in a subgroup of children with high viral loads.

PMID: 25129681 [PubMed - as supplied by publisher]

Related Articles

Stress and asthma: Novel insights on genetic, epigenetic and immunologic mechanisms.

J Allergy Clin Immunol. 2014 Aug 13;

Authors: Rosenberg SL, Miller GE, Brehm JM, Celedón JC

Abstract
In the United States the economically disadvantaged and some ethnic minorities are often exposed to chronic psychosocial stressors and disproportionately affected by asthma. Current evidence suggests a causal association between chronic psychosocial stress and asthma or asthma morbidity. Recent findings suggest potential mechanisms underlying this association, including changes in the methylation and expression of genes that regulate behavioral, autonomic, neuroendocrine, and immunologic responses to stress. There is also evidence suggesting the existence of susceptibility genes that predispose chronically stressed youth to both post-traumatic stress disorder and asthma. In this review we critically examine published evidence and suggest future directions for research in this field.

PMID: 25129683 [PubMed - as supplied by publisher]

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Diurnal and twenty-four hour patterning of human diseases: Cardiac, vascular, and respiratory diseases, conditions, and syndromes.

Sleep Med Rev. 2014 Jul 18;

Authors: Smolensky MH, Portaluppi F, Manfredini R, Hermida RC, Tiseo R, Sackett-Lundeen LL, Haus EL

Abstract
Various medical conditions, disorders, and syndromes exhibit predictable-in-time diurnal and 24 h patterning in the signs, symptoms, and grave nonfatal and fatal events, e.g., respiratory ones of viral and allergic rhinorrhea, reversible (asthma) and non-reversible (bronchitis and emphysema) chronic obstructive pulmonary disease, cystic fibrosis, high altitude pulmonary edema, and decompression sickness; cardiac ones of atrial premature beats and tachycardia, paroxysmal atrial fibrillation, 3rd degree atrial-ventricular block, paroxysmal supraventricular tachycardia, ventricular premature beats, ventricular tachyarrhythmia, symptomatic and non-symptomatic angina pectoris, Prinzmetal vasospastic variant angina, acute (non-fatal and fatal) incidents of myocardial infarction, sudden cardiac arrest, in-bed sudden death syndrome of type-1 diabetes, acute cardiogenic pulmonary edema, and heart failure; vascular and circulatory system ones of hypertension, acute orthostatic postprandial, micturition, and defecation hypotension/syncope, intermittent claudication, venous insufficiency, standing occupation leg edema, arterial and venous branch occlusion of the eye, menopausal hot flash, sickle cell syndrome, abdominal, aortic, and thoracic dissections, pulmonary thromboembolism, and deep venous thrombosis, and cerebrovascular transient ischemic attack and hemorrhagic and ischemic stroke. Knowledge of these temporal patterns not only helps guide patient care but research of their underlying endogenous mechanisms, i.e., circadian and others, and external triggers plus informs the development and application of effective chronopreventive and chronotherapeutic strategies.

PMID: 25129838 [PubMed - as supplied by publisher]

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Physiotherapy in asthma using the new Lotorp method.

Complement Ther Clin Pract. 2014 Jul 30;

Authors: Löwhagen O, Bergqvist P

Abstract
BACKGROUND: Physiotherapy in bronchial asthma has given various results.
AIM: To test a new method focusing on breathing exercise and massage of the thoracic muscles.
PATIENTS AND METHODS: Twenty-eight adult patients with a physician-diagnosed asthma were studied during 6 weeks. All patients were prescribed asthma medication. The new method [active group, n = 17) was compared with physical training (control group, n = 12).
RESULTS: PEF was significantly improved (p = 0.001) in the active group, however, FEV1 showed no significant change. The symptoms "tightness of the chest", "difficult breathing in", "air hunger", and the individually dominating symptom (p = 0.001) were significantly reduced in the active group. Exercise-induced breathing troubles and chest expansion were also significantly reduced.
CONCLUSION: Physiotherapy including breathing exercise and massage of the thoracic muscles (the Lotorp method) in patients with physician-diagnosed asthma resulted in significantly reduced respiratory symptoms during rest and exercise and increased chest expansion. The improvements may be due to an increased mobility of the chest and diaphragm.

PMID: 25130138 [PubMed - as supplied by publisher]