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The Role of Inhaled Corticosteroids in the Treatment of Virus-Triggered Wheezing in Pediatric Patients
Abstracts AB199
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2
The Role of Inhaled Corticosteroids in the Treatment of VirusTriggered Wheezing in Pediatric Patients M. E. Weinstein, D. Axelrod; UMDNJ-New Jersey Medical School, Newark, NJ. RATIONALE: Virus-triggered wheezing (VTW) and bronchiolitis are common diseases of childhood. We performed a meta-analysis to determine the role of inhaled corticosteroids (ICS) in the management of these overlapping diseases. METHODS: A search of Medline and Cochrane databases for the terms ‘‘bronchiolitis’’ or ‘‘virus diseases’’ and ‘‘inhaled corticosteroids’’ was performed. Statistical analyses were performed via RevMan5 software. RESULTS: The search parameters and subsequent bibliography review yielded ten double-blind randomized controlled studies that compared the use ICS to placebo in the management of VTW or bronchiolitis (n51855 children). Six studies examined standard dose ICS (n5630 patients), while four studies examined high-dose ICS (n51225 patients). ICS use at either dose resulted in a significant decline in symptomatic days (Mean difference -0.96 days, 95% Confidence Interval (CI) -1.22, -0.69), with a doubling effect when high-dose ICS was used. High-dose ICS use also resulted in a significant decline in need for systemic steroid use (Odds Ratio (OR) 0.45, 95% CI 0.33, 0.62). However, ICS use resulted in no significant decline in admission rate (OR 0.81, 95% CI 0.46, 1.44). ICS use during the acute illness did not prevent recurrent wheezing episodes at 1 month (OR 0.55, 95% CI 0.13, 2.35), 6 months (OR 1.36, 95% CI 0.58, 3.22), or 12 months (OR 1.19, 95% CI 0.76, 1.85) after initiation. CONCLUSIONS: ICS appears to be effective during acute episodes of VTW or bronchiolitis in reducing symptom duration. High-dose ICS further reduces symptom duration and need for systemic steroids. Acutephase ICS use does not appear to prevent future wheezing episodes.
Omalizumab Therapy For Moderate To Severe Asthma In Private Allergy Practice: a Six Year Experience C. C. Randolph, D. Kearney; Center for Allergy, Asthma and Immunology, Waterbury, CT. RATIONALE: Our six year experience with omalizumab is presented. MATERIAL AND METHODS: Each patient was evaluated with chart review and prospective evaluation by office encounter, asthma control test(ACT)and spirometry on a scheduled basis at least every 3months. The study with ACT was IRB approved. RESULTS:50 patients were begun on Omalizumab therapy over a 6 year period with 15 (30%)discontinuing. Of the 35(70%) that are currently on Omalizumab 29(83%) or 58% of the original 50 consented to participate. Of these29 patients there were 19(66%) females and 10(34%) males, 24 Caucasians(83%) and 5 NonCaucasian(17%) with an age range of 10 to66 years with a mean of 31years and a median of 22years. The Omalizumab was administered for a range of 6 months to 6years with a median of 1.8years and a mean of 2.1years. Total IgE ranged from 6ku/l to 2706 ku/l with a mean of 410 ku/l and a median of 159 ku/l. The pulmonary functions prior to Omalizumab ranged from FEVI37% TO 124% with a median of73% predicted and mean of 76% with no apparent improvement in FEV1 associated with therapy. Current asthma control test indicated good control in 25/29(86%)(>/520)with 4 of these 25(16%)who had had exacerbations with ACT<20 at least once. There were 4/29(14%) with asthma control test consistently
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Adding Osteopathic Intervention May Improve Outcome in Acute Asthma Exacerbation M. Karagic1, S. Gomez2, A. Wilson2, M. Lee-Wong2; 1Ross University Medical School, Roseau, DOMINICA, 2Beth Israel Medical Center, New York, NY. RATIONALE: Will adding non-traditional asthma therapies to traditional interventions improve outcome? METHODS: Patients often ask that non-pharmacologic remedies either replace or supplement their medical therapy. Previously diagnosed chronic asthmatic patients presenting to our outpatient clinic for acute asthma exacerbation were given standard traditional care including albuterol nebulizer treatments. Then, patients were offered supplemental Osteopathic Maneuver Technique (OMT) known as ‘‘rib raising.’’ This technique has been utilized to treat children and adults with asthma to stimulate thoracic sympathetic chain ganglia to enhance respiration. Forty five adult patients consented to receive OMT. In addition to standard medical asthma therapy, they received OMT ‘‘rib raising’’ for five minutes. Peak flows (PF), and asthma symptom scores were obtained pre/post albuterol nebulizer and after OMT. T-test statistical analysis compared peak flows pre/post albuterol nebulizer and post OMT. The overall difference in PF pre/post albuterol and post OMT were compared. RESULTS: Analysis of the data using t-test at 95% CI showed a mean improvement after nebulizer treatment to be 13.64 L/min, after OMT to be 7.95 L/min, with the overall difference after both albuterol nebulizer treatment and OMT to be 14.38 L/min (p<0.05). No adverse effects were reported. All 45 patients stated feeling more ‘‘relaxed’’ after therapy with albuterol and OMT compared to no OMT and treatment with albuterol alone. CONCLUSIONS: Patients given both albuterol and OMT did better objectively (peak flows) and subjectively (symptom scores) than with albuterol alone. Perhaps osteopathic treatments may be offered to supplement standard traditional asthma management in acute settings.
780
Safety, Tolerability And Beneficial Immunological Responses Of Complementary Ashmi Therapy To Inhaled Corticosteroids Therapy In Children With Persistent Allergic Asthma With Or Without Allergic Rhinitis P. J. Busse1, M. Wen2, K. Srivastava1, C. Wei1, G. Li2, N. Yu2, Y. Liu1, S. Wallenstein1, J. Wisniversky1, C. Qu1, H. Sampson1, X. Li1; 1Mount Sinai School of Medicine, New York, NY, 2Weifang Asthma Hospital, Weifang, Shandong, CHINA. RATIONALE: Chronic allergic asthma is the result of a Th2 biased immune status, which may be due to the loss of Th1 (IFN-g) regulation. Steroids control symptoms, but suppress Th1 as well as Th2 immune responses. Our previous study showed that ASHMI (an anti-asthma herbal therapy developed in our laboratory) monotherapy enhanced IFN-g production and and improved asthma control in adults. We investigated whether ASHMI used in addition to cortiocosteroids is safe and whether it maintained or increased clinical effectiveness, and generated a beneficial immune response in children with persistent asthma. METHODS: Fifty-six children, ages 5-14 years, with persistent allergic asthma with or without allergic rhinitis were recruited. Subjects were randomly assigned to receive inhaled corticosteroid (Budesonide) plus ASHMI (standard +ASHMI, n528) or inhaled corticosteroid plus placebo capsules (standard + placebo, n528). Fifty-one patients completed a 3month-treatment regimen; 26 patients in the standard +ASHMI group and 25 in the standard +placebo group. RESULTS: Following treatment, symptom scores in the standard +ASHMI group were significantly lower than in the standard + placebo group (p<0.05). FEV1 values in both patient groups were equally significantly increased. Standard +ASHMI treatment showed greater reduction in total IgE (p<0.05), serum eosinophilic cationic protein (P<0.001), and significantly increased IFN- g (P<0.001), and serum cortisol levels (p<0.05) than standard+ placebo. Patients in both groups showed normal hematology, electrocardiograms, and liver and kidney functions. CONCLUSION: ASHMI used in conjunction with inhaled corticosteroid is safe and well tolerated, and generated both clinical and immunological benefits, which might be of potential benefit in asthma therapy.
TUESDAY
778
J ALLERGY CLIN IMMUNOL VOLUME 125, NUMBER 2
The Role of Inhaled Corticosteroids in the Treatment of VirusTriggered Wheezing in Pediatric Patients M. E. Weinstein, D. Axelrod; UMDNJ-New Jersey Medical School, Newark, NJ. RATIONALE: Virus-triggered wheezing (VTW) and bronchiolitis are common diseases of childhood. We performed a meta-analysis to determine the role of inhaled corticosteroids (ICS) in the management of these overlapping diseases. METHODS: A search of Medline and Cochrane databases for the terms ‘‘bronchiolitis’’ or ‘‘virus diseases’’ and ‘‘inhaled corticosteroids’’ was performed. Statistical analyses were performed via RevMan5 software. RESULTS: The search parameters and subsequent bibliography review yielded ten double-blind randomized controlled studies that compared the use ICS to placebo in the management of VTW or bronchiolitis (n51855 children). Six studies examined standard dose ICS (n5630 patients), while four studies examined high-dose ICS (n51225 patients). ICS use at either dose resulted in a significant decline in symptomatic days (Mean difference -0.96 days, 95% Confidence Interval (CI) -1.22, -0.69), with a doubling effect when high-dose ICS was used. High-dose ICS use also resulted in a significant decline in need for systemic steroid use (Odds Ratio (OR) 0.45, 95% CI 0.33, 0.62). However, ICS use resulted in no significant decline in admission rate (OR 0.81, 95% CI 0.46, 1.44). ICS use during the acute illness did not prevent recurrent wheezing episodes at 1 month (OR 0.55, 95% CI 0.13, 2.35), 6 months (OR 1.36, 95% CI 0.58, 3.22), or 12 months (OR 1.19, 95% CI 0.76, 1.85) after initiation. CONCLUSIONS: ICS appears to be effective during acute episodes of VTW or bronchiolitis in reducing symptom duration. High-dose ICS further reduces symptom duration and need for systemic steroids. Acutephase ICS use does not appear to prevent future wheezing episodes.
Omalizumab Therapy For Moderate To Severe Asthma In Private Allergy Practice: a Six Year Experience C. C. Randolph, D. Kearney; Center for Allergy, Asthma and Immunology, Waterbury, CT. RATIONALE: Our six year experience with omalizumab is presented. MATERIAL AND METHODS: Each patient was evaluated with chart review and prospective evaluation by office encounter, asthma control test(ACT)and spirometry on a scheduled basis at least every 3months. The study with ACT was IRB approved. RESULTS:50 patients were begun on Omalizumab therapy over a 6 year period with 15 (30%)discontinuing. Of the 35(70%) that are currently on Omalizumab 29(83%) or 58% of the original 50 consented to participate. Of these29 patients there were 19(66%) females and 10(34%) males, 24 Caucasians(83%) and 5 NonCaucasian(17%) with an age range of 10 to66 years with a mean of 31years and a median of 22years. The Omalizumab was administered for a range of 6 months to 6years with a median of 1.8years and a mean of 2.1years. Total IgE ranged from 6ku/l to 2706 ku/l with a mean of 410 ku/l and a median of 159 ku/l. The pulmonary functions prior to Omalizumab ranged from FEVI37% TO 124% with a median of73% predicted and mean of 76% with no apparent improvement in FEV1 associated with therapy. Current asthma control test indicated good control in 25/29(86%)(>/520)with 4 of these 25(16%)who had had exacerbations with ACT<20 at least once. There were 4/29(14%) with asthma control test consistently
779
781
Adding Osteopathic Intervention May Improve Outcome in Acute Asthma Exacerbation M. Karagic1, S. Gomez2, A. Wilson2, M. Lee-Wong2; 1Ross University Medical School, Roseau, DOMINICA, 2Beth Israel Medical Center, New York, NY. RATIONALE: Will adding non-traditional asthma therapies to traditional interventions improve outcome? METHODS: Patients often ask that non-pharmacologic remedies either replace or supplement their medical therapy. Previously diagnosed chronic asthmatic patients presenting to our outpatient clinic for acute asthma exacerbation were given standard traditional care including albuterol nebulizer treatments. Then, patients were offered supplemental Osteopathic Maneuver Technique (OMT) known as ‘‘rib raising.’’ This technique has been utilized to treat children and adults with asthma to stimulate thoracic sympathetic chain ganglia to enhance respiration. Forty five adult patients consented to receive OMT. In addition to standard medical asthma therapy, they received OMT ‘‘rib raising’’ for five minutes. Peak flows (PF), and asthma symptom scores were obtained pre/post albuterol nebulizer and after OMT. T-test statistical analysis compared peak flows pre/post albuterol nebulizer and post OMT. The overall difference in PF pre/post albuterol and post OMT were compared. RESULTS: Analysis of the data using t-test at 95% CI showed a mean improvement after nebulizer treatment to be 13.64 L/min, after OMT to be 7.95 L/min, with the overall difference after both albuterol nebulizer treatment and OMT to be 14.38 L/min (p<0.05). No adverse effects were reported. All 45 patients stated feeling more ‘‘relaxed’’ after therapy with albuterol and OMT compared to no OMT and treatment with albuterol alone. CONCLUSIONS: Patients given both albuterol and OMT did better objectively (peak flows) and subjectively (symptom scores) than with albuterol alone. Perhaps osteopathic treatments may be offered to supplement standard traditional asthma management in acute settings.
780
Safety, Tolerability And Beneficial Immunological Responses Of Complementary Ashmi Therapy To Inhaled Corticosteroids Therapy In Children With Persistent Allergic Asthma With Or Without Allergic Rhinitis P. J. Busse1, M. Wen2, K. Srivastava1, C. Wei1, G. Li2, N. Yu2, Y. Liu1, S. Wallenstein1, J. Wisniversky1, C. Qu1, H. Sampson1, X. Li1; 1Mount Sinai School of Medicine, New York, NY, 2Weifang Asthma Hospital, Weifang, Shandong, CHINA. RATIONALE: Chronic allergic asthma is the result of a Th2 biased immune status, which may be due to the loss of Th1 (IFN-g) regulation. Steroids control symptoms, but suppress Th1 as well as Th2 immune responses. Our previous study showed that ASHMI (an anti-asthma herbal therapy developed in our laboratory) monotherapy enhanced IFN-g production and and improved asthma control in adults. We investigated whether ASHMI used in addition to cortiocosteroids is safe and whether it maintained or increased clinical effectiveness, and generated a beneficial immune response in children with persistent asthma. METHODS: Fifty-six children, ages 5-14 years, with persistent allergic asthma with or without allergic rhinitis were recruited. Subjects were randomly assigned to receive inhaled corticosteroid (Budesonide) plus ASHMI (standard +ASHMI, n528) or inhaled corticosteroid plus placebo capsules (standard + placebo, n528). Fifty-one patients completed a 3month-treatment regimen; 26 patients in the standard +ASHMI group and 25 in the standard +placebo group. RESULTS: Following treatment, symptom scores in the standard +ASHMI group were significantly lower than in the standard + placebo group (p<0.05). FEV1 values in both patient groups were equally significantly increased. Standard +ASHMI treatment showed greater reduction in total IgE (p<0.05), serum eosinophilic cationic protein (P<0.001), and significantly increased IFN- g (P<0.001), and serum cortisol levels (p<0.05) than standard+ placebo. Patients in both groups showed normal hematology, electrocardiograms, and liver and kidney functions. CONCLUSION: ASHMI used in conjunction with inhaled corticosteroid is safe and well tolerated, and generated both clinical and immunological benefits, which might be of potential benefit in asthma therapy.
TUESDAY
778