Biomedical subjects

Andrew Bush

Publications and source records attributed to Andrew Bush.

94 records · Page 6Linked to original sources

PubMed2002

Antiasthmatic drug delivery in children.

Asthma therapy can be administered to children via a number of routes, including oral, inhaled (via a multiplicity of devices), rectal, intravenous, subcutaneous, and intramuscular. The inhaled route is used most often. This can reduce, but never eliminate, systemic absorption. Swallowed aerosolized medication is subject to hepatic first-pass metabolism, but this metabolic route is bypassed by the drug impacting on the airway, including the pharynx. Although there are a large number of studies from a laboratory setting about drug deposition characteristics, there is very little evidence from community-based studies about what families think actually works well in the everyday treatment of the child. However, it is clear that altering the inhaler device can result in marked changes in the dose administered, and any such change should be part of a review of the dose of prescribed medication. Nebulizers are being used much less frequently, and in particular, all but the most severe exacerbations can be treated at least as effectively with equivalent dosages of beta(2)-adrenoceptor agonists from a large volume spacer.

Absorption↗

PubMedDate not supplied

Treatment of primary pulmonary hypertension with oral sildenafil.

Sildenafil, a selective phosphodiesterase-5 inhibitor, was administered orally to a 14-year-old girl with primary pulmonary hypertension (PPH) at a dose of 0.5 mg/kg/4 h on a daily basis, increased to doses of 1 and 2 mg/kg at monthly intervals. Following therapy, oxygen saturation increased and exercise capacity improved significantly, but with no change in pulmonary haemodynamics. No side-effects were noted. Sildenafil may be beneficial in children with PPH, but the mechanism of benefit is unclear.

Administration, Oral↗

PubMedDate not supplied

Supporting parents in managing drugs for children with cystic fibrosis.

A semi-structured interview guide was used to interview 17 parents of children with cystic fibrosis identified through a shared care patient database at a London hospital to examine parents' medication-related roles and problems. Parents described their responsibilities in the home and the problems experienced, including adherence to regiments, involvement in decision-making, and relationships with the hospital teams and other healthcare professionals. The findings confirmed medication management as an integral part of the informal caring role. Many practical problems of ensuring the availability and administration of medication on a regular basis were described. Information gaps and problems with medication adherence increased the stress of providing effective care. The involvement of healthcare professionals across primary, secondary and tertiary care sectors in supporting parents in all aspects of medication management, including the development of strategies for transferring the responsibility for medication to their children, must be improved.

Adult↗

PubMedDate not supplied

[Etiological diagnosis of pneumonia--a critical view].

OBJECTIVES: To search literature related to the etiological diagnosis of acute pneumonia in children. SOURCES: Systematic review of Medline and Lilacs databases. SUMMARY OF THE FINDINGS: The use of new diagnostic methods such as immunological techniques and polymerase chain reaction has proven invaluable for specific diagnosis and epidemiological investigation, showing adequate sensitivity, specificity and promptness of results, with the aim of guiding therapy properly. Review of epidemiological studies of community acquired pneumonia showed that Streptococcus pneumoniae is still one of the most significant etiologic agents in all age groups, in developing and industrialized countries. Resistance of this agent to penicillin and cephalosporins is increasing in all continents and is worrisome. Atypical agents such as Mycoplasma pneumoniae and Chlamydia pneumoniae are common in community acquired pneumonia, mainly in children older than 4 years, representing one third of the cases in industrial countries. However, their prevalence in developing countries remain to be determined. Respiratory syncytial virus is also a very common etiology of community acquired pneumonia and may cause severe infections, mainly in infants and younger children. The introduction of new conjugated vaccines for Streptococcus pneumoniae and Haemophilus influenzae type b resulted in significant reduction of morbidity and mortality of pneumonia in children. CONCLUSIONS: A significant impact on morbidity and mortality of acute pneumonia in children is likely to occur if microbiological and antimicrobial control is continuously and dynamically performed, thus allowing for the development of new vaccines, particularly against the respiratory syncytial virus.

English Abstract↗