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Biomedical subjects

H William Kelly

Publications and source records attributed to H William Kelly.

9 recordsLinked to original sources
PubMed2003

The assessment of childhood asthma.

The development of independent outcome measures for assessing the severity of asthma seems justified. The various outcomes measures listed by the guidelines (symptoms, nocturnal awakenings, rescue beta2-agonist use, and lung function) and their response to therapy are predictive of severe exacerbations from asthma. They do not necessarily strongly correlate with each other, however. Measures of AHR, particularly methacholine provocation, and the measurement of FeNO are attractive as assessments of ongoing asthma activity in children when lung function and symptoms are normal.

Anti-Asthmatic Agents↗
PubMed2003

Growth and bone density in children with mild-moderate asthma: a cross-sectional study in children entering the Childhood Asthma Management Program (CAMP).

OBJECTIVES: We sought to determine whether mild-moderate persistent asthma sufficient to produce a decrease in baseline lung function is associated with an adverse effect on growth and bone mineral density (BMD) in children. METHODS: This was a cross-sectional study of 1041 children, 5 to 12 years old (32% ethnic/racial minorities and 40% female), enrolled into the Childhood Asthma Management Program (CAMP). Measures of asthma severity included: Spirometry; bronchial hyperresponsiveness; duration of asthma symptoms; and symptom-based assessment of severity. Multiple regression analyses were used to relate the asthma severity on the primary outcome variables: Height by stadiometry and BMD by dual energy radiographic absorptiometry. RESULTS: The mean +/- SD height percentile was 56.0 +/- 28.5 percentile for the population. The only significant relationship between asthma severity and height percentile was with methacholine bronchoprovocation in girls (beta 2.98, P =.019, covariate multiple regression). The mean +/- SD BMD was 0.65 +/- 0.10 g/cm(2) for the population. The past use of corticosteroids did not adversely affect either growth or BMD. CONCLUSIONS: We found that mild-moderate asthma of as long as 4 to 7 years duration in children does not produce an adverse effect on linear growth or BMD.

Asthma↗
PubMed2003

Comparison of two methods of delivering continuously nebulized albuterol.

OBJECTIVE: To compare the relative delivery of 2 methods for providing continuously nebulized albuterol (CNA): a small-volume nebulizer plus infusion pump versus a large-volume nebulizer. DESIGN: An open, randomized comparison of 3 hours of CNA administration using an in vitro lung model with a follow-up particle size assessment of the large-volume nebulizer. METHODS: Six different nebulizers of each type were connected to a lung model via a volume-limited mechanical ventilator and infant ventilator circuitry. Albuterol was nebulized at 10 mg/h for 3 hours in random order. The small-volume nebulizer used was the Airlife Misty Neb (Baxter, Valencia, CA); the large-volume nebulizer was the HEART Nebulizer (Vortran Medical, Orangevale, CA). One large-volume nebulizer was operated over 8 hours for the output and particle sizing study. RESULTS: The small-volume nebulizer delivered a greater amount of albuterol (mean +/- SD percentage of total nebulized) to the model lung (5.75 +/- 1.38% vs. 4.12 +/- 0.67%; p < 0.025) than the large-volume nebulizer, but demonstrated greater variability. Although total output was not maintained after 8 hours of nebulization with the large-volume nebulizer, the percent of particles in the respirable range remained consistent. CONCLUSIONS: The large-volume nebulizer evaluated in this study maintains consistent output up to 8 hours and provides an acceptable method for delivering CNA through an infant ventilator circuit.

Administration, Inhalation↗
PubMed2003

Opioid withdrawal in critically ill neonates.

OBJECTIVE: To determine the occurrence of and risk factors for opioid withdrawal in critically ill neonates receiving continuous infusions of fentanyl. DESIGN: A prospective interventional cohort study was conducted in a university hospital neonatal intensive care unit with 19 neonates who received a minimum of 24 hours of fentanyl by continuous infusion. MEASUREMENTS: Fentanyl total dose, duration of infusion, and peak infusion rate were recorded. Patients were evaluated for withdrawal using the Neonatal Abstinence Scoring System of Finnegan. Patients with a score >/=8 were considered to have opioid withdrawal. MAIN RESULTS: Withdrawal was observed in 10 (53%) of 19 neonates. The fentanyl total dose (median 525 vs. 168 micro g/kg, respectively; p = 0.03) and infusion duration (median 10 vs. 7 d, respectively; p = 0.04) were significantly greater in neonates with withdrawal compared to those without withdrawal. A fentanyl total dose >/=415 micro g/kg predicted withdrawal with 70% sensitivity and 78% specificity. A fentanyl infusion duration >/=8 days predicted withdrawal with 90% sensitivity and 67% specificity. The most frequent symptoms of withdrawal were sleeping <3 hours after feeding (81%) and increased muscle tone (55%). In all neonates with withdrawal, onset occurred within 24 hours of fentanyl discontinuation. CONCLUSIONS: Opioid withdrawal occurs frequently in critically ill neonates who receive continuous infusions of fentanyl. Longer infusion duration and higher total dose were associated with withdrawal symptoms.

Analgesics, Opioid↗
PubMed2002

The use of inhaled corticosteroids in children with asthma.

The inhaled corticosteroids (ICSs) are the most effective long-term controllers for the treatment of childhood asthma. There is now substantial controlled clinical trial data to support the efficacy and safety of ICS therapy in infants and young children (6 months to 4 years of age). These data support the use of nebulizer suspension or metered-dose inhalers with valved holding chambers as effective forms of delivery in this age group. Currently, selection of delivery method depends on the comfort of the parent and the cooperation of the child, as well as on which drug the clinician chooses. The ICSs have a favorable safety profile when administered in currently recommended dosages. A transient 0.5- to 2-cm growth delay occurs in prepubescent children but does not appear to affect attainment of predicted adult height. Long-term trials support the existing recommendations of lowering dosage once control is achieved and stopping therapy when the child's asthma is in remission.

Administration, Inhalation↗
PubMed2002

Approaching value in asthma management: the need to integrate clinical and economic research with the basic science.

In the management of asthma, clinical decision making is primarily directed toward achieving the best outcome for the patient. However, the interests of the provider, insurer, and employer must also be taken into account. Integral to this process is an understanding of the need to weigh therapeutic objectives against economic concerns. This process involves consideration of the potential for clinical benefit as opposed to adverse treatment effects, as well as direct and indirect costs. Data from clinical trials provide the foundation for evaluating these factors. Randomized clinical trials, postmarketing studies, surveillance programs, and observational claims analyses all contribute valuable information to facilitate this process. Taken together, the results of such analyses form a foundation for providing effective, safe, and cost-efficient care through the practice of evidence-based medicine.

Anti-Asthmatic Agents↗
PubMed2000

Long-term effects of budesonide or nedocromil in children with asthma.

BACKGROUND: Antiinflammatory therapies, such as inhaled corticosteroids or nedocromil, are recommended for children with asthma, although there is limited information on their long-term use. METHODS: We randomly assigned 1041 children from 5 through 12 years of age with mild-to-moderate asthma to receive 200 microg of budesonide (311 children), 8 mg of nedocromil (312 children), or placebo (418 children) twice daily. We treated the participants for four to six years. All children used albuterol for asthma symptoms. RESULTS: There was no significant difference between either treatment and placebo in the primary outcome, the degree of change in the forced expiratory volume in one second (FEV1, expressed as a percentage of the predicted value) after the administration of a bronchodilator. As compared with the children assigned to placebo, the children assigned to receive budesonide had a significantly smaller decline in the ratio of FEV1 to forced vital capacity (FVC, expressed as a percentage) before the administration of a bronchodilator (decline in FEV1:FVC, 0.2 percent vs. 1.8 percent). The children given budesonide also had lower airway responsiveness to methacholine, fewer hospitalizations (2.5 vs. 4.4 per 100 person-years), fewer urgent visits to a caregiver (12 vs. 22 per 100 person-years), greater reduction in the need for albuterol for symptoms, fewer courses of prednisone, and a smaller percentage of days on which additional asthma medications were needed. As compared with placebo, nedocromil significantly reduced urgent care visits (16 vs. 22 per 100 person-years) and courses of prednisone. The mean increase in height in the budesonide group was 1.1 cm less than in the placebo group (22.7 vs. 23.8 cm, P=0.005); this difference was evident mostly within the first year. The height increase was similar in the nedocromil and placebo groups. CONCLUSIONS: In children with mild-to-moderate asthma, neither budesonide nor nedocromil is better than placebo in terms of lung function, but inhaled budesonide improves airway responsiveness and provides better control of asthma than placebo or nedocromil. The side effects of budesonide are limited to a small, transient reduction in growth velocity.

Administration, Inhalation↗