Inhaled steroids and local side-effects.
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Administration, Inhalation↗
Biomedical subjects
K H Carlsen
Publications and source records attributed to K H Carlsen.
[Physical activity and respiratory tract diseases asthma and allergy].
BACKGROUND: This article presents a review of the relationship between physical training and airways diseases: the relationship between physical activity and the development of airways diseases, and the effect of physical training in rehabilitation after airways diseases. MATERIAL AND METHODS: The article is a systematic review of exercise-induced asthma (EIA), the effect of physical training upon bronchial hyperresponsiveness and the development of asthma; how chronic lung diseases affect the ability to participate in physical activity; and the use of physical training in rehabilitation after airways diseases. RESULTS AND INTERPRETATION: Physical training may provoke EIA in asthmatic patients. Furthermore, heavy regular training over long periods of time may contribute to the development of asthma. Mastering EIA is an important goal in the management of asthma, especially in children and adolescents, in order to foster normal physical and mental development. Physical training improves fitness and the mastering of asthma, but not of bronchial hyperresponsiveness and asthma activity. In other airways disorders like cystic fibrosis or chronic obstructive lung disease, a reduced lung function may limit the ability to participate in physical activity. Training is an important tool in the rehabilitation of patients with pulmonary disorders as it improves physical fitness and quality of life.
Adolescent↗
Trends in hospital admissions for childhood asthma in Oslo, Norway, 1980-95.
BACKGROUND: The prevalence of asthma and quality of asthma care both influence hospital admission rates for childhood asthma. Therefore, we aimed to assess possible changes in the hospital admission rate for acute asthma in Oslo, Norway, from 1980 to 1995, as well as evaluate the possible effect of changes in asthma treatment upon hospitalization for acute asthma in this period. METHODS: All pediatric patient records from the two municipal hospitals in Oslo from 1980 through 1995 with the discharge diagnoses (ICD-9) acute asthma, acute bronchitis/bronchiolitis, pneumonia, and/or atelectasis were thoroughly reviewed. RESULTS: Of the 3,538 children admitted for acute asthma, 66% were boys and 75% were younger than 4 years, and the admittance rate increased significantly among children aged 0-3 years. First admissions increased throughout the study, whereas readmissions, as well as the mean duration of hospital stay, decreased significantly. Prophylactic treatment with inhaled steroids prior to admission increased over 1980-89, but stabilized thereafter. The use of a short course of systemic steroids during admission increased markedly from 1991. CONCLUSIONS: The findings of increasing first admission rate as well as overall admission rate for acute asthma in children under 4 years of age, but decreasing readmissions as well as number of treatment days in hospital, probably reflect changes in the management of the disease, as well as an increasing prevalence of childhood asthma.
Acute Disease↗
Low-dose inhaled budesonide once or twice daily for 27 months in children with mild asthma.
This study is an extended follow-up for 24 months of a 12-week trial to study the long-term clinical efficacy of low-dose inhaled budesonide (BUD) once or twice daily in children with mild asthma. A total of 122 children (mean age 9.7 years, girls/boys; 42/80) with mild asthma (FEV1 103.7% of predicted, reversibility in FEV1 3.5%, and fall in FEV1 after exercise 12.2%), not previously treated with inhaled steroids, were included in a double-blind, randomized, parallel-group study. The children were treated with inhaled BUD 100 or 200 microg administered via Turbuhaler once daily in the morning, 100 microg twice daily, or placebo for 27 months. Exercise and methacholine challenges were performed at 3-month intervals the first year and at 6-month intervals the second year, in a total of seven visits. A significant dose-response effect favoring BUD 200 microg daily (vs 100 microg daily) was found when comparing changes in FEV1, FEF25%, and FEV50%; the fall in FEV1 after an exercise test; and the effect on blood eosinophils. Bronchial hyperreactivity to methacholine decreased significantly on three visits in patients treated with BUD 200 microg daily compared to placebo. Growth rate was not significantly affected except in children aged 7-11 years at baseline after 12 months of treatment. In conclusion, 100 or 200 microg daily of inhaled BUD for 27 months is safe and effective in protecting against exercise-induced asthma and achieving nearly normal lung function. Baseline lung function was not significantly affected in this group of children with mild asthma.
Administration, Inhalation↗
Asthma and allergy among schoolchildren in a mountainous, dry, non-polluted area in Norway.
The aim of this study was to assess prevalence of asthma and allergy in the non-polluted mountain area of Upper Hallingdal, Norway. All schoolchildren (7-16 years) who in a previous questionnaire survey (n = 1177) reported 'sometime' asthma were enrolled in group I (n = 80), the 59 who reported asthma-like symptoms in the past 12 months formed group II, and 77 of the healthy controls were randomly selected as group III. All 216 children underwent clinical examination, skin prick test, spirometry, bronchial provocation (PD20 metacholine) and treadmill exercise test. Subsequently they were reclassified as (1) healthy, never had asthma or symptoms, (2) symptoms not confirmed as asthma, (3) previous asthma, now healthy, (4) current asthma. Lifetime asthma prevalence was 10.2%. Based upon clinical examination, the specificity and sensitivity of the questionnaire for asthma diagnosis were 88 and 74%, respectively. Forced vital capacity was significantly higher among the asthmatics (group 4 versus 1), whereas forced expiratory volume in one second (FEV1) and forced expiratory flow at 50% of vital capacity were similar in all groups. More than 10% reduction in FEV1 following treadmill-run was found in 20% of children. Children with current asthma compared to controls had significantly; lower mean values of PD20 (9.1 versus 16.5 micromol), higher eosinophil cationic protein (13.4 versus 7.7 micromol) and more frequent sensitization to animal dander (56% versus 10%). In conclusion, despite a favorable climate, little mite sensitization and low outdoor pollution, asthma prevalence was surprisingly high in Upper Hallingdal. Sensitization to animal dander was the most important contributing factor for current asthma.
Adolescent↗
Low-dose budesonide improves exercise-induced bronchospasm in schoolchildren.
The aim of this study was to compare the clinical efficacy of low-dose inhaled budesonide (once or twice daily) and placebo, administered via Turbuhaler, on exercise-induced bronchoconstriction (EIB) in children with mild asthma. Fifty-seven steroid-naive children (7-16 years old; 41 boys, 16 girls) with EIB participated in this sub-population study according to the following inclusion criterion: a maximum fall in forced expiratory volume in 1 s (FEV1) > or = 10% after a standardized treadmill test. Mean baseline FEV1 was 100.3% of predicted, and mean maximum fall in FEV1 after the standardized exercise test was 22%. The study was a double-blind, randomized, parallel-group design. After 2 weeks of run-in, the children received inhaled budesonide 100 microg or 200 microg once daily in the morning, 100 microg twice daily, or placebo, for 12 weeks. After 12 weeks of treatment, the fall in FEV1 after the exercise test was significantly less in all three budesonide groups (7.2-7.8%) vs. placebo (16.7%). Daytime symptom scores were significantly lower in all three budesonide groups compared with placebo (p <0.02). The three budesonide groups did not differ significantly, and no significant change in lung function was found in any group. Therefore children with mild asthma, but with significant EIB, improved their exercise tolerance and symptom control after 3 months of treatment with a low dose of inhaled budesonide given once or twice daily.
Administration, Inhalation↗
Inhaled nebulized adrenaline improves lung function in infants with acute bronchiolitis.
Beta2-agonists have questionable symptomatic effect in infants with acute bronchiolitis, whereas inhaled, nebulized racemic adrenaline, commonly used in Norway, appears (clinically) to be effective. Limited lung function observations during acute bronchiolitis exists, and less for assessing possible effects inhaled adrenaline. In this preliminary study, tidal flow-volume loops were measured in 16 infants with acute bronchiolitis and seven healthy controls (mean age 7.9 and 4.4 months, respectively), with repeated measurements 15 min after inhaled nebulized racemic adrenaline (4 mg diluted in 2 ml saline) in nine bronchiolitis patients. The ratio of time to reach peak tidal expiratory flow to total expiratory time (tPTEF/tE) was significantly reduced in children with acute bronchiolitis (mean, 95% CI) (0.08, 0.05-0.10) compared to controls (0.31, 0.18-0.43), with significant improvement after inhaled racemic adrenaline 0.19 (0.13-0.25), parallel with significant clinical improvement. Lung function (tPTEF/tE) was reduced in infants with acute bronchiolitis and improved significantly after inhaled racemic adrenaline. Inhaled racemic adrenaline is potentially an important alternative for treating infants with acute bronchiolitis.
Acute Disease↗
Exercise-induced bronchoconstriction depends on exercise load.
UNLABELLED: Exercise-induced bronchoconstriction (EIB) is often used as a measure of bronchial hyperresponsiveness and employed in epidemiological studies. Different tests are used, including free running tests with poor standardization of exercise load. The present study aimed to assess the role of exercise load in relationship to level of EIB. METHODS: 20 asthmatic children, 9-17 years old with a history of EIB, underwent two treadmill test with 85% and 95% exercise load. The children ran with increasing speed for the first 2 min until reaching a heart rate of 85% or 95% of calculated maximum (220-age) and maintained this speed for the last 4 min. Lung function was measured before running, and 0, 3, 6, 10 and 15 min after the run. Borg scale for perceived exertion was employed for children's self-evaluation of exercise load. RESULTS: Peak heart rate, mean Borg score during 85% exercise load was 178.7/13.6 and during 95% was 194.3/18.2 (P<0.001). Maximum fall in FEV1 after 85% exercise load was 8.84% vs. 25.11% after 95% (P<0.001). Nine subjects (40%) fell > or = 10% in FEV1 after 85% exercise load vs. 20 subjects (100%) after 95% exercise load. EIB from the 95% exercise load test had markedly higher correlation with serum ECP (r=0.77, P<0.001). CONCLUSION: Exercise load is essential for the interpretation of EIB, and strict standardization of exercise tests should be undertaken. The EIB from the high exercise load tests seemed better correlated to inflammatory activity than the low exercise load test.
Adolescent↗
Asthma drug adherence in a long term clinical trial.
AIM: To measure drug adherence in children with mild asthma receiving long term prophylactic treatment. METHODS: Double blind randomised placebo controlled trial. Patients received inhaled budesonide 100 microg or 200 microg daily, or placebo for 27 months. All participants were asked to inhale medication or placebo from two different Turbuhalers (morning and evening) during the study. A total of 122 children (80 boys, 42 girls) aged 7-16 years with mild asthma (mean FEV(1) 103.7% of predicted) were included in the trial. Drug adherence was assessed by counting the number of remaining doses in the inhaler when study medication was returned at six month intervals. RESULTS: A statistically significant and continuing decrease in measured drug adherence was found from three to nine months and then to 27 months, reaching mean values of 40.6% and 46. 9% for inhaled morning and evening medication respectively. Drug adherence declined more rapidly in the placebo group (compared to active treatment); this difference became significant after two years of treatment. Children aged 9 years or less had better drug adherence during the entire study period, but the difference was only significant for the first three months of the study. Measured drug adherence was significantly higher for evening medication compared to morning medication for all study intervals after nine months. CONCLUSION: Measured drug adherence diminishes significantly when treating children with mild asthma in a long term trial. This emphasises the importance of monitoring compliance in clinical trials.
Adolescent↗
Patient compliance in a clinical trial with inhaled budesonide in children with mild asthma.
Children's use of inhalation devices can give valuable information about their adherence to asthma therapy. The aim of this study was to examine treatment adherence of low dose inhaled budesonide or placebo administered via Turbuhaler twice daily in children with mild asthma participating in an asthma trial, by comparing diary registration with the number of doses remaining in the inhaler. A total of 163 children (age 7-16 yrs, 56 females, 107 males) with mild asthma (mean baseline forced expiratory volume in one second (FEV1) was 103% of predicted), were included into a double blind, randomized study. After a two-week run-in period, the children received inhaled budesonide, either 100 microg or 200 microg daily, and/or placebo for 12 weeks. All patients used daily diary cards throughout the study. Results from 161 patients were analysed. Mean compliance according to the diary was 93%, whereas estimated mean compliance when counting remaining doses in the Turbuhaler was 77%. Overuse of medication was found in 7% of the children. There was no significant difference in compliance between sex in the study group, whereas children aged < or =9 yrs had significantly better drug adherence than older children. No significant relationship was found between symptom score and compliance. In conclusion, even with optimal patient follow-up in a clinical trial, adherence to prophylactic asthma treatment is considerably lower than the patients own reports from the use of daily diary cards.
Administration, Inhalation↗
Perinatal risk factors for recurrent wheeze in early life.
The possible value of tidal flow volume (TFV) loops measured at birth in relation to the risk of developing recurrent or persistent bronchial obstruction within two years of life was assessed. TFV loops were measured at a mean age of 2.7 days in 802 neonates enrolled in the 'Environment and Childhood Asthma' (ECA) study in Oslo. Of these, 77 children developed recurrent or persistent bronchial obstruction (cases) and were included in a nested case-control study within the ECA study; 88 controls (the child born closest in time to the case), with no history of bronchial obstruction in the first two years of life, were also included. Information on socio-economic factors, parental atopic diseases and parental smoking habits during the pregnancy was collected from a questionnaire completed by the parents in the maternity ward, and cord blood IgE (CB-IgE) was determined as part of routine sampling in the delivery ward. Mean tPTEF/tE (time to reach peak flow to total expiratory time) was slightly lower in cases (0.31; 95% CI 0.28-0.34) than in controls (0.33; 0.31-0.35) (difference not significant), whereas geometric mean CB-IgE was significantly higher among cases (0.39; 0.30-0.52) than controls (0.27; 0.23-0.33). No significant differences between cases and controls were found for respiratory rate, peak tidal expiratory flow or expiratory volume. However, the odds ratio for developing recurrent or persistent bronchial obstruction was 3.5 (1.1-11.6) if tPTEF/tE was < 0.20 and 4.1 (1.1-14.5) with maternal daily smoking during the pregnancy, after adjusting for age, weight, sex, CB-IgE, parental atopy, maternal education and family income. The TFV parameter tpTEF/tE < 0.20 measured within the first week of life as well as maternal daily smoking during pregnancy are significant, independent risk factors for developing recurrent or persistent bronchial obstruction within the first two years of life.
Case-Control Studies↗
Wheezing in school children is not always asthma.
Our objective was to study whether children with reported asthma differed from children with wheeze but without asthma, and from children with neither asthma nor wheeze, regarding lung function, bronchial hyper-responsiveness (BHR) using methacholine inhalation, exercise-induced bronchoconstriction (EIB), and skin prick test (SPT) reactivity. School children (n=2188), enrolled in a survey of asthma, were classified into three mutually exclusive groups by parental report of: asthma, wheeze, and no asthma/no wheeze. A random sample of 80 children in each group was tested (n=240). Among asthmatics, 68% (95% confidence interval (CI), 57-79) had a BHR (measured as PD20 forced expiratory volume in 1 s (FEV1) < or = 8.16 micromol using methacholine) compared to 31% (CI 20-42%) and 30% (CI 19-40%) in the wheeze and no asthma/no wheeze groups. The dose-response slope (DRS) confirmed the PD20 data and distinguished equally between groups. EIB (> or =10% fall in FEV1) was more frequent (40%, CI 29-52%) among asthmatics than among children with wheeze (12%, CI 4-19%) and no asthma/no wheeze (7%, CI 1-13%). The prevalence of at least one positive SPT was twice as high in the asthma group (58%, CI 47-69%) than in the wheeze (27%, CI 16-37%) and the no asthma/no wheeze (25%, CI 15-35%) groups. These results indicate that children with asthma differ from children with wheeze and children with no asthma/no wheeze regarding lung function, BHR, EIB, and SPT reactivity. Children with wheeze are more similar to children with no asthma/no wheeze with respect to these parameters.
Adolescent↗
Cold air inhalation and exercise-induced bronchoconstriction in relationship to metacholine bronchial responsiveness: different patterns in asthmatic children and children with other chronic lung diseases.
Cold air inhalation and exercise-induced bronchoconstriction (EIB) have both been used as measures of bronchial responsiveness. Both stimuli are often combined in the Nordic climate. The main objective of the present study was to investigate the climatic influence of cold temperatures upon exercise-induced asthma. The secondary aims were: (a) to assess metacholine bronchial hyper-responsiveness and EIB in children with bronchial asthma (n = 32; mean age 10.8 years) compared to children with other chronic lung diseases (CLD) (n = 26, mean age 10.1 years); and (b) to assess the influence of cold air inhalation upon EIB in the two groups of children. Methods used were: (a) the metacholine concentration causing a reduction in FEV1 of 20% (PC20-M), (b) maximum FEV1 fall (delta FEV1) after submaximal treadmill run (EIB test); and (c) delta FEV1 after submaximal treadmill run while inhaling cold (-20 degrees C) dry air (CA-EIB test). Geometric mean PC20-M did not differ significantly between the asthma children (1.28 mg ml-1) and the CLD children (2.90 mg ml-1). In the asthma children, mean delta FEV1 after EIB test was 12.8% vs 21.8% after adding cold air (P < 0.0001), compared to 5.2 and 7.4%, respectively (P = 0.03), in the CLD group. Maximum sensitivity and specificity for the EIB test were 69.8% at a fall in FEV1 of 6.8%; for the CA-EIB test, 72% at a fall in FEV1 of 10.2%; and for metacholine provocation, 56% at a PC20-M of 1.5 mg ml-1. In conclusion, children with bronchial asthma are substantially more sensitive to cold air than children with CLD, and EIB is markedly increased by cold air inhalation in asthmatic children, maintaining the specificity of the EIB test and increasing the sensitivity. The low sensitivity of the EIB test is probably influenced by the use of inhaled steroids. Metacholine inhalation test has less specificity and sensitivity in discriminating asthma from other chronic lung diseases.
Asthma, Exercise-Induced↗
Serum inflammatory markers and effects of age and tobacco smoke exposure in young non-asthmatic children.
Serum eosinophil cationic protein (ECP), but not serum myeloperoxidase (MPO), has been found to reflect disease activity of asthma and eczema, but no reference values exist for young children. Thus, we aimed to provide values of serum-ECP and serum-MPO in young children without obstructive airways disease (OAD), and determine possible influencing factors. Parental interview was performed and serum was collected from a total of 245 children (207 children aged 24-41 months and 76 children aged 0-23 months) with no history of lower respiratory disease. Repeated serum samples were obtained in 38 subjects. Ten percent of the children had active eczema at examination. All children were controls in the "Environment and Childhood Asthma" study in Oslo. Geometric means (GM +/- 1.96 SD) for serum ECP were 11.8 microg/l (2.5-56.0) and 7.9 microg/l (2.0-30.4), respectively, in the 0-23 and 24-41-month-old children, with the corresponding values for serum MPO 453 microg/l (153-1349) and 347 microg/l (142-859), respectively. Age was inversely associated with serum-ECP and serum-MPO, most pronounced in the youngest children. Active eczema and maternal daily smoking adversely affected serum-ECP, but not serum-MPO. Gender and parental atopy did not influence the results. We conclude that serum-ECP in very young children is influenced by age and active eczema and is related to maternal smoking in a dose-dependent fashion. These factors should be considered when assessing inflammatory markers in very young children.
Age Factors↗
Exposure to nitrogen dioxide and the occurrence of bronchial obstruction in children below 2 years.
BACKGROUND: The objective of the investigation was to test the hypothesis that exposure to nitrogen dioxide (NO2) has a causal influence on the occurrence of bronchial obstruction in children below 2 years of age. METHODS: A nested case-control study with 153 one-to-one matched pairs was conducted within a cohort of 3754 children born in Oslo in 1992/93. Cases were children who developed > or = 2 episodes of bronchial obstruction or one episode lasting >4 weeks. Controls were matched for date of birth. Exposure measurements were performed in the same 14-day period within matched pairs. The NO2 exposure was measured with personal samplers carried close to each child and by stationary samplers outdoors and indoors. RESULTS: Few children (4.6%) were exposed to levels of NO2 > or = 30 microg/m3 (average concentration during a 14-day period). In the 153 matched pairs, the mean level of NO2 was 15.65 microg/m3 (+/-0.60, SE) among cases and 15.37 (+/-0.54) among controls (paired t = 0.38, P = 0.71). CONCLUSIONS: The results suggest that NO2 exposure at levels observed in this study has no detectable effect on the risk of developing bronchial obstruction in children below 2 years of age.
Air Pollution, Indoor↗
Recurrent respiratory tract infections during the first 3 years of life and atopy at school age.
BACKGROUND: The hypothesis that infections reduce the risk of atopy was investigated by estimating the association between recurrent respiratory tract infections during the first 3 years of life and atopy at school age. METHODS: According to surveys in three different areas of Norway, children were classified into three groups: asthma, wheeze without asthma (wheeze), and no asthma/no wheeze. The skin prick test (SPT) was conducted on a stratified random sample of children (n = 502). The outcome was at least one positive SPT. The exposure variable was retrospective parental report of respiratory tract infections during the first 3 years of life. RESULTS: Infections were negatively associated with atopy, crude odds ratio (cOR) = 0.3, 95% confidence interval (95% CI) 0.1-0.7, in the asthma group. A similar association was present in children with wheeze cOR = 0.4 (95% CI 0.1-1.2). The number of siblings was not associated with atopy in any group. Infections remained negatively associated with atopy in children with asthma, aOR = 0.3 (95% CI 0.1-0.7), in a logistic regression model adjusting for confounding factors. A similar pattern was present in the wheeze group. CONCLUSIONS: Recurrent respiratory tract infections during the first 3 years of life are negatively associated with atopy at school age in children with asthma.
Adolescent↗
Exercise induced asthma in children and adolescents and the relationship to sports.
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Adolescent↗
Clinical efficacy of low-dose inhaled budesonide once or twice daily in children with mild asthma not previously treated with steroids.
The aim of the present study was to examine the efficacy of low-dose inhaled budesonide (BUD) administered via Turbuhaler once or twice daily on symptoms, lung function and bronchial hyperreactivity in children with mild asthma. One hundred and sixty-three children (mean age 9.9 yrs, 56 females/107 males) with mild asthma (forced expiratory volume in one second (FEV1) 103% of predicted, morning peak expiratory flow (PEF) 87% pred, reversibility in FEV1 3%, fall in FEV1 after exercise 10.4% from pre-exercise value) and not previously treated with inhaled steroids, were included in a double-blind, randomized, parallel-group study. After a two-week run-in period, the children received inhaled BUD 100 microg or 200 microg once daily in the morning, 100 microg twice daily or placebo for 12 weeks. Exercise and methacholine challenges were performed before and at the end of treatment. After 12 weeks of therapy, the fall in FEV1 after an exercise test was significantly less in all three BUD groups (43-5.1%) than in the placebo group (8.6%). Bronchial hyperreactivity to methacholine with the provocative dose causing a 20% fall in FEV1 decreased significantly in the BUD 100 microg twice-daily group compared with placebo (ratio at the end of treatment 156%). Changes in baseline lung function (FEV1 and PEF) were less marked than changes in bronchial responsiveness. In conclusion, low doses of inhaled budesonide, given once or twice daily, provided protection against exercise-induced bronchoconstriction in children with mild asthma and near normal lung function.
Administration, Inhalation↗