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Biomedical subjects

Paul L P Brand

Publications and source records attributed to Paul L P Brand.

7 recordsLinked to original sources
PubMed2005

Key issues in inhalation therapy in children.

In order to achieve asthma control it is essential that children receive the appropriate education and training pertaining to the management of their disease, are prescribed the correct medication according to severity, and most importantly, are prescribed the correct inhaler to ensure medication is deposited in their lungs. There are three major misconceptions which physicians and patients have regarding the use of inhalers in children. Firstly, that the nebulizer is more effective than a pressurised metered dose inhaler (pMDI) plus spacer in treating acute asthma in children. Secondly that using an inhaler correctly is easy, and lastly that correct use of the inhaler, once taught, persists over time. However, recent studies have shown that these conceptions are false. Firstly, comparable efficacy is achieved by treatment with inhaled corticosteroids or bronchodilators delivered through a nebulizer and a pMDI plus spacer, both when used to treat acute asthma and for maintenance therapy. Secondly, contrary to general opinion, using an inhaler correctly is difficult for children. Many children with asthma use their inhaler devices incorrectly, even after instruction for correct use of the inhaler. Thirdly, correct inhalation technique deteriorates over time; and inhalation instructions, therefore, should be given repeatedly to achieve and maintain correct inhalation technique in asthmatic children. The profile of the ideal inhaler comprises good drug deposition in the lower airways, deliverance of a consistent dose, being easy to teach and to use correctly, and being small in size and convenient to handle. It should also be multidose, require a low inspiratory airflow for activation, provide feedback to patients on correct use of the inhaler, be re-usable, have an appealing design and feel, and have a reliable dose counter which may help to monitor the patient's compliance. The Novolizer device, a new multidose dry powder inhaler (DPI), shows many of these characteristics making it potentially very suitable for children with asthma.

Administration, Inhalation↗
PubMed2004

Variation of peak inspiratory flow through dry powder inhalers in children with stable and unstable asthma.

Drug release from dry powder inhalers depends for a large part on a sufficiently high peak inspiratory flow (PIF). We determined the variation of PIF through two commonly prescribed dry powder inhalers in children with asthma. We analyzed the effect of inhaler device, age, and severity of asthma symptoms on variation of PIF. Fifty-eight children with asthma (4-15 years old) recorded PIF values together with asthma symptoms in a diary twice daily for 4 weeks. PIF was measured with a portable PIF-meter (In-Check) equipped with adapters to simulate flow resistance through the Accuhaler and Turbohaler inhalers. Children generated higher PIF values through an Accuhaler adapter than through a Turbohaler adapter (95% CI for difference, 25.7-31.7). Mean PIF values increased with age, independent of type of inhaler. The mean (SD) variation of PIF (low%high) was 72.3 (8.1)% for patients using the Accuhaler adapter, and 67.0 (14.5)% for patients using the Turbohaler adapter (mean difference, 5.2%; 95% CI, -0.9 to 11.4). Children < or =7 years of age had a significantly greater variation of PIF in addition to a lower mean PIF (P = 0.0003). PIF decreased significantly when symptoms of asthma increased (mean maximal decrease 11 l/min; P < 0.01), but the correlation between PIF and morning and evening symptoms was weak (r = -0.18 and r = -0.16, respectively). Patients who reported moderate or severe symptoms during the study period had a significantly greater variation of PIF compared to patients who remained free of symptoms or reported mild symptoms. The majority of patients generated PIF >30 l/min during the study, even when they experienced symptoms of asthma. The variation of PIF through the Accuhaler and Turbohaler adapter was significantly greater for children < or =7 years of age and for patients experiencing moderate or severe symptoms of asthma.

Adolescent↗
PubMed2003

The "wandering needle".

Suspected aspiration of a radiopaque foreign body can easily be confirmed by a chest film. We report a case of a boy with chest-film confirmed aspiration of a needle into his right main bronchus, in whom no needle was found during bronchoscopy. In retrospect, the boy had expectorated the needle without noticing it in the interval between making the diagnosis and the actual bronchoscopy. We propose to reconfirm aspiration of a radiopaque foreign body by fluoroscopy shortly before commencing bronchoscopy.

Bronchi↗
PubMed2002

Bronchodilator response in asthmatic children is significantly reduced when measured immediately after methacholine challenge.

AIM: Airway responses to a bronchodilator (BDR) and to methacholine are frequently measured in the assessment of childhood asthma and in pulmonary research. For practical reasons, we wondered whether it would be possible to obtain a reliable BDR immediately after completion of a methacholine challenge test. To this end, we compared BDR with and without a preceding methacholine challenge. METHODS: The BDR was measured twice in random order on consecutive days in 24 asthmatic children with methacholine hyperresponsiveness. It was calculated as the change in forced expiratory volume in one second (FEV1) before and 20 min after inhaling 800 microg of salbutamol (metered dose inhaler with a spacer), expressed as a percentage of the predicted value (deltaFEV1%pred). On one day BDR was measured immediately after completing a methacholine challenge, on the other day without any preceding challenge. RESULTS: Mean(SD) baseline FEV1%pred was not significantly different between test days [98.6(14.2)% and 98.1(13.8)%, respectively, p=0.53]. The geometric mean provocative dose of methacholine producing a 20% fall in FEV1 (PD20) was 56.2 microg (range 10.3-306.2 microg). The mean (SEM) BDR without preceding methacholine challenge was 10.8(1.4)%, while after preceding methacholine challenge it was 5.2(1.5)% (mean difference 5.6%, 95% CI 3.0%-8.1%, p<0.001). Mean(SEM) postbronchodilator FEV1%pred was 109.4(3.0)% without and 103.4(2.7)% with preceding methacholine challenge (mean difference 6.0%, 95% CI 3.5%-8.6%, p<0.001). CONCLUSION: A preceding methacholine challenge significantly reduces BDR in asthmatic children. Therefore, a BDR, measured immediately after completing a methacholine challenge, cannot be used as a substitute for a separate bronchodilator test.

Administration, Inhalation↗