1.
Question 5: Magnesium Sulphate for Acute Asthma in children.
Aniapravan, R, Pullattayil, A, Al Ansari, K, Powell, CVE
Paediatric respiratory reviews. 2020;:112-117
Abstract
Most children who present to the emergency department with acute asthma, respond well to inhaled β2-agonists (spacer or nebuliser), oxygen (if required) and systemic steroids. Guidelines across the world agree on this simple, straight forward evidenced based approach. In children with more severe asthma attacks and those who do not respond to initial treatment, the evidence base for the secondary level treatment is less clear. Many regimens exist for the next step. Intravenous Magnesium Sulphate (MgSO4) is now used frequently in these situations and some centres are starting to use nebulized MgSO4 as part of the initial maximal inhaled therapy options. This paper examines the role of MgSO4 in acute asthma in children. It focusses on how MgSO4 might work, what are the current recommendations for use and then what is the current evidence base to support its use. We have presented the evidence for the use of both nebulized and intravenous MgSO4. At the end of the paper we have suggested future directions for research in this area. Our aim is to present a synthesis of the current role of MgSO4 in the management of an acute asthma attack.
2.
Inhaled magnesium sulfate in the treatment of acute asthma in children.
Normansell, R, Knightly, R, Milan, SJ, Knopp-Sihota, JA, Rowe, BH, Powell, C
Paediatric respiratory reviews. 2018;:31-33
3.
[Current position of new fixed-dose combination of tiotropium and olodaterol - its role in the treatment of chronic obstructive pulmonary disease in the Czech Republic].
Koblížek, V, Svoboda, M
Vnitrni lekarstvi. 2016;(12):1011-1020
Abstract
COPD is a serious pulmonary disease with rising global socioeconomic impact. From the perspective of the Czech Republic COPD was responsible for 21 000 acute hospitalizations and 3 500 deaths, mortality reaches 33/100 000 in 2015. Early stages of disease may be associated with a significant reduction of exercise capacity and the reduction of activities of daily living. Moreover early stages of bronchial obstruction are associated with the fastest lung function decline. Finally, early elimination of the risk of inhalation exposure is able to influence the course of the disease and to reduce its mortality. Most current treatment strategies and national recommendations attributed central role to bronchodilator drugs. Long-acting bronchodilators (LAMA and LABA) creates an essential component of the treatment of symptomatic individuals in the Czech COPD guidelines as well. Actual version of this document constitutes as standard therapy: long-lasting inhaled bronchodilators, targeted efforts to eliminate inhalation risk, vaccination, regular exercise, repeated inhalation technique training, identification, and treatment of relevant comorbidities. All other drugs (inhaled-corticosteroids, mucoactive medication, roflumilast, antibiotics), and non-pharmacological (lung volume reductions, nutrition support, long-term oxygen, home non-invasive ventilation, lung transplantation, palliative care) procedures are intended for a specific subgroups of patients only. The newest type of bronchodilator therapy is represented by a fixed dual bronchodilation. Currently we can use four original drug combinations: titropium + olodaterol, glycopyrronium + indacaterol, umeklidinium + vilanterol and aclidinium + formoterol in the Czech Republic. This area is an enterprising research. For example comprehensive scientific program covering eight studies on 15 000 COPD patients (TOviTO) assess the therapeutic benefits of tiotropium + olodaterolu in terms of lung function, quality of life, exercise tolerance, daily physical activity and the incidence of acute exacerbations. Meanwhile the published results of analyzed studies TONADO, OTEMTO, VIVACITO, and the first results of the study DYNAGITO have showed that fixed dual bronchodilation should be a mandatory treatment to all the symptomatic COPD patients. Unfortunately "face to face" comparison of different drug combinations is still missing. However, the treatment with tiotropium + olodaterol combination has been demonstrated to significantly (35 %) reduce the occurrence of clinically significant deterioration, which may lead to the stabilization of this multicomponent disease.Key words: COPD - hospitalizations - inhaled bronchodilators - mortality - treatment.
4.
The safety of long-acting β2-agonists in the treatment of stable chronic obstructive pulmonary disease.
Decramer, ML, Hanania, NA, Lötvall, JO, Yawn, BP
International journal of chronic obstructive pulmonary disease. 2013;:53-64
Abstract
BACKGROUND Inhaled long-acting bronchodilators are the mainstay of pharmacotherapy for chronic obstructive pulmonary disease (COPD). Both the twice-daily long-acting β(2)-adrenoceptor agonists (LABAs) salmeterol and formoterol and the once-daily LABA indacaterol are indicated for use in COPD. This review examines current evidence for the safety of LABAs in COPD, focusing on their effect on exacerbations and deaths. METHODS We searched PubMed for placebo-controlled studies evaluating long-term (≥24 weeks) use of formoterol, salmeterol, or indacaterol in patients with stable COPD, published between January 1990 and September 2012. We summarized data relating to exacerbations and adverse events, particularly events related to COPD. RESULTS From 20 studies examined (8774 LABA-treated patients), there was no evidence of an association between LABA treatment and increased exacerbations, COPD-related adverse events, or deaths. Where analyzed as an efficacy outcome, LABA treatment was generally associated with significant or numerical reductions in COPD exacerbations compared with placebo. Incidences of COPD-related adverse events were similar for active and placebo treatments. The incidence of adverse events typically associated with the β(2)-agonist drug class such as skeletal muscle tremors and palpitations was low (often <1% of patients), and there were no reports of increased incidence of cardiac arrhythmias. The systemic effects of β(2)-adrenoceptor stimulation, such as high glucose and potassium levels, were considered minor. CONCLUSION Current evidence from clinical studies of the safety and tolerability profile of LABAs supports their long-term use in COPD.