Nebulized corticosteroids

In a study of asthmatic children 5-12 years of age, those treated with budesonide administered via a dry powder inhaler 200 mcg twice daily (n=311) had a -centimeter reduction in growth compared with those receiving placebo (n=418) at the end of one year; the difference between these two treatment groups did not increase further over three years of additional treatment. By the end of four years, children treated with the budesonide dry powder inhaler and children treated with placebo had similar growth velocities. Conclusions drawn from this study may be confounded by the unequal use of corticosteroids in the treatment groups and inclusion of data from patients attaining puberty during the course of the study. The growth of pediatric patients receiving inhaled corticosteroids, including Pulmicort RESPULES, should be monitored routinely (., via stadiometry). The potential growth effects of prolonged treatment should be weighed against clinical benefits obtained and the risks and benefits associated with alternative therapies. To minimize the systemic effects of inhaled corticosteroids, including Pulmicort RESPULES, each patient should be titrated to his/her lowest effective dose [see Dosage and Administration (2) , Warnings and Precautions () ] .

Frequent feeds should be encouraged and breastfeeding supported; both may be facilitated by providing supplemental oxygen. Infants with a respiratory rate >60 breaths/min, particularly those with nasal congestion, may have an increased risk of aspiration and may not be safe to feed orally. [1] When supplemental fluids are required, a recent randomized trial found nasogastric (NG) and intravenous (IV) routes to be equally effective, with no difference in length of hospital stay. [33] NG insertion may require fewer attempts and have a higher success rate than IV placement. If NG bolus feeds are not tolerated, slow continuous feeds are an option. If the IV route is used, isotonic fluids (% NaCl/5% dextrose) are preferred for maintenance, with regular monitoring of serum Na [34] because of the risk of hyponatremia. [35]

Thyroid storm is a life-threatening condition of the hyperthyroid state. 26 It most commonly occurs in patients with Graves' disease but may also occur in those with multinodular goiter or toxic adenoma. 27 It is treated by correcting the hyperthyroidism and treating the precipitating events. 26 Correction of the hyperthyroid state involves using drugs such as propylthiouracil or methimazole (Tapazole), beta blockers or corticosteroids, which decrease the peripheral effects of thyroid hormone and the conversion of thyroxine (T 4 ) to the more potent triiodothyronine (T 3 ). 22 , 26 Dexamethasone can be used for that purpose, at a dosage of 2 mg intravenously every six hours, and can eventually can be switched to an oral dosage of 2 mg every six hours. 28

Acute bronchitis, as the term implies, is a lower respiratory tract syndrome and another common source of acute cough. It manifests as a persistent cough, with or without sputum production, in patients with a normal chest radiograph. Although it is much less prevalent than the common cold, acute bronchitis is the most common diagnosis given to patients presenting to a physician with acute cough. It is caused by a respiratory virus more than 90% of the time. Viral cultures and serologic assays are not routinely ordered; hence, the organism responsible is rarely identified.

Inhaled short-acting beta 2 agonist treatment is the mainstay of office or emergency department treatment of moderate to severe asthma exacerbations. If the patient can tolerate a measurement of PEF or forced expiratory volume in one second (FEV 1 ), an initial value should be obtained and repeated to monitor treatment response. In patients with severe exacerbations, continuous beta 2 agonist administration has been shown to improve pulmonary function measurements and reduce hospital admission with no notable differences in pulse, blood pressure, or tremor. 21 The use of high-dose albuterol ( mg via nebulizer every 20 minutes for three doses) 22 and intravenous beta 2 agonists does not appear to be beneficial and is not recommended. 23

Nebulized corticosteroids

nebulized corticosteroids

Acute bronchitis, as the term implies, is a lower respiratory tract syndrome and another common source of acute cough. It manifests as a persistent cough, with or without sputum production, in patients with a normal chest radiograph. Although it is much less prevalent than the common cold, acute bronchitis is the most common diagnosis given to patients presenting to a physician with acute cough. It is caused by a respiratory virus more than 90% of the time. Viral cultures and serologic assays are not routinely ordered; hence, the organism responsible is rarely identified.

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