Nebulised sodium cromoglycate in infancy: airway

نویسنده

  • A Swarbrick
چکیده

Over a two year period 100 infants with histories of wheeze were challenged with nebulised water. They were sedated and lung function measured by total body plethysmography. Thirteen of the 53 infants who developed bronchoconstriction after challenge with nebulised water were given nebulised sodium cromoglycate and rechallenged with nebulised water. All infants were initially challenged with normal saline, after which there was no significant change in lung function. After challenge with nebulised water and sodium cromoglycate there were significant decreases in specific conductance compared with those found after challenge with normal saline. After rechallenge with nebulised water there was no deterioration in lung function. Although sodium cromoglycate caused a deterioration in lung function in these infants, it protected their airways from challenge with nebulised water. Nebulised sodium cromoglycatel and salbutamol2 have little clinical effect on the airways of children under the age of 1 year. Recently, however, nebulised salbutamol has been shown to protect against the bronchoconstricting action of nebulised water in infants,3 but it may cause a transient paradoxical deterioration in the lung function of wheezy infants.4 The cause of this deterioration is not known, but may be associated with the acidity, preservatives, or osmolality of the nebulised solution, or with the drug itself. The aim of this study was to assess how much nebulised sodium cromoglycate protected the airways of wheezy infants from challenge with nebulised water. The immediate reaction to the sodium cromoglycate nebuliser solution, which is hypo-osmolar was assessed. Patients and methods During an 18 month period 100 infants with Department of Child Health, University Hospital, Queen's Medical Centre, Nottingham NG7 2UH C O'Callaghan A D Milner A Swarbrick Correspondence to: Dr O'Callaghan. Accepted 8 November 1989 histories of wheeze were challenged with nebulised water. Thirteen of the 53 infants who developed bronchoconstriction after the challenge were entered into this study (table 1). At the time of the investigation two infants had mild wheeze. The others were clinically well and it was at least two months since their bronchiolitic illness. No infant had had an upper respiratory tract infection in the two weeks leading up to the study. The infants were sedated with chloral hydrate 120 mg/kg and thoracic gas volume and airways resistance were measured by total body plesthysmography as previously described.5 Baseline measurements of thoracic gas volume and airways resistance were made. Ultrasonically nebulised normal saline (21°C, volume 150 ml) from an intersurgical Variosonic nebuliser at setting 3 was given to the infants by face mask for two mintues at a flow rate of 5 1/minute. Thoracic gas volume and airways resistance were measured immediately after nebulisation and at five minute intervals until the readings were stable (defined as no change over a five minute period). A dense mist occasionally escaped from the space between the mask and the face in the first few seconds of nebulisation owing to an inadequate seal. The mask was readjusted and the study restarted with an adequate seal. Infants were given ultrasonically nebulised water from the same nebuliser (21°C volume, 150 ml) for two minutes. Thoracic gas volume and airways resistance were again measured at regular intervals until readings were stable. The infants who developed signs of bronchoconstriction after being given nebulised water were given nebulised sodium cromoglycate through a Unicorn nebuliser chamber (Medic AID) (volume 2 ml of 1% sodium cromoglycate). A flow rate of 4-5 1/minute was maintained for five minutes. Thoracic gas volume and airways resistance were measured until stable. Fifteen minutes after receiving the nebulised sodium cromoglycate the infants were chalTable 1 Details of 13 patients Case No Age (months) Sex History of confirmed respiratory Family history of atopy Weight syncytial virus bronchiolitis (kg) 1 3 Female No Yes 7-6 2 8 Female No Yes 8-5 3 4 Male Yes Yes 6-7 4 13 Male Yes No 12-0 5 12 Male No No 10-7 6 12 Male No Yes 9-2 7 19 Male Yes Yes 8-0 8 13 Female No Yes 10-2 9 9 Male Yes Yes 9 4 10 9 Male No Yes 10-4 11 6 Male Yes Yes 9 4 12 7 Male Yes No 9 9 13 12 Male Yes No 11-4 404 group.bmj.com on April 13, 2017 Published by http://adc.bmj.com/ Downloaded from

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تاریخ انتشار 2006