SPECIFIC TARGETING OF INHALED STEROIDS TO SMALL AIRWAYS IN CHILDREN WITH PROBLEMATIC SEVERE ASTHMA USING THE AKITA: A CASE SERIES H.M. Janssens MD PhD, J.L. Overweel-Uyterlinde Department of Pediatric Pulmonology, Erasmus MC- Sophia Children's Hospital, Rotterdam, The Netherlands. INTRODUCTION
Asthma is an inflammatory disease affecting the small airways.
Small airways are a difficult target for inhaled therapy. There is a group of patients whose asthma cannot be controlled
sufficiently with the traditionally available inhaled therapies.
They have frequent exacerbations needing systemic steroids,
With the AKITA nebulizer the small airways can be specifically
targeted with steroids. No clinical data in asthmatic children are
To describe the experience of using the AKITA nebulizer for
treatment of children with problematic severe asthma.
Figure 2: FEV1 change after start AKITA.
Mean improvement of FEV1= 32% (range 7-60%)
- Subjects: 6 children aged 7-17 years with problematic severe asthma.
- Device: AKITA nebulizer combined with PARI LCPLUS.
- Medication: twice daily ipratropium bromide 0.5 mg/ albuterol 2.5 mg, followed by Fluticasone 1 mg. Filling dose: 2 ml.
- Inhalation: initially: 1 cycle with the dornase card, leaving a
- All patients were trained by the respiratory nurse.
- Monitoring: Spirometry and exhaled FeNO performed on
regular bases in the out-patient clinic.
- Mean age of onset AKITA nebulizer: 13.1 y (range 7-17 y)
FEF75 baseline FEF75top
- 5 pts on high doses inhaled corticosteroids (ICS),
Figure 3: FEF75 change after start AKITA
Mean improvement of FEF75= 36% (range 13-74)
- All patients frequent exacerbations and hospital admissions
All patients improved with FEV1 and FEF75 (figure 2 and 3).
An example of lung function course is shown in figure 1.
Patients with initially high FeNO decreased considerably. In all
but one, maintenance asthma medication used before start of
AKITA could be reduced. Overall there were less symptoms
reported, and less exacerbations. None of he patients had
hospital admissions during the use of the AKITA.
FeNO baseline FeNObest Figure 3: FeNO change after start AKITA Mean FeNO change after start AKITA= -37 ppB (range -84-0) Monitoring: Patients were closely monitored and assisted by the respiratory nurse. Adherence could be monitored by reading the memory of the AKITA. Adherence was > 90%. Except for pt E: she stopped
and restarted regular ICS when asthma was stable.
Figure 1: Lung function course of patient E.
Arrows indicate start AKITA. Stopped several times because of
The AKITA nebulizer is a promising tool to treat problematic
severe asthma. It is able to stabilize severe asthma and
In 2 patients growth retardation was seen at the initial high
improve peripheral airflow parameters as FEF75. Special
dose. This recovered after fluticasone dose was reduced to 2
attention should be paid to side-effects of corticosteroids, such
dd half cycle (500 mcg). One patient experienced gingivitis and
as growth retardation, when high doses are used. Steroid dose
skinrash, which both improved after cessation of fluticasone
should be reduced as fast as possible when asthma symptoms
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02_972959 ftoc.qxd 1/31/05 3:37 PM Page vii Contents Introduction * xvi PART 1: KEY INFORMATION FOR UNDERSTANDING AND MANAGING ADHD Section 1.1: Understanding Attention-Deficit/Hyperactivity Disorder * 3 Definitions and Descriptions of ADHD * 3 Behavioral Characteristics of ADHD * 4 The Predominantly Inattentive Type of ADHD * 4 The Predominantly Hyperactive-Impulsi