Microsoft word - posterisam2013versie3.doc

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 FEV1 baseline
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. Patients characteristics
- 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 Clinical effect
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 CONCLUSIONS
The AKITA nebulizer is a promising tool to treat problematic Side effects:
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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