How effective is albuterol delivered by metered-dose inhaler for treating acute bronchitis. What are the key findings of clinical trials on albuterol for bronchitis symptoms. How does albuterol compare to antibiotics for acute bronchitis treatment.

Understanding Acute Bronchitis and Treatment Options

Acute bronchitis is a common respiratory condition characterized by inflammation of the bronchial tubes, leading to coughing and other symptoms. While it is often caused by viral infections, treatment approaches can vary. This article examines the use of albuterol, a bronchodilator medication, delivered via metered-dose inhaler (MDI) as a treatment option for acute bronchitis.

What is acute bronchitis?

Acute bronchitis is an inflammation of the lining of the bronchial tubes, which carry air to and from the lungs. It typically develops from a respiratory infection like the common cold or flu. The main symptom is a persistent cough, often accompanied by the production of mucus.

Common treatment approaches

• Rest and hydration
• Over-the-counter cough suppressants
• Antibiotics (though not typically recommended for viral bronchitis)
• Bronchodilators like albuterol

The Role of Albuterol in Bronchitis Treatment

Albuterol is a short-acting beta-2 agonist that works by relaxing the muscles around the airways, making breathing easier. While commonly used for asthma, its potential benefits for acute bronchitis have been a subject of clinical research.

How does albuterol work?

Albuterol acts on beta-2 receptors in the smooth muscle of the bronchial tubes. This action leads to bronchodilation, or widening of the airways, which can help relieve cough and wheezing associated with bronchitis.

Metered-dose inhaler delivery

Using a metered-dose inhaler (MDI) allows for direct delivery of albuterol to the airways. This method provides a consistent dose and can be more effective than oral medications for targeting respiratory symptoms.

Clinical Trial: Albuterol MDI for Acute Bronchitis

A significant clinical trial conducted by W.J. Hueston and published in the Journal of Family Practice in 1994 examined the effectiveness of albuterol delivered by MDI for treating acute bronchitis. This double-blind, randomized, placebo-controlled study provides valuable insights into the potential benefits of albuterol for this condition.

Study design and participants

The trial involved healthy adult patients presenting with a productive cough lasting less than 30 days. Participants were randomly assigned to receive either albuterol via MDI or a placebo inhaler. Additionally, the study incorporated a second randomization for erythromycin or placebo, allowing for analysis of potential interactions between treatments.

Key findings

• Patients using albuterol MDI were significantly less likely to be coughing after 7 days of treatment compared to those using a placebo inhaler (61% vs. 91%, P = .02).
• The beneficial effect of albuterol persisted when analysis was stratified by cigarette smoking status and concomitant use of erythromycin.

Interpreting the Results: Albuterol’s Effectiveness

The clinical trial results suggest that albuterol delivered by MDI can be an effective treatment for acute bronchitis, particularly in reducing the duration of cough symptoms.

Is albuterol more effective than antibiotics for bronchitis?

While the study did not directly compare albuterol to antibiotics, it demonstrated that albuterol’s effectiveness was independent of whether patients also received erythromycin (an antibiotic). This suggests that albuterol may provide benefits beyond those offered by antibiotic treatment alone.

Considerations for different patient groups

The study’s stratified analysis indicates that albuterol’s benefits were observed across different patient subgroups, including smokers and non-smokers. This suggests that albuterol MDI could be a versatile treatment option for diverse patient populations with acute bronchitis.

Comparing Albuterol to Other Bronchitis Treatments

To fully understand the potential of albuterol for acute bronchitis, it’s important to consider how it compares to other common treatment approaches.

Albuterol vs. antibiotics

While antibiotics are often prescribed for bronchitis, their effectiveness is limited for viral cases. Albuterol’s mechanism of action directly addresses bronchial constriction, potentially offering more targeted symptom relief.

Albuterol vs. over-the-counter cough medications

Many OTC cough medications aim to suppress the cough reflex or thin mucus. Albuterol’s bronchodilating effects may provide more comprehensive relief by addressing the underlying airway constriction.

Potential Side Effects and Considerations

While the clinical trial demonstrated the benefits of albuterol MDI for acute bronchitis, it’s important to consider potential side effects and contraindications.

Common side effects of albuterol

• Nervousness or shakiness
• Increased heart rate
• Headache
• Throat irritation

Patient considerations

Albuterol may not be suitable for all patients, particularly those with certain cardiovascular conditions or sensitivities to beta-agonists. As with any medication, it should be used under the guidance of a healthcare professional.

Implications for Clinical Practice

The findings of the clinical trial on albuterol MDI for acute bronchitis have several important implications for healthcare providers and patients.

Rethinking bronchitis treatment protocols

Given the demonstrated effectiveness of albuterol, clinicians may consider incorporating it as a first-line treatment for acute bronchitis, particularly in cases where cough is a predominant symptom.

Reducing unnecessary antibiotic use

By offering an effective alternative to antibiotics, albuterol MDI treatment could help reduce the overuse of antibiotics for viral bronchitis, contributing to efforts to combat antibiotic resistance.

Future Research Directions

While the clinical trial provides valuable insights, there are still areas where further research could enhance our understanding of albuterol’s role in treating acute bronchitis.

Long-term outcomes and repeated use

Future studies could examine the effects of albuterol treatment on long-term bronchitis outcomes and assess the safety and efficacy of repeated use for recurrent bronchitis episodes.

Combination therapies

Research into potential synergistic effects between albuterol and other treatments, such as mucolytics or anti-inflammatory medications, could lead to more comprehensive treatment strategies for acute bronchitis.

The clinical trial conducted by W.J. Hueston provides compelling evidence for the effectiveness of albuterol delivered by metered-dose inhaler in treating acute bronchitis. Patients receiving albuterol were significantly less likely to be coughing after a week of treatment compared to those using a placebo inhaler. This effect was consistent across different patient subgroups and independent of antibiotic use.

These findings suggest that albuterol MDI could be a valuable treatment option for acute bronchitis, potentially reducing the duration of symptoms and improving patient outcomes. By offering an alternative to antibiotics, albuterol treatment may also contribute to more judicious use of antimicrobial medications.

As with any medical intervention, the use of albuterol for bronchitis should be tailored to individual patient needs and monitored by healthcare professionals. Further research can help refine treatment protocols and explore potential combination therapies to maximize the benefits of albuterol in managing acute bronchitis.

Ultimately, the incorporation of albuterol MDI into bronchitis treatment strategies represents a promising approach to addressing this common respiratory condition. By directly targeting bronchial constriction, albuterol offers a mechanism of action well-suited to alleviating the cough and discomfort associated with acute bronchitis.

Albuterol delivered by metered-dose inhaler to treat acute bronchitis

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Clinical Trial

. 1994 Nov;39(5):437-40.

W J Hueston 
¹

Affiliations

Affiliation

• ¹ Department of Family Medicine, University of Wisconsin, Eau Claire.

• PMID:

  7864949

Clinical Trial

W J Hueston.

J Fam Pract.

1994 Nov.

. 1994 Nov;39(5):437-40.

Author

W J Hueston 
¹

Affiliation

• ¹ Department of Family Medicine, University of Wisconsin, Eau Claire.

• PMID:

  7864949

Abstract

Background:

Previous research has suggested that cough associated with acute bronchitis is more likely to subside within 7 days when treated with albuterol than with an antibiotic. This study examines the effectiveness of aerosolized albuterol for the treatment of acute bronchitis in patients treated with erythromycin or placebo.

Methods:

A double-blind, randomized placebo-controlled trial of albuterol delivered by metered-dose inhaler (MDI) was conducted in a primary care setting with healthy adult patients who presented with a productive cough of fewer than 30 days’ duration. In addition to randomization for albuterol, patients were also randomized to receive erythromycin or placebo. Outcomes were assessed at follow-up after 7 days.

Results:

Patients treated with albuterol MDI were less likely to be coughing after 7 days of treatment than were patients using a placebo inhaler (61% still coughing vs 91%, P = .02). When analysis was stratified by cigarette smoking status and the use of erythromycin, the differences observed between albuterol MDI patients and controls persisted.

Conclusions:

Albuterol appears to reduce the likelihood that patients with acute bronchitis will be coughing after 7 days following initiation of treatment. This effect appears to be independent of cigarette smoking or the concomitant use of antibiotics.

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How it works and side effects

Albuterol, or salbutamol, is a short-acting bronchodilator that helps ease any breathing difficulties due to chronic obstructive pulmonary disease (COPD). It comes as an inhaler or nebulizer. Some side effects may occur when taking albuterol.

A bronchodilator opens the bronchi, the passages that allow air to enter the lungs. When the airways relax and open, more air can flow, making breathing easier.

Albuterol comes in two forms: nebulizers and metered-dose inhalers (MDI). Nebulizers create a mist that a person inhales through a face mask or mouthpiece over several minutes. The MDI delivers medication directly into the lungs through a fine mist when the user inhales while pressing down on the inhaler’s canister.

This article looks at albuterol for COPD, including how it works, how to use it, and its potential side effects.

The medication treats various COPD symptoms, including:

• bronchospasms, when the muscles in the lung begin to tighten and interrupt airflow
• breathing difficulties
• coughing
• wheezing

Albuterol is a selective beta2-adrenergic receptor (B2AR) agonist. This means that it only binds to B2ARs on the smooth muscles in the airways and activates them. As a result, the airway walls relax.

Albuterol is a quick-acting medication that begins working within minutes and lasts for about 4 to 6 hours.

Combining albuterol with other medications for COPD management, such as corticosteroids or long-acting beta-agonists, can provide even greater relief. A doctor will design a treatment plan according to a person’s needs.

Albuterol comes in various dosing forms and strengths. Doctors may use certain factors, such as the severity of their condition and the person’s reaction to albuterol, to help them decide how and when to use it for COPD.

Dosing

Someone with COPD can take albuterol through a nebulizer machine or MDI. Doctors determine the appropriate dose, for example:

Nebulizer

If a person experiences bronchospasms and breathing difficulties, a nebulized solution of 2.5 milligrams (mg) two or three times daily when necessary can ease symptoms quickly.

For severe bronchospasm, a person can increase the dosage from 2.5 to 5 mg every 20 minutes for three times the first hour, then 2.5 to 10 mg every 1-4 hours as necessary.

Learn more about how to use a nebulizer.

MDIs

Doctors often advise 1–2 puffs of 90 micrograms (mcg) every 4 to 6 hours with inhalers.

For severe bronchospasm, the dose can increase to 4–8 puffs of 90 mcg every 20 minutes for up to 4 hours, followed by 4–8 puffs every 1-4 hours as necessary.

A person must not exceed 12 puffs within 24 hours.

Learn more about how to use an inhaler.

Special precautions

Albuterol carries several warnings and precautions, including the risk of experiencing:

• potentially life threatening paradoxical bronchospasms, meaning it can worsen breathing or wheezing
• deterioration of asthma symptoms
• inadequate symptom control

Furthermore, doctors may advise people with certain health conditions to use alternative medications instead, such as those with:

• hypokalemia, or low potassium levels
• heart disease
• overactive thyroid
• diabetes
• seizures

Additionally, a person should not take albuterol during pregnancy and while chestfeeding unless necessary. Pregnant people should only use albuterol if the potential benefits outweigh the risks.

The most common side effects of albuterol are jitteriness, tremors, and nervousness. These issues happen primarily in children aged 2 to 6 years but can occur at any age.

Tremors occur because of the activation of the B2ARs and affect around 1 in 5 people.

About 1 in 10 individuals experience insomnia or nausea. Less commonly, individuals may experience the following:

• fever
• vomiting
• headache
• dizziness
• cough
• nosebleeds
• swollen lymph nodes
• allergic reactions

Albuterol may also increase blood pressure and can cause hypokalemia.

Doctors may also recommend albuterol to treat asthma, bronchitis, and other breathing problems. It also has uses in emergencies for those with severe asthma or COPD attacks.

Doctors may even recommend albuterol for breathing difficulties during exercise.

Additionally, albuterol has off-label use as a treatment for hyperkalemia, which refers to high potassium levels in the blood. However, a person should not use it as the sole therapy for this condition. Doctors should only recommend its use after attempting to treat the condition by other means first.

Learn more about off-label drug use.

Albuterol is a bronchodilator that helps relax the airways to make breathing easier. Doctors use it to treat COPD, asthma, and other breathing issues. A person takes albuterol through an inhaler or nebulizer.

Common side effects of this medication include jitteriness, tremors, and nervousness. It may also cause insomnia or nausea.

People with certain health conditions or during pregnancy should not take albuterol unless necessary. As with any medication, individuals should discuss the risks and benefits of using albuterol with a doctor, who can recommend the best course of action.

causes, symptoms and treatments

Contents

• 1 Acute bronchiolitis: symptoms, treatment and causes
  • 1.1 Acute bronchiolitis: causes, symptoms and treatments
    • 1. 1.1 What is acute bronchiolitis?
  • 1.2 Acute bronchiolitis: causes, symptoms and treatments
    • 1.2.1 What are the causes of acute bronchiolitis?
  • 1.3 How is acute bronchiolitis transmitted?
  • 1.4 Who is at risk for acute bronchiolitis?
  • 1.5 Symptoms of acute bronchiolitis
  • 1.6 Diagnosis of acute bronchiolitis
  • 1.7 Treatment of acute bronchiolitis
    • 1.7.1 Pharmacotherapy
    • 1.7.2 Antibiotics
    • 1.7.3 Oxygen therapy
    • 1.7.4 Supportive methods
  • 1.8 Which drugs help with acute bronchiolitis?
  • 1.9 What methods help relieve acute bronchiolitis?
  • 1.10 Complications of acute bronchiolitis
  • 1.11 How can acute bronchiolitis be prevented?
  • 1.12 Related videos:
  • 1.13 Q&A:
    • • 1.13.0.1 What is acute bronchiolitis?
      • 1.13.0.2 How can acute bronchiolitis be suspected?
      • 1.13.0. 3 How is acute bronchiolitis treated?
      • 1.13.0.4 Can acute bronchiolitis be prevented?
      • 1.13.0.5 How long does acute bronchiolitis last?
      • 1.13.0.6 What precautions should be taken when treating acute bronchiolitis in children?

Acute bronchiolitis is a respiratory disease that most commonly affects children under 2 years of age. An article about the symptoms, causes and treatment of acute bronchiolitis.

Bronchiolitis is an upper respiratory disease that most often affects young children. Many parents worry about the health of their children during SARS and similar diseases. Acute bronchiolitis usually begins with its characteristic symptoms: runny nose, cough, and fever. However, if left untreated, this disease can lead to serious consequences, including problems with the health of the lungs and respiratory system.

In this article, we look at the causes of acute bronchiolitis, as well as its symptoms, diagnosis, and treatment. Learn how to reduce your chances of contracting the disease and how to seek medical attention if you or your child already has symptoms.

In addition, we will analyze which methods of treatment are most effective for bronchiolitis, which medications can be used to alleviate the condition and timely cure, as well as which preventive methods are used to reduce the likelihood of the onset of the disease.

Acute bronchiolitis: causes, symptoms and treatments

What is acute bronchiolitis?

Acute bronchiolitis is a common respiratory disease that often occurs in young children. It causes inflammation of small bronchial tubes called bronchioles.

The illness begins with a runny nose, cough, followed by redness of the mouth, wheezing, fever, and rapid heartbeat. Individual characteristics of the disease depend on the presence of concomitant diseases and age characteristics.

Acute bronchiolitis can lead to breathing difficulties, eating disorders, dehydration and other dangerous complications. Therefore, it is very important to consult a doctor as soon as the first symptoms appear.

• Acute bronchiolitis is a common disease that often occurs in children.
• Inflammation of the bronchioles is the main symptom of bronchiolitis.
• Causing factors are viruses and other infections.
• Symptoms – runny nose, cough, redness of the mouth, wheezing, increased body temperature and rapid heartbeat.
• Complications – respiratory problems, eating disorders, dehydration and other problems.

Acute bronchiolitis: causes, symptoms and treatments

What are the causes of acute bronchiolitis?

Acute bronchiolitis is inflammation of the bronchial tubes that carry air to the lungs. This disease is often observed in children, especially preschoolers, but also occurs in adults. It is caused by viruses that enter the body through drops of saliva exhaled when coughing and sneezing, as well as through contact with objects that have been infected with viruses.

Other causes may include:

1. an allergic reaction to dust, lint or other allergens;
2. long history of smoking or exposure to tobacco smoke;
3. gastroesophageal reflux;
4. possible exposure to polluted air or radiation zone;
5. active use of alcohol and drugs.

Acute bronchiolitis can also occur as a result of long-term exposure to stress, insufficient sleep and unbalanced diet. If there are risk factors, it is recommended to visit a doctor and prevent the disease.

How is acute bronchiolitis transmitted?

Acute bronchiolitis is an infectious disease that causes inflammation of the bronchioles, the small tubes that carry air to the lungs. Transmission of the disease occurs through contact with an infected person or animal.

The viruses that cause bronchiolitis are airborne. This means they can be spread when an infected person coughs or sneezes. In addition, they can be transmitted through kissing, contact with hands, contaminated things and surfaces.

The viruses that cause bronchiolitis can also be transmitted from animals such as rodents and kids. In this case, transmission may occur through contact with animal excretions or contact with contaminated surfaces.

The risk of contracting bronchiolitis is increased in children under 2 years of age, in immunocompromised people and in people living in closed communities.

One of the best ways to protect against bronchiolitis is to practice good hygiene, such as washing your hands regularly, avoiding contact with infected people and animals, keeping rooms well ventilated, and wearing masks during outbreaks.

Who is at risk for acute bronchiolitis?

Acute bronchiolitis is a disease that mainly affects children aged 3 months to 2-3 years. However, this does not exclude the possibility of getting sick in adults.

Factors that may increase the risk of developing acute bronchiolitis include:

• Viruses. Acute bronchiolitis can develop due to viral infections such as respiratory syncytial infection, adenovirus infection, influenza and others
• Immune system disorder. People with impaired immune systems, including those who are immunocompromised, may have acute bronchiolitis more often than others.
• Smoking. Smoking is a risk factor in many diseases, including acute bronchiolitis. Smokers suffer from acute bronchiolitis more often than non-smokers
• Heredity. Heredity may play a role in the development of acute bronchiolitis, in particular if you were born with an abnormality in the structure of the lungs or have relatives with similar abnormalities

You should also pay attention to the environment. Children living in poor environmental conditions may develop acute bronchiolitis more often than other children. In addition, contact with infected children may increase the risk of illness.

Symptoms of acute bronchiolitis

Acute bronchiolitis is manifested by a number of characteristic symptoms. The most common symptoms of acute bronchiolitis are cough, shortness of breath and shortness of breath.

More severe cases may be accompanied by severe chest pain, life-threatening oxygen deficiency, elevated heart rate, and precancerous conditions.

In children under 2 years of age, acute bronchitis can be manifested by an increase in body temperature (up to 38 degrees), decreased appetite and increased irritability, as well as disturbed sleep and general condition.

• Dry cough
• Shortness of breath
• Shortness of breath
• Chest pain
• Increased heart rate
• Fever in children under 2 years of age

9001 1

Diagnosis of acute bronchiolitis

Acute bronchiolitis is a disease that can lead to serious consequences, so correct diagnosis is extremely important.

History and examination of the patient. The specialist should perform a detailed complete blood and urine test, and examine the chest for wheezing, which may suggest bronchiolitis.

Functional studies. These measurements, such as measures of lung volume and forced expiratory volume, help the clinician understand how severely the patient’s airway is affected.

Bronchoscopy. This is a procedure in which the doctor uses a special instrument to look at the lungs and bronchial tubes. This can help determine if there are any obstructions in the bronchi.

Immunodiagnostics. This is a special test that can help detect the presence of the virus that causes bronchiolitis. It can also be used to rule out other possible causes of discomfort.

This whole complex test must be carried out by a specialist in order to accurately diagnose acute bronchiolitis and prescribe the correct treatment.

Treatment of acute bronchiolitis

Pharmacotherapy

Standard treatment for acute bronchiolitis includes the use of bronchodilators and glucocorticosteroids. Bronchodilators widen the airways, reducing air retention. Glucocorticosteroids can reduce inflammation in the airways and slow the progression of the disease. Inhalation forms are usually preferred during the first 24 hours of patient management.

Antibiotics

In case of acute bronchiolitis caused by a bacterial infection, antibiotics may be prescribed. However, they are not usually required for pneumonia and viral infections. Antibiotics may also be given if co-infections such as pneumonia are suspected.

Oxygen therapy

In acute bronchiolitis, breathing problems may occur due to narrowing of the airways. In such cases, oxygen supply procedures for several days may seem to be necessary to ensure sufficient levels of oxygen in the body.

Maintenance methods

In acute bronchiolitis, it is especially important to maintain good bronchial hygiene, especially in patients under 6 months of age, in whom the disease may be more severe. This can be done with the help of the lung drainage position, chest massage and the use of special devices to improve respiratory functions.

Which drugs help with acute bronchiolitis?

Acute bronchiolitis is a disease that can greatly complicate the course of the respiratory processes. To avoid serious consequences, treatment must be started immediately. The following are the most effective medications that are used for acute bronchiolitis:

• Bronchodilators . Drugs that dilate the bronchi and help improve respiratory function. For example, salibutamol, albuterol, berotek, etc.
• Glucocorticosteroids . Medications that reduce inflammation in the airways. They are used in cases where bronchiolitis is accompanied by severe edema. For example, prednisone, dexamethasone, etc.
• Antibiotics . They are prescribed when a bacterial infection has joined. This takes into account the sensitivity of microorganisms to antibiotics. For example, azithromycin, amoxicillin, cefuriaxime, etc.

Drugs are prescribed only by a doctor after diagnosis and determination of the cause of the disease. Self-medication can be dangerous and lead to serious complications.

What methods help relieve acute bronchiolitis?

Acute bronchiolitis is a condition in which the airways become severely inflamed, resulting in narrowed airways and difficulty breathing. Experts identify several methods that help alleviate the condition in acute bronchiolitis.

• Inhalation is one of the most effective ways. They are carried out using a special sprayer (nebulizer), which helps to deliver drugs directly to the lungs. Inhalations allow you to make the treatment more effective and less impact on other organs.
• Drug Therapy – Doctors usually prescribe mucolytics and bronchodilators to help loosen and moisten sputum and widen the airways. In addition, antibacterial or antiviral drugs may be prescribed if the disease is caused by an infection.
• Physical activity restriction – Treatment of acute bronchiolitis often includes a period of rest and restriction of physical activity to reduce lung strain and make breathing easier. It is important to remember that this is a temporary measure and after recovery, you need to gradually return to normal life activities.

In any case, in the acute form of bronchiolitis, it is required to be observed by a doctor and strictly follow his recommendations for the treatment and prevention of the disease.

Complications of acute bronchiolitis

Acute bronchiolitis can lead to various complications. One of the most serious complications is the development of pneumonia.

Pneumonia can occur when a virus or bacteria invades deeper into the lungs, causing inflammation and dysfunction of the respiratory system.

If you notice a worsening of your acute bronchiolitis, you should contact your doctor immediately. Timely treatment will help to avoid serious complications and achieve full recovery.

How to prevent acute bronchiolitis?

Acute bronchiolitis is an infectious disease that often affects young children. To prevent this disease, a number of measures must be observed.

• Avoid contact with sick people . Close contact with sick people should be avoided, especially if they are coughing or sneezing.
• Wash your hands frequently . Washing your hands regularly throughout the day will help prevent infection.
• Practice respiratory hygiene . Flush your nose and throat with saline solutions, especially after being in public places.
• Avoid dust and smoke . Acute bronchiolitis can be caused by dust and smoke, so contact with these substances should be avoided.
• Vaccinate your children . Children, especially those who often suffer from respiratory diseases, are recommended to be vaccinated against influenza and pneumococcal infection.

Knowing the causes and actions that can help prevent acute bronchiolitis will help keep you healthy and prevent illness.

Related videos:

Q&A:

What is acute bronchiolitis?

Acute bronchiolitis is an inflammation of the small bronchi that usually affects young children, especially those aged 3 months to 2 years. Acute bronchiolitis can be caused by a variety of viruses, including influenza and RSV.

How can acute bronchiolitis be suspected?

Some of the most common symptoms of acute bronchiolitis are cough, shortness of breath, noisy breathing, fever, and weakness. With these symptoms, you need to see a doctor to make an accurate diagnosis.

How is acute bronchiolitis treated?

Treatment for acute bronchiolitis may include medication to reduce inflammation and cough, oxygen therapy, inhalation of high oxygen air, and antibiotics to prevent bacterial infection. In cases with the most severe symptoms, hospitalization may be required.

Can acute bronchiolitis be prevented?

Although there is no way to completely prevent acute bronchiolitis, there are a number of things you can do to reduce your risk of developing it, such as washing your hands frequently, avoiding contact with people who are sick, and keeping the room well ventilated.

How long does acute bronchiolitis last?

The duration of acute bronchiolitis depends on the individual patient and the severity of the disease, but it usually lasts from several days to several weeks. It is necessary to follow the doctor’s prescriptions and not postpone them at your own discretion.

What precautions should be taken when treating acute bronchiolitis in children?

Seek medical attention at the first signs of illness, monitor the child’s condition and attend a non-medical appointment for examination and control of the disease, and follow all recommendations. To prevent the spread of the disease, separate the child’s personal hygiene items, such as towels, and avoid touching the child’s face unless hands have been washed.

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2020

№4-2020

Our experience of using Apokvel in the treatment of chronic cough in cats

Therapy

Author: Kupriyanova LI, Ph. D., veterinarian, dermatologist, endocrinologist, head of the therapy department, SVK “Astin”. Bagrintseva E. G., veterinarian, cytologist, head of the therapy department, SVK “Astin”. Myachina A. V., veterinarian, leading specialist of the department of visual diagnostics, SVK “Astin”.

Bronchial disease in cats is associated with airway inflammation (either eosinophilic or neutrophilic), uncomplicated by infections and invasions, and results in excessive mucus production, epithelial hyperplasia, and airway smooth muscle contraction in the asthmatic form. Over time, inflammation changes the airways, leading to bronchial constriction and obstruction, and cough or respiratory distress syndrome occurs. The hallmark symptom of asthma is respiratory distress syndrome associated with bronchospasm ¹ . The etiological factors of the disease have not been fully elucidated, so it is believed that one of the factors is sensitization to an antigen or allergen. In a 2007 study, serum and skin allergy tests in cats with chronic cough showed sensitivity to more allergens than in cats without this symptom ² .
Asthma is an example of a type I hypersensitivity reaction. Dendritic cells (phagocytes) in the bronchial epithelium encounter an inhaled antigen, then the cells migrate to the regional lymphoid tissue and present the antigen to a naive T-lymphocyte, which further differentiates into Th3, responsible for stimulating the humoral immune response, and induces B-cells to switch to the production of IgE . The sensitization effect is the concentration of a large number of antigen-specific IgE antibodies that can be detected in the bloodstream and, more importantly, bind to Fcε receptors on the surface of circulating basophils and tissue mast cells, important participants in hypersensitivity reactions. One of the key mediators of pruritus is IL-31 secreted by Th3 and mast cells. Also important in the late phase of the process is the active involvement of eosinophils and macrophages. In particular, the presence of eosinophils is regarded as a hallmark of type I hypersensitivity ³ .
Cats from 2 to 8 years old suffer from chronic bronchitis and asthma, and asthma is more common in representatives of the Siamese breed ⁴ . Clinical symptoms are manifested in the form of a cough or respiratory distress syndrome, which can be observed both throughout the year and seasonally. Cough dry, with paroxysmal attacks, occurring from once a day to periodic attacks several times a week or a month. Symptoms may worsen over time ⁵ . Clinical examination often reveals an increase in the tracheal reflex, harsh breathing, and expiratory wheezing. On x-ray diagnosis, signs of thickening of the bronchial walls are found, usually described as “doughnuts” and “tram lines”. Also, atelectasis can be detected, more often in the right middle lobe of the lung ⁶ . X-rays are not considered the gold standard for diagnosing chronic bronchitis in cats because changes are often non-specific or absent.
For a more complete diagnosis, bronchoscopy is performed with further cytological and bacteriological studies of bronchoalveolar lavage.
Asthma in cats can either resolve spontaneously or become a disease requiring lifelong management. International recommendations usually include drugs from the group of glucocorticosteroids (local or systemic), as well as bronchodilators (systemic or local)1,4.

Materials and methods

The studies were carried out on the basis of the network of veterinary clinics “Astin”, in which 15 cats of various breeds took part (Table 1) aged from 3 to 7 years. All cats had symptoms of chronic dry cough that worsened over time, which was the reason for the visit. At the time of the initial intake, according to the anamnesis, all cats that were included in the experiment coughed at least 1 time per day (coughing attack lasted from 1 to 5 minutes).
Table 1.

The conditions for selecting cats for research were:

• housing without going outside;
• annual vaccination;
• industrial power type;
• no signs of respiratory infection at an early age.

The following standard protocol for diagnosing chronic cough was applied to all study participants:

• Screening for the presence of respiratory infections (namely: bordetellosis, chlamydia, herpesvirus type 1 infection, calicivirus) using the PCR method. The study was carried out jointly with the laboratory “Zaitsev +”, Moscow.
• Clinical blood analysis was performed using an automatic hematology analyzer “VetScan HM5” company Abaxis.
• X-ray examination of the chest (ventrodorsal, right and left lateral projections) was performed using the Examion Maxivet DR apparatus.
• Deworming to rule out parasitic pneumonia was carried out using Profender (twice with an interval of 10 days).
• EchoCG was done to exclude cardiopathologies and to reduce the risks of anesthesia.
• Bronchoscopy with bronchoalveolar lavage, its subsequent cytological evaluation and bacteriological culture was performed using a Karl Storz bronchoscope according to the standard technique. The endotracheal method was used for sampling. The tube was pretreated with a bronchodilator (albuterol) ⁷ . During the study, the patient was placed in a position on the chest or on the side. The bronchoscope was inserted through an endotracheal tube, thus minimizing contact with the oropharynx. Fluid administration (0.9% sodium chloride solution in a volume of 5 ml/animal) was carried out under visual control of a bronchoscope. No more than three aliquots of liquid were used per animal ⁹ . Then the samples were placed in a test tube with K3-EDTA for cytological examination and on a transport medium for bacteriological seeding.
• Cytological examination of the fluid sediment obtained after lavage and centrifugation was performed using a Hospitex Microscreen microscope (20x eyepiece and objectives with magnifications of 20, 40 and 100), staining of preparations was performed according to Romanovsky.
• Bacteriological examination was carried out in a third-party Pasteur laboratory.

Test results:

• Negative PCR results for viral infections in all cats.
• Two out of fifteen cats had eosinophilia in their blood.
• X-rays in 12 of 15 cats had changes indirectly confirming the presence of asthma: displacement of the caudal border of the lungs, flattening of the dome of the diaphragm. Mixed pattern of the lungs: interstitial and bronchial patterns with a predominance of bronchial (Fig. 1, 2), three cats in the study showed no changes.
• Echocardiography in all cats showed no pathological changes.
• In 100% of cats, bronchoscopy revealed thick mucus in the bronchi and hyperemia. Bacteriological cultures in all cats were negative, or microflora grew from the enrichment medium in an amount not exceeding 1*102 CFU, which, according to the latest data, is not a pathology. A bronchoalveolar lavage study showed the presence of eosinophilic inflammation (Figures 3, 4) with a slight neutrophilic component in all 15 cats. At the same time, the number of eosinophils averaged 73.5% in relation to the rest of the cells. There were no signs of an infectious or neoplastic process. In 50% of cats, Kurshman’s spirals were found, indirectly confirming the presence of obstructive changes in the bronchi.

Fig. 1. Left lateral view of the chest in a cat with chronic cough. The predominance of the bronchial pattern.

Fig. 2. Right lateral view of the chest in a cat with chronic cough. The predominance of the bronchial pattern, thickening of the walls of the bronchi (“doughnuts”).

Fig. 3, 4. BAL cytology. Kurshman spiral and eosinophilic inflammation.

Based on the data obtained during the studies, the clinical diagnosis of asthma/chronic bronchitis was made due to the fact that it is often impossible to differentiate between these two conditions. Since eosinophilic inflammation was detected in the cytological study of BAL in all cats, the authors of the article suggested that in addition to classical drugs for the control of chronic cough (systemic or inhaled corticosteroids, bronchodilators), these animals should be helped by oclacitinib (trade name “Apoquel”, the company “Zoetis » [Zoetis]) based on its selective action on JAK1 and JAK3. The essence of the action of the drug is to inhibit the function of pro-inflammatory and pro-allergic cytokines, which play a leading role in the development of chronic bronchitis in cats, with a minimal effect on JAK2, which is involved in the function of hematopoiesis.
The doses selected for initial therapy were those described in several articles on controlling pruritus in cats with the same drug (they range from 0.8 to 1.2 mg/kg, i.e. twice as high as in dogs)8. The authors of the article decided to settle on an average value of 1 mg/kg or slightly less, especially since the weight of all cats in the experiment was from 3.5 to 4 kg. Oclacitinib was given as monotherapy at 3.6 mg twice daily for 14 days, followed by a switch to once daily and possibly every other day. 14 days after the start of the drug, it was planned to repeat the clinical blood test and the bronchoalveolar lavage procedure to assess the dynamics of therapy.
After the appointment of oclacitinib, the manifestations of cough in all cats from the experimental group gradually became less frequent and, on average, completely disappeared by the tenth day of taking the drug.
The expected side effects such as vomiting, diarrhoea, polyuria/polydipsia and apathy were not observed in any cat. The owners also noted no difficulties in giving the drug. Fourteen days after starting oclacitinib, only one cat developed absolute leukopenia, which resolved spontaneously after switching to once-daily tablets.
In none of the cats, repeated bronchoalveolar lavage cytology revealed signs of eosinophilic inflammation (the number of eosinophils did not exceed 10% of the total cells), therefore, it can be logically concluded that, compared with traditional methods of treatment, the use of oclacitinib in mono mode is a more desirable alternative. .
When switching to once-daily oclacitinib, two cats experienced a relapse of cough, so it became necessary to resume the 2-time regimen of the drug with a dosage reduced to 0.8 mg/kg and subsequent monitoring of clinical blood tests. 10 cats managed to be transferred to taking the drug once a day at a dose of 1 mg/kg, three – to a dose every other day at a dose of 0. 8 mg/kg.

Talk

Of course, the problem of diagnosing chronic cough in cats at this stage in the development of veterinary medicine has not been fully resolved. In this study, we relied on an integrated approach that included the exclusion of infectious, parasitic and cardiogenic causes of cough, as well as the detection of predominantly eosinophilic inflammation in bronchoalveolar lavage. Classical guidelines for the treatment of chronic bronchitis in cats describe mainly topical and/or systemic glucocorticosteroid hormones, as well as topical and systemic bronchodilators. Based on the fact that long-term glucocorticosteroid therapy can have a number of significant side effects (primarily iatrogenic hyperadrenocorticism, diabetes mellitus, acute pancreatitis, an increased risk of urinary tract infections, and the difficulty of conducting local therapy in cats), we proposed an alternative option – oclacitinib as monotherapy.
A positive response to treatment in all patients from the experimental group gives encouraging results for further research in this area. Of course, statistics on long-term results and complications are required, however, during the observation period that was included in the studies (1 month), we did not find any side effects or ineffectiveness of the drug. Some of the patients who participated in the studies are observed for more than a year without worsening of the condition and the development of side effects. It is also important to take into account the fact that the cats described in the article were diagnosed to the maximum, and this is far from always possible in everyday practice. The absence of a definitive diagnosis suggests that the proposed drug will not be adequately effective when used in mono mode.
Conflict of Interest: The authors declare that Zoetis was in no way involved in the conduct of this study or in the publication of its results.

Literature:

1. Lynelle R. Johnson Canine and Feline Respiratory Medicine Second Edition, 126–129, 2020.
2. Moriello K. A., Stepien R. L., Henik R. A., Wenholz L. J. Pilot study: prevalence of positive aeroallergen reactions in 10 cats with small-airway disease without concurrent skin disease. Vet. Dermatol, 2007.
3. Michael J. Day, Ronald D. Schultz. Veterinary Immunology – Principles and Practice. 2nd Edition, 141–142, 2014.
4. Gary D. Norsworthy. The Feline Patient, 5th Edition, chapter 27, 2018.
5. Grobman M., Graham A., Outi H., Dodam J., Reinero C. Chronic neurokinin-1 receptor antagonism fails to ameliorate clinical signs, airway hyper-responsiveness or airway eosinophilia in an experimental model of feline asthma. J Fel Med Surg, 18(4): 273–279, 2015.
6. Dear J., Johnson L. Lower respiratory tract endoscopy in the cat: Diagnostic approach to bronchial disease. J Fel Med Surg, 15(11): 1019–1027, 2013.
7. Venema C., Patterson C. Feline Asthma: What’s new and where might clinical practice be heading? J Fel Med Surg, 12: 681–692, 2010.
8. Natalia Lôres Lopes , Diefrey Ribeiro Campos and others. A Blinded, Randomized, Placebo-Controlled Trial of the Safety of Oclacitinib in Cats. BMC Vet Res, 8:15(1):137, May 2019.
9. Johnson L. R., Drazenovich T. L. Flexible bronchoscopy and bronchoalveolar lavage in 68 cats (2001–2006). J Vet Intern Med, 21: 219–225, 2007.


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