Reversibility of pulmonary function after inhaling salbutamol in different doses in a standard and a forward leaning body posture in asthmatic children.

Kelderman, S. (Sophie) (2014) Reversibility of pulmonary function after inhaling salbutamol in different doses in a standard and a forward leaning body posture in asthmatic children. thesis, Medicine.

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Abstract

Background Pulmonary medication is mostly delivered in the form of inhaled aerosols to minimize systemic side-effects. A major drawback, however, is that with most delivery systems the majority of inhaled particles impacts in the oropharynx, reducing the dose reaching the lung and resulting in side-effects. This is especially true in children, as their airways are smaller. Stretching the airway by a forward leaning body posture with the neck flexed backwards (“sniffing position”) may improve pulmonary deposition and the effects on lung function. In a previous pilot study a greater forced expiratory volume in 1 s (FEV1) reversibility was observed during spirometry in asthmatic children inhaling in a forward leaning body posture compared to inhaling in the standard body posture. Methods 22 asthmatic children, 5-14 years old, were recruited from the outpatient clinic of the pediatric department of Medisch Spectrum Twente, Enschede. All children performed four times spirometric reversibility measurements within a period of two weeks. Children inhaled either 200μgr or 400μgr salbutamol with a breath actuated inhaler (BAI) in the standard or in the forward leaning body posture with the neck flexed backwards in a randomized cross-over design. Reversibility of forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), peak expiratory flow (PEF), maximum expiratory flow at 25% of forced vital capacity (MEF25) and maximum expiratory flow at 75% of forced vital capacity (MEF75) were analysed. Results No significantly different reversibility for all parameters was shown in the forward leaning body posture compared to the standard body posture after inhaling 200µgr or 400µgr salbutamol. Girls showed a significantly greater mean FEV1 reversibility (11.4% ± 11.6%) after inhaling 400μgr in the standard body posture compared to inhalation of 200μgr in the standard body posture (5.1%± 7.5%, p= 0.029, 95CI -0.118; -0.008). Boys showed a significantly greater mean FEV1 reversibility (6.8%±5.0%) after inhaling 400μgr in the forward leaning body posture compared to inhalation of 200μgr in the forward leaning body posture (2.5% ±4.8%, p=0.009, 95CI -0.070; -0.017). Also boys showed a significantly greater mean reversibility of PEF (12.6%±12.9%) after inhaling 200μgr in the standard body posture compared to inhalation of 200μgr in the forward leaning body posture (4.5% ±10.2%, p=0.016, 95CI 0.020; 0.142). Conclusion We conclude that inhaling salbutamol in a forward leaning body posture compared to a standard body posture led to a non-significant increase in reversibility of lung function in clinical stable asthmatic children. Inhalation of 400µgr compared to 200µgr salbutamol increases reversibility of lung function.

Item Type:	Thesis (Thesis)
Supervisor name:	Thio, Dr. B.J. and Visser, Drs. R. and Pediatric department and Medisch Spectrum Twente, Enschede
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:48
Last Modified:	25 Jun 2020 10:48
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/885

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