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This study was designed to determine whether infants generate sufficient inspiratory pressure gradient to open the unidirectional valve of various commercially available holding chambers, as well as the time required to reach this gradient. A prospective, cross-sectional study was performed of 80 healthy infants (aged 1-24 months) seen in the childcare outpatient clinic of a pediatric hospital, from October to December of 2007. Using the same inhalation technique recommended for treatment of respiratory diseases and asthma in this age group, four holding chambers were analyzed: Flumax Baby, AlergoChamber, LuftChamber, and ACE (n = 20 infants per analysis group). The variables measured were gradient of inspiratory pressure and time for the valve to open. The holding chambers did not differ in gradient of inspiratory pressure (p = 0.382) or time to open the valve (p = 0.199). Fifteen of 80 infants were not able to generate sufficient inspiratory pressure to open the valve (1 using AlergoChamber, 5 using Flumax Baby, 6 using ACE, and 3 using LuftChamber), with no significant differences between devices. The holding chambers were similar regarding pressure gradient and time required to open the valve. The fact that 19% of the sample was unable to open the valve suggests that it would be useful to determine the ability of small children (<24 months of age) to use holding chambers before prescribing them. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Evaluate the efficacy of adding two intravenous bolus of aminophylline to the standard treatment of acute asthma episode in children admitted to the pediatric emergency room (PER). Methods: Between March 2001 and February 2002, 60 children (2–5 years old), admitted to the PER at Hospital de Clínicas de Porto Alegre (Brazil), due to an episode of acute asthma, refractory to conventional therapy (an oral dose of steroids and at least three doses of inhaled albuterol, associated or not with oxygen) were enrolled in a randomized, double blind, placebo controlled clinical trial. The randomization was performed in blocks of 10 patients, who received a “bronchodilator solution” (either saline or aminophylline), in two doses: on arrival at the PER and again 6h later. The intervention group received aminophylline 5mg/kg/dose diluted in normal saline (NS) solution up to a 20mL volume, while the placebo group received plain NS, both in an infusion rate of 1cc/min. The main outcomes were total length of hospital stay, length of supplemental oxygen use, number of bronchodilator nebulizations and/or aerosol inhalations performed and patient destination. The groups were compared using the Students t-test, Mann–Whitney test and Chi-Square test, accepting p<0.05 as significant. Results: Comparing the main outcomes, we did not find differences between the placebo and aminophylline groups: 29.0±14.7 versus 26.2±13.4 beta-agonist nebulizations per patient (p=0.46); 2.4±10.6 versus 5.6±14.2 aerosol inhalations per patient (p=0.32); 24.7±30.0 versus 26.0±25.2h for oxygen supplement (p=0.86); 43.2±30.0 versus 43.6±23.7h for length of hospital stay (p=0.95). We also did not find differences between the two groups related to the blood pressure, heart rate, respiratory rate and oxygen saturation. Conclusion: In children aged 2–5 years admitted to a PER with asthma, two intravenous doses of 5mg/kg of aminophylline given 6h apart did not change the length of stay in hospital, the number of nebulizations given or the duration of oxygen therapy required. We are unable to tell whether there would be benefit with higher doses of aminophylline designed to give levels in the usual therapeutic range. [Copyright &y& Elsevier]