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Focus Chlamydia Pneumoniae And Macrolides

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Focus Chlamydia Pneumoniae And Macrolides

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Discuss About The Focus Chlamydia Pneumoniae And Macrolides.

Answer:

Introduction:
Asthma is a well-known and highly prevalent chronic lung disease that is caused due to narrowing and inflammation of airways (Webley and Hahn 2017). This is caused by common respiratory viruses like rhinoviruses and lead to exacerbation of asthma in both children and adults (Bochkov et al. 2015). In this condition the airway produce more mucus that make difficulty in breathing and as a result gasping, tightness of chest, shortness of breath and coughing is triggered. Salbutamol is an antagonist of beta2-adrenergic receptor and are used as a bronchodilator in asthma treatment (Billington, Penn and Hall 2016). Delivery of Salbutamol via inhalation requires the administration of smaller doses and with smaller doses rapid onset of the action of the drug is observed. In the given case study a 10 years old child is suffering from Asthma and is admitted to hospital for the diagnosis of exacerbation of asthma secondary to bronchitis. Doctor has prescribed the patient Salbutamol which is a bronchodilator. Delivery of this drug can be done both by a nebuliser or a operations. Various research has been conducted to study the effectiveness of nebuliser or spacer in the administration of the drug to children who are suffering from asthma. This essay will highlight various research based evidences on the effectiveness of these two different routes of drug administration.
Discussion:
A spacer is a device used by the patient suffering from asthma and are known to deliver aerosolized medication with an ease from a metered dose inhaler (MDI). This is made up of plastic and its shape resembles a tube or a football. Whereas, a nebuliser is a machine that is used to convert liquid state of medicine to a fine mist form that enable the patient to inhale. Both nebulizer and inhalers with a spacer are used in the treatment of asthma in children. Many research based evidences suggest that both spacer and nebulizers are equally effective for the treatment of asthma to the children. In many randomised controlled clinical trials many outcomes are considered to draw a result. These parameters are rate of hospital admission, severity score of asthma and the score of pulmonary functions.
A randomised clinical trial was conducted in a paediatric emergency department to compare the clinical effect of the treatment by using two different methods. Researchers used nebulizers with metered dose inhalers and spacers to evaluate the effectiveness. The result that they obtained was that there are similar rate of hospitalization of patient and device acceptance rates among parents. Moreover any significant differences were absent in parameters like respiratory rate, heart rate and oxygen saturation rate after the treatment (Mitselou, Hedlin and Hederos 2016). Another research was conducted to study the efficacy of salbutamol administration via jet nebulizer and home-made non-valved spacer (HM NVS) in children suffering from acute exacerbation of asthma. Patient were enrolled in a randomised pattern and each patient were given three doses of the drug salbutamol in either of the two ways, that is, either through HM NVS or via jet nebulizers. Analysis were done on the basis of wheeze heart rate, saturation level of Oxygen and rate of respiration. These data were recorded throughout the treatment period. As compared to the baseline, the improvement in result has been noticed at the end of the treatment. However, no significant differences in parameters were observed between two groups that is between groups who are receiving treatments via jet nebulisers and groups that was dependent on HM NVS. Both delivery processes were equally effective (Yasmin et al. 2012).
Another research evidence also suggested that the use of spacers in delivering beta 2 antagonist to children is as effective as nebulizers (Leo and Song 2017). One study was conducted in paediatric wards to implement the replacement of the use nebulizers by spacers for the treatment of children suffering from asthma. Their objective was the implementation of this new policy for improving the treatment of asthma. They selected children those who are admitted for the necessary treatment of asthma. They also trained nursing staff to use metered dose inhalers attached with spacers regularly. Nebulizers were replaced at a preset date and the effect of the change was measured by supervising physicians. They administered Salbutamol via metered dose inhaler that is attached to spacer device at a particular dose. For 3 years due to change in policy up to 92.5%, patients were administered with spacer throughout their staying period in hospital. The outcome and the cost analysis were recorded after two years of treatment. A reduction in cost was observed with an estimation of 63%. So this study concluded that treatment of asthma using spacer is feasible and replacement of nebulizer can be done (Breuer et al. 2015). Another study compared the use of nebulizer and do-it-yourself (DIY) spacer in children to see the response of treatment. Children between 1-15 years of age were enrolled in the study those who were hospitalized for asthmatic attack. They were divided into two groups, one of the group is administered with beta 2 antagonist via nebulizer while the other receive the drug via spacer. Data were recorded at 24 hours intervals for two days from the time of admission. Parameters that were measured were vital signs, saturation level of oxygen (oximetry) and asthma scores. No considerable differences in parameters in the effectiveness of this drug between two groups were observed. However a significant difference in side effects were observed between two groups. Group using DIY spacer was suffering from less tachycardia and agitation.
One more study was conducted whose objective was to compare the effectiveness of Salbutamol, a beta 2 antagonist, delivery via nebulizers and metered-dose inhalers with spacers in children. This was a single blinded randomised trial conducted in Chile. This study also showed that administration of beta 2 antagonists by spacer is as effective as nebulizers (Rubinstein et al. 2016). Similar research was conducted in tertiary care government hospital to compare the efficacy of nebulizers and metered dose inhalers in children suffering from moderate asthma exacerbation. Both groups were given some dosage of salbutamol and after the therapy it was observed that MDI spacers were equally effective as nebulizers for the delivery of the drug. In developing countries, due to some noticeable advantages in economic are power requirement, utilization of spacers are much preferred as compared to the usage of nebulizer (Samuel et al. 2015).

Conclusion:
From the above discussion this can be concluded that for the treatment of asthma in children, drug can be delivered either by nebulizers or via spacers. Several research suggested that the effectiveness of both spacers and nebulizer are significantly similar for the treatment of paediatric asthma. This essay highlighted many findings of recent research that proposed that the parameters like respiratory rate, oxygen saturation level and asthma severity rate almost remain same in both cases. Though some research pointed out few side effects of nebulizers like high cost, more agitation and tachycardia as compared to spacers, yet in terms of their efficacy, both can be placed together, as mentioned before.

References:
Billington, C.K., Penn, R.B. and Hall, I.P., 2016. β 2 Agonists. In Pharmacology and Therapeutics of Asthma and COPD (pp. 23-40). Springer, Cham.
Bochkov, Y.A., Watters, K., Ashraf, S., Griggs, T.F., Devries, M.K., Jackson, D.J., Palmenberg, A.C. and Gern, economics., 2015. Cadherin-related family member 3, a childhood asthma susceptibility gene product, mediates rhinovirus C binding and replication. Proceedings of the National Academy of Sciences, 112(17), pp.5485-5490.
Breuer, O., Shoseyov, D., Kerem, E. and Brooks, R., 2015. Implementation of a Policy Change: Replacement of Nebulizers by Spacers for the Treatment of Asthma in Children. The Israel Medical Association journal: IMAJ, 17(7), pp.421-424.
Leo, H.L. and Song, B.J., 2017. Spacers Versus Nebulizers in Treatment of Acute Asthma-A Prospective Randomized Study in Preschool Children. Pediatrics, 140(Supplement 3), pp.S218-S218.
Mitselou, N., Hedlin, G. and Hederos, C.A., 2016. Spacers versus nebulizers in treatment of acute asthma–a prospective randomized study in preschool children. Journal of Asthma, 53(10), pp.1059-1062.
Prieto, M., Rucker, A.C. and Payne, A.S., 2018. Increasing Metered Dose Inhaler Use For Acute Asthma Exacerbations In The Pediatric Emergency Department: A Quality Improvement Challenge. Clinical Pediatric Emergency Medicine.
Rubinstein, M., Nelson, B.A., Rubilar, L., CastroRodriguez, J.A. and Girardi, G., 2016. ROUTE OF DELIVERY OF BETA-AGONIST THERAPY. Pediatric Evidence: The Practice-Changing Studies, p.90.
Samuel, J., Johns George, B. and Betty Carla, S.R., 2015. NEBULIZERS VS METERED DOSE INHALERS IN MILD TO MODERATE ASTHMA EXACERBATIONS IN CHILDREN. International Journal of Pharmaceutical, Chemical & Biological Sciences, 5(1).
Webley, W.C. and Hahn, D.L., 2017. Infection-mediated asthma: etiology, mechanisms and treatment options, with focus on Chlamydia pneumoniae and macrolides. Respiratory research, 18(1), p.98.
Yasmin, S., Mollah, A.H., Basak, R., Islam, K.T. and Chowdhury, Y.S., 2012. Efficacy of salbutamol by nebulizer versus metered dose inhaler with home-made non-valved spacer in acute exacerbation of childhood asthma. Mymensingh medical journal: MMJ, 21(1), pp.66-71.

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