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To collect the existing information on tiotropium as an add-on treatment for asthma in children and adolescents. The use of tiotropium bromide in children between 1 and 6 years old. Asthma is a disease that can be difficult to control. For the treatment of this, there is a combination of medications, but often complete control of the disease is not achieved. The addition of tiotropium, a long-acting muscarinic antagonist, to treatment with inhaled corticosteroids has been recommended to improve lung function in adults and adolescents who have uncontrolled asthma. Here we present a review of the eight clinical trials that show the use of tiotropium in pediatric patients with asthma. The results demonstrate efficacy in improving lung function (evaluated with different parameters), in both children and adolescents; it also shows the safety of the drug in short and long-term uses.

Background. IgE sensitization (atopy) to pets is commonly evaluated using pet dander extracts. However, the diagnosis by components seems to be more adequate to evaluate the clinical relevance (allergy) of sIgE sensitization.Objective. To study the association between IgE sensitization to pet allergen components and clinical symptoms.Methodology. Dander extracts and sIgE levels to pet components (Can f 1, Can f 2, Can f 3, Can f 5, Fel d 1, Fel 2, and Fel 4) were measured in a rhinitis group (n=101) and a control group (n=68). Nasal provocation tests with pet extract were done in patients with atopy to pets.Results. Dog (34.6% vs. 23.5%) and cat dander (26.7% vs. 8.8%,p=0.05) IgE sensitization was frequent among rhinitis and no-rhinitis subjects, and it was similar to dog (29.7% vs. 20.5%) and cat (18.8% vs. 8.8%) components. Polysensitization for dog (3.1, 95% CI: 1.5 to 6.1,p<0.001) or cat (2.5, 95% CI: 0.8 to 8.0,p=0.01) components was the principal risk factor for a positive nasal provocation test. Additionally, positive nasal provocation test with one animal increased the risk of atopy and positive nasal provocation test to others animals. Pet ownership or asthma was not associated with increased risk of atopy or positive nasal provocation test.Conclusions. Sensitization to pet dander extract identifies atopic patients, but its utility to predict clinical relevance is poor. Allergenic components could help to define the clinical relevance of sensitization to furry animals and could reduce the need for provocation test.

Objectives Nasal specific IgE (NsIgE) is the most common marker to identify type-2 inflammation in local allergic rhinitis (LAR). However, the comparison of NsIgE in different types of rhinitis, its frequency in tropical countries, and its diagnostic performance for predicting the outcome of a nasal challenge test (NCT) has had limited study. The main objective of this study was to explore the diagnostic performance of NsIgE to Dermatophagoides pteronyssinus (Der p) among different types of rhinitis and control subjects in a tropical population. Methods We evaluated the frequency of NsIgE, systemic atopy (serum sIgE and Skin Prick Test), and nasal eosinophils, and we performed nasal challenge tests (NCTs) with Der p in 3 groups of patients; rhinitis without atopy (RWoA) (n = 25), rhinitis with atopy (RWA) (n = 25), and control subjects (n = 18). Results NsIgE had a low sensitivity and specificity to predict a positive NCT in the RWoA group: 48% had NsIgE, but only 28% had a positive NCT. Among the RWA group 84% had NsIgE and 80% had a positive NCT; the association of NsIgE and positive NCT was high (>80%). In the control group 27.8% had NsIgE, but none had a positive NCT. Conclusions NsIgE performs poorly in predicting NCT results in patients with non-allergic rhinitis. More methodical investigations are needed in this complex area of rhinitis. In patients with allergic rhinitis, NsIgE was useful in predicting a positive nasal challenge, but not superior to the systemic atopic test.