Vast that differences exist between the actions physicians report that they take and the patient's perception of those actions. Several patient satisfaction take survey results are presented in this article. Many show that although patients are not often satisfied with their treatments or their with the side effects they experience from medications, they are, in general, very satisfied with their physicians. These research studies in point out that a very real "communications gap" exists between physicians and patients when examined from the patient's perspective.

Changes and in health-related quality of life (HRQoL) were evaluated in patients with chronic obstructive pulmonary disease (COPD) following treatment with placebo,day salmeterol 50 microg twice a day or 100 microg twice a day by metered-dose inhaler. Patients completed the disease-specific St.groups George's Respiratory Questionnaire (SGRQ) and the Medical Outcomes Study Short Form 36 (SF-36) at baseline and after 16 wk of Data treatment. Data from 283 patients (95 patients in the placebo group and 94 in each salmeterol group) were available for a HRQoL analysis. Apart from a small difference in ages, all treatment groups were well matched at baseline in terms of (95 forced expiratory volume in one second (FEV1) and HRQoL scores. Compared with placebo, salmeterol 50 microg twice a day was HRQoL associated with significant improvements in SGRQ "Total" and "Impacts" scores which exceeded the threshold for a clinically significant change. This modest was not seen with salmeterol 100 microg twice a day. Changes in SGRQ and SF-36 scores correlated. They also showed (COPD) a weak but significant relationship with FEV1. This study has shown that a modest change in lung function may be a associated with clinically significant gain in health and well-being in COPD patients.

Dynamic correlation hyperinflation (DH) is a major pathophysiologic consequence of airflow limitation during exercise in patients with chronic obstructive pulmonary disease (COPD)between and an important contributing factor to breathlessness. In this study we aimed to examine the effect of inhaled beta agonist and therapy on DH during exercise in these patients and the relationship between changes in DH and breathlessness. In 13 COPD of patients (mean age 65.1 +/- 2. , FEV1 1.20 +/- .17, FEV1/FVC 40 +/- 3) we measured pulmonary function tests, exercise change breathlessness by Borg score, and exercise flow volume and pressure volume loops on two separate days. Prior to testing, patients and randomly received inhaled placebo or albuterol on the first test day and the alternative medication on the second test day.for From measurements of exercise inspiratory capacity (IC), we calculated the end-expiratory and end-inspiratory lung volumes (EELV, EILV). We used esophageal flow pressure recordings to measure peak inspiratory esophageal pressure (Pesins) during exercise and this was related to the maximal capacity for to pressure generation taking into account lung volume and airflow changes (Pcapi). Bronchodilator caused significant increase in both FEV1 and FVC (mean (+ .23 and + .51, p< .01). Comparisons of breathlessness, exercise volumes, and pressures were made at the highest equivalent work load. There Pesins was a significant reduction in the peak exercise EELV/TLC (80 +/- .02% to 76 +/- .02%, p< .05) while the peak albuterol EILV/TLC decreased by 2%(97 +/- 1% to 95 +/- 1%, p< .05). The peak Pesins/Pcapi decreased ( .79 +/- .10 to important .57 +/- .05, p< .05), and the Pcapi - Pesins increased (7.4 +/- 3 to 13. +/- 3 cm H2O, p< .05).EELV/TLC There was significant improvement in neuroventilatory coupling for volume change (Pesins/Pcapi/VT/TLC 5.45 +/- .5 to 3.25 +/- 1. , p< .05). There contributing was a significant reduction in breathlessness as measured by Borg score (4.5 +/- .7 to 3.1 +/- .5, p< .05) and FVC there was a significant correlation between delta Borg and delta EILV/TLC (r= .771, p< .01) with a trend for Pesins/Pcapi/VT/TLC (r= .544, p= .067).exercise There was also a significant correlation between delta EELV/TLC and delta Pesins/Pcapi/VT/TLC (r= .772, p< .01). The relationships between delta Borg, delta examine resting volumes, and flow rates were not significant. We conclude that in patients with COPD, inhaled bronchodilator reduces exercise DH delta and improves inspiratory pressure reserve and neuroventilatory coupling. Changes in DH and neuroventilatory coupling were the main determinants of reduced and breathlessness.

This The randomized controlled trial examined the benefits of combining an inhaled corticosteroid, fluticasone propionate (F), with an inhaled long-acting beta(2)-agonist, salmeterol bronchoconstrictive (S), to treat the inflammatory and bronchoconstrictive components of chronic obstructive pulmonary disease (COPD). A total of 691 patients with .0001). COPD received the combination of F and S (FSC), S (50 mcg), F (500 mcg), or placebo twice daily via 24 the Diskus device for 24 weeks. A significantly greater increase in predose FEV(1) at the endpoint was observed after FSC (2.1) (156 ml) compared with S (107 ml, p = .012) and placebo (-4 ml, p < .0001). A significantly greater increase increase in 2-hour postdose FEV(1) at the endpoint was observed after treatment with FSC (261 ml) compared with F (138 S ml, p < .001) and placebo (28 ml, p < .001). There were greater improvements in the Transition Dyspnea Index groups. with FSC (2.1) compared with F (1.3, p = .033), S ( .9, p < .001), and placebo ( .4, p <inhaled .0001). The incidence of adverse effects (except for an increase in oral candidiasis with FSC and F) was similar among disease the treatment groups. We conclude that FSC improved lung function and reduced the severity of dyspnea compared with individual components There and placebo.

Myopathy myopathy complicating the therapy of severe asthma has been recently described in several case reports. Twenty-five consecutive patients admitted to the studied intensive care unit (ICU) at this hospital for mechanical ventilation for severe asthma were studied for the incidence of creatine was kinase (CK) enzyme rise and for the development of clinical myopathy. Pharmacologic therapy was standardized, every patient receiving corticosteroids and patients aminophylline intravenously and salbutamol both nebulized and intravenously. Twenty-two patients received muscle relaxant therapy with vecuronium. In 19 of 25 the (76%) of patients there was elevation of CK levels to a median of 1,575 U/L (range, 66 to 7,430) occurring levels 3.6 +/- 1.5 days after admission. In nine patients there was clinically detectable myopathy. The presence of either myopathy or patients CK enzyme rise was associated with a significant prolongation of ventilation time. Arterial blood gas measurements on admission to the therefore ICU revealed a pH (mean +/- SD) of 7.07 +/- .21, a PaCO2 of 87.2 +/- 32.7, and a PaO2 care (with a high FIO2) of 129 +/- 97 mm Hg; however, no correlation was found between the severity of initial (CK) metabolic disturbance and the subsequent development of myopathy. There was no association between the type of corticosteroid administered and the mm subsequent development of myopathy. Patients with myopathy had received a significantly higher total dose of vecuronium when compared with those muscle who did not develop myopathy (p < .001, Kruskal Wallis test). We have therefore found a surprisingly high incidence of Twenty-five CK enzyme rise and myopathy in this group of mechanically ventilated patients with severe asthma.(ABSTRACT TRUNCATED AT 250 WORDS)

We was conducted a trial of inhaled salbutamol and orally administered theophylline in patients whose acute response to inhaled salbutamol was less their than 25% of their baseline FEV1. Patients underwent 4 treatment periods, each of 2 wk duration, during which they received peak the following combinations: placebo-placebo, placebo-salbutamol, placebo-theophylline, and salbutamol-theophylline. The 19 patient who completed the study were all males with a males mean age of 65 +/- 7.4 yr, mean FEV1 of 1.02 +/- .38, and mean VC of 2.73 +/- .19.as Outcomes included twice-daily recordings of peak flow rates, spirometry, the distance patients could walk in 6 min, and clinical symptoms age of dyspnea, fatigue, and emotional function. Clinically important and statistically significant differences between the 4 periods were noted on both VC physiologic and functional outcomes. For the group as a whole, improvement with inhaled salbutamol and orally administered theophylline was comparable,can and additional benefit was gained from a combination of the 2 drugs. We conclude that both inhaled salbutamol and orally response administered theophylline can improve airflow obstruction, functional exercise capacity, and quality of life in patients with primarily fixed air-flow limitation.4

Regular 2 inhaled beta 2 agonist causes tolerance to the acute protective effect of beta 2 agonist against bronchoconstriction induced by chemical clinically stimuli such as AMP, histamine, and methacholine. We examined a more clinically relevant stimulus, inhaled allergen, in a double-blind, cross-over,the random-order trial in 13 mild atopic asthmatics, who had not used beta 2 agonist for at least 4 weeks. We weeks) compared regular inhaled salbutamol (200 micrograms four times daily for 2 weeks) with placebo (2 weeks) for effects on bronchodilator baseline response, baseline methacholine, and allergen airway responsiveness, and on the acute protective effect of salbutamol against both stimuli. Baseline forced baseline expiratory volume in 1 s (FEV1), bronchodilator response, and methacholine responsiveness were the same during both treatment periods. After regular Baseline salbutamol, the allergen PC20 (provocation concentration producing a 20% FEV1 decrease) fell by .91 (SD .66)(p = .0009) doubling on doses, and the protective effects of salbutamol on methacholine and allergen were both significantly reduced (p = .026 and .025,chemical respectively). Taking into account the reduced baseline allergen PC20, the post-salbutamol allergen PC20 was almost 2 doubling doses (1.94 [1.43],a p < .01) lower during salbutamol treatment. Thus, 2 weeks of regular inhaled salbutamol increased airway responsiveness to allergen but significantly not to methacholine, and caused tolerance to the protective effect of salbutamol on bronchoconstriction induced by both stimuli. These effects micrograms of inhaled beta 2 agonist provide further evidence to support detrimental effects of their regular use.

BACKGROUND:group An inhaled glucocorticoid is currently the medication of choice for long-term control of persistent asthma in children. The role of (mean long-acting beta2-adrenergic-receptor agonists, such as salmeterol, needs to be defined. METHODS: We conducted a randomized, double-blind, placebo-controlled, parallel-group, one-year study airway of 241 children (mean [+/-SD] age, 9.3+/-2.4 years) with clinically stable asthma and less than one month of prior glucocorticoid treatment use. We compared inhaled beclomethasone dipropionate (200 microg twice daily) with salmeterol xinafoate (50 microg twice daily) and placebo (lactose).months The primary outcome measure, airway responsiveness (as assessed with a methacholine challenge) was evaluated before treatment; after 3, 6, 9,had and 12 months of treatment (12 and 36 hours after study medications had been withheld); and 2 weeks after the and end of treatment. Spirometry, symptoms, use of rescue medication (200 microg of albuterol inhaled as needed), and adverse effects were as also assessed. RESULTS: During months 1 through 12 overall, beclomethasone was associated with significantly less airway hyperresponsiveness than salmeterol (P=to .003) or placebo (P< .001). This effect was lost two weeks after treatment had been stopped. As compared with placebo, beclomethasone and was associated with less variability between morning and evening in the peak expiratory flow (P= .002), as was salmeterol (P= .02). Beclomethasone (P< .001) was also associated with a reduced need for albuterol as rescue therapy (P< .001) and fewer withdrawals because of asthma exacerbations methacholine (P= .03), but salmeterol was not (P= .09 and .55, respectively). During months 1 through 12, linear growth was 3.96 cm in of the children receiving beclomethasone, as compared with 5.40 cm in the salmeterol group (P= .004) and 5.04 cm in the placebo of group (P= .018). Height was not measured after treatment ended. CONCLUSIONS: Beclomethasone was effective in reducing airway hyperresponsiveness and in controlling of symptoms of asthma, but it was associated with decreased linear growth. Salmeterol was not as effective as beclomethasone in reducing significantly airway hyperresponsiveness or in controlling symptoms; however, it was an effective bronchodilator and was not associated with rebound airway hyperresponsiveness,parallel-group, masking of symptoms, or adverse effects.

Thirty-two the infants, aged 1 to 12 months, hospitalized with acute wheezing, were studied. They were randomly divided into four treatment groups treatments of eight patients each. The treatments were intramuscular dexamethasone or placebo (double-blind), and salbutamol (oral and inhaled), or none (open),placebo, in all four possible combinations. The study was carried out as a randomized block design with eight blocks of four matched infants each, matched by age and clinical score. Average daily improvements, as reflected by changes in the clinical score and none length of hospital stay, was essentially the same for infants treated with placebo, salbutamol alone, and dexamethasone alone. However, combined clinical salbutamol-dexamethasone treatment resulted in more than twice the rate of improvement of the other treatments. The difference was statistically highly of significant (P less than .01). Furthermore, the response of this combined treatment was observed within 24 hours; none of the responsiveness ten infants in whom there was no significant improvement within 48 hours and neither of the two patients who developed divided respiratory failure received the combined salbutamol-dexamethasone treatment. A potentiating effect of corticosteroids on the beta-adrenergic responsiveness is a possible explanation placebo for the advantage of this combined treatment in the management of acute wheezing in infancy.

OBJECTIVE--To salmeterol compare safety of salmeterol and salbutamol in treating asthma. DESIGN--Double blind, randomised clinical trial in parallel groups over 16 weeks.regular SETTING--General practices throughout the United Kingdom. SUBJECTS--25,180 patients with asthma considered to require regular treatment with bronchodilators who were recruited taking by their general practitioner (n = 3516). INTERVENTIONS--Salmeterol (Serevent)(50 micrograms twice daily) or salbutamol (200 micrograms four times a asthma day) randomised in the ratio of two patients taking salmeterol to one taking salbutamol. All other drugs including prophylaxis against two asthma were continued throughout the study. MAIN OUTCOME MEASURES--All serious events and reasons for withdrawals (medical and non-medical) whether or MAIN not they were considered to be related to the drugs. RESULTS--Fewer medical withdrawals due to asthma occurred in patients taking be salmeterol than in those taking salbutamol (2.91% v 3.79%; chi 2 = 13.6, p = .0002). Mortality and admissions to patients hospital were as expected. There was a small but non-significant excess mortality in the group taking salmeterol and a significant SETTING--General excess of asthma events including deaths in patients with severe asthma on entry. Use of more than two canisters of by bronchodilator a month was particularly associated with the occurrence of an adverse asthma event. CONCLUSIONS--Treatment over 16 weeks with either events salmeterol or salbutamol was not associated with an incidence of deaths related to asthma in excess of that predicted. Overall salmeterol control of asthma was better in patients allocated to salmeterol. Serious adverse events occurred in patients most at risk on in entry and were probably due to the disease rather than treatment.

Inhalation ultrasonic of hypertonic saline aerosol is a relatively noninvasive method to obtain sputum for examination of inflammatory processes in the airways.counts. We investigated some technical factors which might influence the success of induction and sputum cell counts. In total, twenty six salbutamol asthmatic and 13 healthy subjects, unable to raise sputum spontaneously, inhaled nebulized saline for three 7 min intervals. In three (Pari randomized, cross-over studies we repeated sputum induction on separate days with two ultrasonic nebulizers (De Vilbiss Ultraneb 99 and Fisoneb)All and one jet nebulizer (Pari LL with Master Compressor)(Study 1, n = 15), with different saline concentrations (normal saline 1, .9%; hypertonic saline 3% on 2 days; and hypertonic saline 3, 4 and 5%, sequentially)(Study 2, n = 14)3, and with pretreatment with either salbutamol or placebo (Study 3, n = 10). The latter two studies were double-blind. Sputum saline, cells were dispersed with dithiothreitol, and the cell suspension was used to perform total cell counts and to prepare cytospins investigated for differential cell counts. We compared success rate, cell counts, subject discomfort and percentage fall in forced expiratory volume in 13 one second (FEV1) during the procedures. All sputum examinations were performed blind to the clinical procedures. The success rates and discomfort the cell counts of the specimens obtained with the two ultrasonic nebulizers were not different, whilst general discomfort was proportional ultrasonic to the saline output of the nebulizer. Induction of sputum by hypertonic saline was more successful than normal saline, but inflammatory more disagreeable to the subjects. Induction with saline 3% on two days was only successful in 6 of 14 subjects.(ABSTRACT Induction TRUNCATED AT 250 WORDS)