Albuterol :: therapeutic use
Latest Paper:
Department of pediatrics, division of allergy and immunology, College of Medicine, University of California, Irvine, USA. wberger@uci.edu
Vast differences exist between the actions physicians report that they take and the patient's perception of those actions. Several patient satisfaction survey results are presented in this article. Many show that although patients are not often satisfied with their treatments or with the side effects they experience from medications, they are, in general, very satisfied with their physicians. These research studies point out that a very real "communications gap" exists between physicians and patients when examined from the patient's perspective.
Mesh-terms: Acute Disease; Adrenal Cortex Hormones :: therapeutic use; Adrenergic beta-Agonists :: adverse effects; Adrenergic beta-Agonists :: therapeutic use; Albuterol :: adverse effects; Albuterol :: therapeutic use; Asthma :: complications; Bronchial Spasm :: drug therapy; Bronchial Spasm :: etiology; Bronchodilator Agents :: adverse effects; Bronchodilator Agents :: therapeutic use; Communication; Humans; Patient Satisfaction; Physician-Patient Relations; Pulmonary Disease, Chronic Obstructive :: complications; Treatment Outcome;
Most cited papers:
Division of Physiological Medicine, St. George's Hospital Medical School, London, United Kingdom.
Changes in health-related quality of life (HRQoL) were evaluated in patients with chronic obstructive pulmonary disease (COPD) following treatment with placebo, salmeterol 50 microg twice a day or 100 microg twice a day by metered-dose inhaler. Patients completed the disease-specific St. George's Respiratory Questionnaire (SGRQ) and the Medical Outcomes Study Short Form 36 (SF-36) at baseline and after 16 wk of treatment. Data from 283 patients (95 patients in the placebo group and 94 in each salmeterol group) were available for HRQoL analysis. Apart from a small difference in ages, all treatment groups were well matched at baseline in terms of forced expiratory volume in one second (FEV1) and HRQoL scores. Compared with placebo, salmeterol 50 microg twice a day was associated with significant improvements in SGRQ "Total" and "Impacts" scores which exceeded the threshold for a clinically significant change. This was not seen with salmeterol 100 microg twice a day. Changes in SGRQ and SF-36 scores correlated. They also showed a weak but significant relationship with FEV1. This study has shown that a modest change in lung function may be associated with clinically significant gain in health and well-being in COPD patients.
Mesh-terms: Administration, Inhalation; Adrenergic beta-Agonists :: administration & dosage; Adrenergic beta-Agonists :: therapeutic use; Albuterol :: administration & dosage; Albuterol :: analogs & derivatives; Albuterol :: therapeutic use; Bronchodilator Agents :: administration & dosage; Bronchodilator Agents :: therapeutic use; Cohort Studies; Double-Blind Method; Drug Administration Schedule; Female; Human; Lung Diseases, Obstructive :: drug therapy; Lung Diseases, Obstructive :: physiopathology; Lung Diseases, Obstructive :: psychology; Male; Middle Aged; Quality of Life; Questionnaires; Support, Non-U.S. Gov't; Treatment Outcome;
Division of Pulmonary Medicine, Cedars Sinai Medical Center, Los Angeles, California 90048, USA.
Dynamic hyperinflation (DH) is a major pathophysiologic consequence of airflow limitation during exercise in patients with chronic obstructive pulmonary disease (COPD) and an important contributing factor to breathlessness. In this study we aimed to examine the effect of inhaled beta agonist therapy on DH during exercise in these patients and the relationship between changes in DH and breathlessness. In 13 COPD patients (mean age 65.1 +/- 2. , FEV1 1.20 +/- .17, FEV1/FVC 40 +/- 3) we measured pulmonary function tests, exercise breathlessness by Borg score, and exercise flow volume and pressure volume loops on two separate days. Prior to testing, patients randomly received inhaled placebo or albuterol on the first test day and the alternative medication on the second test day. From measurements of exercise inspiratory capacity (IC), we calculated the end-expiratory and end-inspiratory lung volumes (EELV, EILV). We used esophageal pressure recordings to measure peak inspiratory esophageal pressure (Pesins) during exercise and this was related to the maximal capacity for pressure generation taking into account lung volume and airflow changes (Pcapi). Bronchodilator caused significant increase in both FEV1 and FVC (+ .23 and + .51, p< .01). Comparisons of breathlessness, exercise volumes, and pressures were made at the highest equivalent work load. There was a significant reduction in the peak exercise EELV/TLC (80 +/- .02% to 76 +/- .02%, p< .05) while the peak EILV/TLC decreased by 2%(97 +/- 1% to 95 +/- 1%, p< .05). The peak Pesins/Pcapi decreased ( .79 +/- .10 to .57 +/- .05, p< .05), and the Pcapi - Pesins increased (7.4 +/- 3 to 13. +/- 3 cm H2O, p< .05). There was significant improvement in neuroventilatory coupling for volume change (Pesins/Pcapi/VT/TLC 5.45 +/- .5 to 3.25 +/- 1. , p< .05). There was a significant reduction in breathlessness as measured by Borg score (4.5 +/- .7 to 3.1 +/- .5, p< .05) and 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). 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 resting volumes, and flow rates were not significant. We conclude that in patients with COPD, inhaled bronchodilator reduces exercise DH and improves inspiratory pressure reserve and neuroventilatory coupling. Changes in DH and neuroventilatory coupling were the main determinants of reduced breathlessness.
Mesh-terms: Administration, Inhalation; Adrenergic beta-Agonists :: therapeutic use; Aged; Albuterol :: therapeutic use; Bronchodilator Agents :: therapeutic use; Comparative Study; Dyspnea :: physiopathology; Dyspnea :: prevention & control; Esophagus :: drug effects; Esophagus :: physiopathology; Exertion :: physiology; Female; Forced Expiratory Volume :: drug effects; Human; Inspiratory Capacity :: drug effects; Lung :: drug effects; Lung :: physiopathology; Lung Diseases, Obstructive :: physiopathology; Lung Diseases, Obstructive :: prevention & control; Male; Middle Aged; Peak Expiratory Flow Rate :: drug effects; Pressure; Pulmonary Ventilation :: drug effects; Respiratory Mechanics :: drug effects; Support, Non-U.S. Gov't; Total Lung Capacity :: drug effects; Vital Capacity :: drug effects;
Donald A Mahler,
Patrick Wire,
Donald Horstman,
Chai-Ni Chang,
Julie Yates,
Tracy Fischer,
Tushar Shah
Dartmouth Hitchcock Medical Center, Section of Pulmonary and Critical Care Medicine, 1 Medical Center Drive, Lebanon, NH 03756-0001, USA. donald.a.mahler@hitchcock.org
This randomized controlled trial examined the benefits of combining an inhaled corticosteroid, fluticasone propionate (F), with an inhaled long-acting beta(2)-agonist, salmeterol (S), to treat the inflammatory and bronchoconstrictive components of chronic obstructive pulmonary disease (COPD). A total of 691 patients with COPD received the combination of F and S (FSC), S (50 mcg), F (500 mcg), or placebo twice daily via the Diskus device for 24 weeks. A significantly greater increase in predose FEV(1) at the endpoint was observed after FSC (156 ml) compared with S (107 ml, p = .012) and placebo (-4 ml, p < .0001). A significantly greater increase in 2-hour postdose FEV(1) at the endpoint was observed after treatment with FSC (261 ml) compared with F (138 ml, p < .001) and placebo (28 ml, p < .001). There were greater improvements in the Transition Dyspnea Index with FSC (2.1) compared with F (1.3, p = .033), S ( .9, p < .001), and placebo ( .4, p < .0001). The incidence of adverse effects (except for an increase in oral candidiasis with FSC and F) was similar among the treatment groups. We conclude that FSC improved lung function and reduced the severity of dyspnea compared with individual components and placebo.
Mesh-terms: Administration, Inhalation; Administration, Topical; Adrenergic beta-Agonists :: administration & dosage; Adrenergic beta-Agonists :: adverse effects; Adult; Aged; Aged, 80 and over; Albuterol :: administration & dosage; Albuterol :: adverse effects; Albuterol :: analogs & derivatives; Albuterol :: therapeutic use; Androstadienes :: administration & dosage; Androstadienes :: adverse effects; Androstadienes :: therapeutic use; Anti-Inflammatory Agents :: administration & dosage; Anti-Inflammatory Agents :: adverse effects; Bronchodilator Agents :: administration & dosage; Bronchodilator Agents :: adverse effects; Double-Blind Method; Drug Combinations; Female; Forced Expiratory Volume; Glucocorticoids; Human; Male; Middle Aged; Nebulizers and Vaporizers; Peak Expiratory Flow Rate; Powders; Pulmonary Disease, Chronic Obstructive :: drug therapy; Pulmonary Disease, Chronic Obstructive :: physiopathology;
Department of Respiratory Medicine and Intensive Care, Alfred Hospital, Prahran, Australia.
Myopathy complicating the therapy of severe asthma has been recently described in several case reports. Twenty-five consecutive patients admitted to the intensive care unit (ICU) at this hospital for mechanical ventilation for severe asthma were studied for the incidence of creatine kinase (CK) enzyme rise and for the development of clinical myopathy. Pharmacologic therapy was standardized, every patient receiving corticosteroids and aminophylline intravenously and salbutamol both nebulized and intravenously. Twenty-two patients received muscle relaxant therapy with vecuronium. In 19 of 25 (76%) of patients there was elevation of CK levels to a median of 1,575 U/L (range, 66 to 7,430) occurring 3.6 +/- 1.5 days after admission. In nine patients there was clinically detectable myopathy. The presence of either myopathy or CK enzyme rise was associated with a significant prolongation of ventilation time. Arterial blood gas measurements on admission to the ICU revealed a pH (mean +/- SD) of 7.07 +/- .21, a PaCO2 of 87.2 +/- 32.7, and a PaO2 (with a high FIO2) of 129 +/- 97 mm Hg; however, no correlation was found between the severity of initial metabolic disturbance and the subsequent development of myopathy. There was no association between the type of corticosteroid administered and the subsequent development of myopathy. Patients with myopathy had received a significantly higher total dose of vecuronium when compared with those who did not develop myopathy (p < .001, Kruskal Wallis test). We have therefore found a surprisingly high incidence of CK enzyme rise and myopathy in this group of mechanically ventilated patients with severe asthma.(ABSTRACT TRUNCATED AT 250 WORDS)
Mesh-terms: Administration, Inhalation; Adrenal Cortex Hormones :: administration & dosage; Adrenal Cortex Hormones :: therapeutic use; Adult; Albuterol :: administration & dosage; Albuterol :: therapeutic use; Aminophylline :: administration & dosage; Aminophylline :: therapeutic use; Asthma :: classification; Asthma :: complications; Asthma :: therapy; Blood Gas Analysis; Creatine Kinase :: blood; Electrolytes :: blood; Female; Human; Incidence; Infusions, Intravenous; Intensive Care Units; Male; Middle Aged; Myocardial Diseases :: epidemiology; Myocardial Diseases :: etiology; Myocardial Diseases :: metabolism; Prospective Studies; Respiration, Artificial; Risk Factors; Severity of Illness Index; Vecuronium Bromide :: administration & dosage; Vecuronium Bromide :: therapeutic use; Victoria :: epidemiology;
We conducted a trial of inhaled salbutamol and orally administered theophylline in patients whose acute response to inhaled salbutamol was less than 25% of their baseline FEV1. Patients underwent 4 treatment periods, each of 2 wk duration, during which they received the following combinations: placebo-placebo, placebo-salbutamol, placebo-theophylline, and salbutamol-theophylline. The 19 patient who completed the study were all males with a mean age of 65 +/- 7.4 yr, mean FEV1 of 1.02 +/- .38, and mean VC of 2.73 +/- .19. Outcomes included twice-daily recordings of peak flow rates, spirometry, the distance patients could walk in 6 min, and clinical symptoms of dyspnea, fatigue, and emotional function. Clinically important and statistically significant differences between the 4 periods were noted on both physiologic and functional outcomes. For the group as a whole, improvement with inhaled salbutamol and orally administered theophylline was comparable, and additional benefit was gained from a combination of the 2 drugs. We conclude that both inhaled salbutamol and orally administered theophylline can improve airflow obstruction, functional exercise capacity, and quality of life in patients with primarily fixed air-flow limitation.
Mesh-terms: Aged; Albuterol :: administration & dosage; Albuterol :: therapeutic use; Bronchodilator Agents :: administration & dosage; Bronchodilator Agents :: therapeutic use; Human; Lung Diseases, Obstructive :: drug therapy; Lung Diseases, Obstructive :: physiopathology; Male; Middle Aged; Nebulizers and Vaporizers; Physical Endurance; Quality of Life; Respiratory Function Tests; Support, Non-U.S. Gov't; Theophylline :: administration & dosage; Theophylline :: therapeutic use;
Respiratory Medicine Unit, City Hospital, Nottingham, UK.
Regular inhaled beta 2 agonist causes tolerance to the acute protective effect of beta 2 agonist against bronchoconstriction induced by chemical stimuli such as AMP, histamine, and methacholine. We examined a more clinically relevant stimulus, inhaled allergen, in a double-blind, cross-over, random-order trial in 13 mild atopic asthmatics, who had not used beta 2 agonist for at least 4 weeks. We compared regular inhaled salbutamol (200 micrograms four times daily for 2 weeks) with placebo (2 weeks) for effects on bronchodilator response, baseline methacholine, and allergen airway responsiveness, and on the acute protective effect of salbutamol against both stimuli. Baseline forced expiratory volume in 1 s (FEV1), bronchodilator response, and methacholine responsiveness were the same during both treatment periods. After regular salbutamol, the allergen PC20 (provocation concentration producing a 20% FEV1 decrease) fell by .91 (SD .66)(p = .0009) doubling doses, and the protective effects of salbutamol on methacholine and allergen were both significantly reduced (p = .026 and .025, respectively). Taking into account the reduced baseline allergen PC20, the post-salbutamol allergen PC20 was almost 2 doubling doses (1.94 [1.43], p < .01) lower during salbutamol treatment. Thus, 2 weeks of regular inhaled salbutamol increased airway responsiveness to allergen but not to methacholine, and caused tolerance to the protective effect of salbutamol on bronchoconstriction induced by both stimuli. These effects of inhaled beta 2 agonist provide further evidence to support detrimental effects of their regular use.
Mesh-terms: Administration, Inhalation; Adolescent; Adult; Albuterol :: administration & dosage; Albuterol :: pharmacology; Albuterol :: therapeutic use; Allergens :: diagnostic use; Asthma :: drug therapy; Asthma :: physiopathology; Bronchial Provocation Tests; Bronchoconstriction :: drug effects; Double-Blind Method; Drug Tolerance; Female; Forced Expiratory Volume :: drug effects; Human; Male; Methacholine Chloride :: diagnostic use; Middle Aged; Support, Non-U.S. Gov't;
BACKGROUND: An inhaled glucocorticoid is currently the medication of choice for long-term control of persistent asthma in children. The role of 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 of 241 children (mean [+/-SD] age, 9.3+/-2.4 years) with clinically stable asthma and less than one month of prior glucocorticoid use. We compared inhaled beclomethasone dipropionate (200 microg twice daily) with salmeterol xinafoate (50 microg twice daily) and placebo (lactose). The primary outcome measure, airway responsiveness (as assessed with a methacholine challenge) was evaluated before treatment; after 3, 6, 9, and 12 months of treatment (12 and 36 hours after study medications had been withheld); and 2 weeks after the end of treatment. Spirometry, symptoms, use of rescue medication (200 microg of albuterol inhaled as needed), and adverse effects were also assessed. RESULTS: During months 1 through 12 overall, beclomethasone was associated with significantly less airway hyperresponsiveness than salmeterol (P= .003) or placebo (P< .001). This effect was lost two weeks after treatment had been stopped. As compared with placebo, beclomethasone was associated with less variability between morning and evening in the peak expiratory flow (P= .002), as was salmeterol (P= .02). Beclomethasone was also associated with a reduced need for albuterol as rescue therapy (P< .001) and fewer withdrawals because of asthma exacerbations (P= .03), but salmeterol was not (P= .09 and .55, respectively). During months 1 through 12, linear growth was 3.96 cm in the children receiving beclomethasone, as compared with 5.40 cm in the salmeterol group (P= .004) and 5.04 cm in the placebo group (P= .018). Height was not measured after treatment ended. CONCLUSIONS: Beclomethasone was effective in reducing airway hyperresponsiveness and in controlling symptoms of asthma, but it was associated with decreased linear growth. Salmeterol was not as effective as beclomethasone in reducing airway hyperresponsiveness or in controlling symptoms; however, it was an effective bronchodilator and was not associated with rebound airway hyperresponsiveness, masking of symptoms, or adverse effects.
Mesh-terms: Administration, Inhalation; Adolescent; Adrenergic beta-Agonists :: therapeutic use; Albuterol :: analogs & derivatives; Albuterol :: therapeutic use; Asthma :: drug therapy; Asthma :: physiopathology; Beclomethasone :: adverse effects; Beclomethasone :: therapeutic use; Bronchial Hyperreactivity :: drug therapy; Bronchodilator Agents :: therapeutic use; Child; Comparative Study; Double-Blind Method; Female; Glucocorticoids :: adverse effects; Glucocorticoids :: therapeutic use; Growth :: drug effects; Human; Male; Placebos; Pulmonary Ventilation :: drug effects; Support, Non-U.S. Gov't;
Thirty-two infants, aged 1 to 12 months, hospitalized with acute wheezing, were studied. They were randomly divided into four treatment groups of eight patients each. The treatments were intramuscular dexamethasone or placebo (double-blind), and salbutamol (oral and inhaled), or none (open), in all four possible combinations. The study was carried out as a randomized block design with eight blocks of four infants each, matched by age and clinical score. Average daily improvements, as reflected by changes in the clinical score and length of hospital stay, was essentially the same for infants treated with placebo, salbutamol alone, and dexamethasone alone. However, combined salbutamol-dexamethasone treatment resulted in more than twice the rate of improvement of the other treatments. The difference was statistically highly significant (P less than .01). Furthermore, the response of this combined treatment was observed within 24 hours; none of the ten infants in whom there was no significant improvement within 48 hours and neither of the two patients who developed respiratory failure received the combined salbutamol-dexamethasone treatment. A potentiating effect of corticosteroids on the beta-adrenergic responsiveness is a possible explanation for the advantage of this combined treatment in the management of acute wheezing in infancy.
Mesh-terms: Acute Disease; Adrenergic beta-Agonists :: administration & dosage; Albuterol :: administration & dosage; Albuterol :: therapeutic use; Comparative Study; Dexamethasone :: administration & dosage; Dexamethasone :: therapeutic use; Double-Blind Method; Drug Therapy, Combination; Female; Human; Infant; Male; Random Allocation; Respiratory Sounds; Support, Non-U.S. Gov't; Time Factors;
OBJECTIVE--To compare safety of salmeterol and salbutamol in treating asthma. DESIGN--Double blind, randomised clinical trial in parallel groups over 16 weeks. SETTING--General practices throughout the United Kingdom. SUBJECTS--25,180 patients with asthma considered to require regular treatment with bronchodilators who were recruited by their general practitioner (n = 3516). INTERVENTIONS--Salmeterol (Serevent)(50 micrograms twice daily) or salbutamol (200 micrograms four times a day) randomised in the ratio of two patients taking salmeterol to one taking salbutamol. All other drugs including prophylaxis against asthma were continued throughout the study. MAIN OUTCOME MEASURES--All serious events and reasons for withdrawals (medical and non-medical) whether or not they were considered to be related to the drugs. RESULTS--Fewer medical withdrawals due to asthma occurred in patients taking salmeterol than in those taking salbutamol (2.91% v 3.79%; chi 2 = 13.6, p = .0002). Mortality and admissions to hospital were as expected. There was a small but non-significant excess mortality in the group taking salmeterol and a significant excess of asthma events including deaths in patients with severe asthma on entry. Use of more than two canisters of bronchodilator a month was particularly associated with the occurrence of an adverse asthma event. CONCLUSIONS--Treatment over 16 weeks with either salmeterol or salbutamol was not associated with an incidence of deaths related to asthma in excess of that predicted. Overall control of asthma was better in patients allocated to salmeterol. Serious adverse events occurred in patients most at risk on entry and were probably due to the disease rather than treatment.
Mesh-terms: Administration, Inhalation; Adolescent; Adrenergic beta-Agonists :: administration & dosage; Adrenergic beta-Agonists :: therapeutic use; Adult; Aged; Albuterol :: administration & dosage; Albuterol :: analogs & derivatives; Albuterol :: therapeutic use; Asthma :: drug therapy; Asthma :: mortality; Bronchodilator Agents :: administration & dosage; Bronchodilator Agents :: therapeutic use; Double-Blind Method; Female; Great Britain :: epidemiology; Human; Incidence; Male; Middle Aged;
Dept of Medicine, St. Joseph's Hospital, Hamilton, Ontario, Canada.
Inhalation of hypertonic saline aerosol is a relatively noninvasive method to obtain sputum for examination of inflammatory processes in the airways. We investigated some technical factors which might influence the success of induction and sputum cell counts. In total, twenty six asthmatic and 13 healthy subjects, unable to raise sputum spontaneously, inhaled nebulized saline for three 7 min intervals. In three randomized, cross-over studies we repeated sputum induction on separate days with two ultrasonic nebulizers (De Vilbiss Ultraneb 99 and Fisoneb) and one jet nebulizer (Pari LL with Master Compressor)(Study 1, n = 15), with different saline concentrations (normal saline .9%; hypertonic saline 3% on 2 days; and hypertonic saline 3, 4 and 5%, sequentially)(Study 2, n = 14) and with pretreatment with either salbutamol or placebo (Study 3, n = 10). The latter two studies were double-blind. Sputum cells were dispersed with dithiothreitol, and the cell suspension was used to perform total cell counts and to prepare cytospins for differential cell counts. We compared success rate, cell counts, subject discomfort and percentage fall in forced expiratory volume in one second (FEV1) during the procedures. All sputum examinations were performed blind to the clinical procedures. The success rates and the cell counts of the specimens obtained with the two ultrasonic nebulizers were not different, whilst general discomfort was proportional to the saline output of the nebulizer. Induction of sputum by hypertonic saline was more successful than normal saline, but more disagreeable to the subjects. Induction with saline 3% on two days was only successful in 6 of 14 subjects.(ABSTRACT TRUNCATED AT 250 WORDS)
Mesh-terms: Administration, Inhalation; Adult; Albuterol :: therapeutic use; Asthma :: diagnosis; Bronchial Provocation Tests :: methods; Cell Count; Comparative Study; Cross-Over Studies; Double-Blind Method; Female; Human; Male; Nebulizers and Vaporizers; Premedication; Saline Solution, Hypertonic :: diagnostic use; Specimen Handling :: methods; Sputum :: cytology; Sputum :: secretion; Support, Non-U.S. Gov't;
