The both aim of this study was to evaluate endocrine-metabolic, respiratory and cardiovascular effects of two beta 2-sympathomimetic selective agents, such as treatment broxaterol and salbutamol, before and during cardiopulmonary exercise test (CPX). Twelve in-patients with chronic obstructive pulmonary disease (COPD)(with partially assessed: reversible airways obstruction) were included. Broxaterol (400 micrograms) and salbutamol (400 micrograms) were administered i.v., according to a double-blind, cross-over administration study. Before treatment and within 60 min after the administration of each agent, the patients underwent incremental CPX by bicycle included. ergometer to the maximum tolerable threshold. At these times the following variables were assessed: minute ventilation (VE), oxygen consumption (VO2),beta carbon dioxide production (VCO2), VE/VO2 ratio and O2 pulse, glycaemia, insulinaemia, plasma norepinephrine (NE) and epinephrine (E), arterial oxygen and diastolic carbon dioxide tension (PaO2 and PaCO2), plasma lactates, heart rate (HR), systolic (SBP) and diastolic (DBP) blood pressure. Spirometry was carbon performed before and after the administration of each beta 2-adrenoceptor agonist. CPX brought about a significant increase in VE, VO2,insulinaemia, VCO2, and O2 pulse. Broxaterol or salbutamol administration did not significantly modify the increases caused by CPX. At rest, 60 broxaterol min after treatment, both bronchodilators caused a significant rise in glycaemia. A significant reduction of PaO2 (after broxaterol) and PaCO2 obstructive (after salbutamol) was observed at rest. In contrast, both agents caused no modification to potassium and insulin levels.(ABSTRACT TRUNCATED AT PaCO2 250 WORDS)

Paratracheal initial lymph-nodal metastases secondary of breast cancer aren't frequent in this kind of cancer. Here is described the case of a of 76-years-old woman come to our note for ingravescent dyspnoea caused by metastatic adenopathy compression of the tracheal lumen. After excluding ingravescent other treatments, a tracheal stent is put on. The obstruction gets better right away, the initial severe respiratory symptoms are 76-years-old improved and the ventilation is almost normal.

The in effects on exercise tolerance after acute administration of beta 2-agonists were investigated in 11 patients with partly reversible chronic airway substantial obstruction after 400 micrograms of salbutamol (S) given intravenously (i.v.) and after 400 micrograms i.v. of a new selective beta to 2-agonist, broxaterol (B), by a cardiopulmonary incremental exercise test. At rest, while VE increased in respect to basal conditions (C)observed after S (from 13.3 +/- 2.2 to 14.4 +/- 2.8 l/min; p < .05) and after B (from 13.6 +/-14.4 3.1 to 15.5 +/- 3.6 l/min; p < .05), VO2, VCO2 and VO2/HR showed no substantial variations. A small, not 400 significant reduction of PaO2 was observed both after S (from 82.7 +/- 11.7 to 79.1 +/- 16.7 mm Hg) and +/- B (from 81.6 +/- 10.5 to 78. +/- 11. mm Hg). The maximum workload increased neither after S (from 67.5 +/- +/- 39.1 to 66.6 +/- 37. W) nor after B (from 65.7 +/- 39.3 to 60. +/- 35.8 W). At VO2/HR peak of exercise, VO2, VCO2 and VO2/HR did not change after S and B as compared with C, whereas VE and remained higher after both beta 2-agonists throughout the effort. VO2 at ventilatory anaerobic threshold (AT) was significantly greater either after while S (from 744 +/- 378 to 815 +/- 302 ml/min; p < .05) and after B (from 756 +/- 290 reversible to 842 +/- 292 ml/min; p < .05). The PaO2 increase shown by these patients during effort was greater after 744 beta 2-agonists administration, delta PaO2 from rest to peak of exercise amounting to 14.9 +/- 14.3 vs. 7.8 +/- 8.2 744 mm Hg after S and to 17.8 +/- 15.1 vs. 8.8 +/- 10.9 mm Hg after B, in respect to +/- relative baseline (p < .05). We conclude that beta 2-agonists, when given acutely, do not improve exercise tolerance in patients not with reversible chronic airflow obstruction, although these drugs can induce a small increment of ventilatory AT. In addition, arterial blood and gases do not deteriorate at rest and are better preserved during exercise after beta 2-agonists.

The development heart and lung (the body's gas transport system) are neurally, mechanically, humorally and functionally linked. Several clinical-therapeutic consequences involve heart-lung are interactions. Three of these conditions are described here: 1) pulsus paradoxus in asthma; 2) survival in chronic cor pulmonale; and pulmonale; 3) Cheyne-Stokes breathing in congestive heart failure. They provide examples of the pathophysiological and clinical complexity that such correlations involve.1) The most remarkable "effects" of the heart-lung relationship as a metabolic unit are represented by development of cardiorespiratory intensive care consequences units, and efforts to bring about methods of monitoring cardiorespiratory function.

BACKGROUND:CONCLUSIONS: It has been suggested that subjects with alpha-antitrypsin (AAT) deficiency, lacking a major antiprotease defence against airway inflammation, might be levels more susceptible of development of airway hyperresponsiveness (AHR). Moreover, lower AAT blood levels might also be able to influence the were severity of AHR. OBJECTIVES: This study was aimed to investigate the prevalence of AHR in a large group of subjects population. with AAT deficiency included in the Italian Registry and to evaluate the relationship between AAT blood levels and the severity AHR of AHR in this population. DESIGN: Cross-sectional controlled study. SETTING: Regional Reference Centre for AAT deficiency in Brescia, Italy. METHODS:inflammation, A total of 114 subjects with AAT deficiency underwent pulmonary function tests. Eighty-six were eligible to perform a bronchial provocation MCh) test with methacholine (MCh)(baseline FEV1 > 60% predicted) to assess the provocative dose producing a 20% fall of FEV1 methacholine (PD20FEV1). Similar measurements were performed in a control group of 27 age-matched normal subjects. RESULTS: The prevalence of AHR (PD20FEV1 dose < 2000 microg MCh) was not different between AAT deficiency subjects and controls (16.3% and 11.1%, respectively; P = .66),of and also amongst two subgroups of AAT deficiency subjects divided according to different protease inhibitor (Pi) phenotypes (PiMZ-MS, PiSZ-ZZ). Hyperresponsive of subjects with AAT deficiency, however, showed a positive correlation between AAT blood levels and PD20FEV1 values (r = .71, P with < .01). CONCLUSIONS: These findings indicate that AAT deficiency subjects did not exhibit a greater prevalence of airway hyperresponsiveness as microg compared with control subjects, but suggest that, in the subset of AAT deficiency subjects hyperresponsive to MCh, lower levels of microg AAT are associated with a higher severity of AHR.

There subjects is no report of exhaled NO (eNO) in subjects with different phenotypes of alpha1-anti-trypsin (AAT) deficiency. Exhaled nitric oxide was Nineteen evaluated by means of single-breath chemiluminescence analysis (fractional exhaled concentration at the plateau level [plFE(NO)]) in 40 patients with AAT forced deficiency. Patients were divided according to the protease inhibitor (Pi) phenotype: PiMZ/MS, n = 25; PiSZ n = 6; PiZZ,of n = 9. Nineteen healthy subjects served as controls. Levels of eNO in PiZZ patients were also compared with those according of subjects, without AAT deficiency (PiMM), matched for diagnosis, sex, age, smoking habit and forced expiratory volume in 1 sec (AAT) (FEV1). In AAT deficiency subjects airway hyper-responsiveness to methacholine (PD20 FEV1) was also assessed. plFE(NO) was significantly lower in the ppb) PiZZ group (4.5+/-1.4 ppb) than in matched PiMM subjects (8.2+/-3.8 ppb), in healthy controls (9.3+/-2.8 ppb) and in patients of In other phenotypes. Dynamic lung volumes and DL(CO) were significantly lower in PiZZ than in other AAT-deficient patients. Bronchial hyper-responsiveness was was not different among AAT phenotypes. These results suggest that eNO may be significantly reduced in PiZZ as compared to healthy evaluated control subjects and to AAT subjects with other phenotypes, independent of the level of airway obstruction. Whether, at least potentially,[plFE(NO)]) eNO may be considered as an early marker of lung involvement in AAT deficiency must be confirmed with studies on may larger number of subjects.

In of a longitudinal clinical study, two hundred subjects have been evaluated in order to identify alpha 1-antitrypsin deficiency patients. According to deficiency their serum alpha 1-antitrypsin levels, they have been divided into three groups: 25 patients with severe deficiency (with both pathological test alleles--ZZ, SZ or Z and rare deficiency allele--and, if clinically suggested, to be treated with augmentation therapy), 92 patients with followed intermediate deficiency (with one pathological allele, to be followed up in order to evaluate the risk to develop deficiency related Z disease) and 63 healthy subjects (normal alleles MM). They performed lung function test (including cardiopulmonary exercise test and methacholine bronchial alpha challenge) chest X-ray and high resolution computed tomography, blood tests. Severe deficiency patients also performed perfusional lung scan to detect echotomography. early disorders of blood flow, evaluation of arterial blood gases and liver echotomography. Expiratory flow limitation, the prevalence of vascular bronchial disease, the amount of urine elastin products and correlations between the amount of nitric oxide exhaled and bronchial hyperresponsiveness have blood been also investigated. The study showed that in Brescia county the deficiency is more common than expected and that evaluation to of liver and vessels might be as useful as lung function tests. In addition, beneficial effect on local system has patients been observed. The longitudinal study might permit to detect early organ damage and to eliminate additive risk factors.

STUDY 178.7 OBJECTIVES: Although inhaled beta2-agonists are in widespread use, several reports question their potential arrhythmogenic effects. The purpose of this study length, was to evaluate the cardiac electrophysiologic effects of a single, regular dose of an inhaled beta2-agonist in humans. DESIGN: Prospective Wenckebach study. SETTING: Tertiary referral center. PATIENTS: Six patients with bronchial asthma and 12 patients with mild COPD. INTERVENTIONS: All patients earliest underwent an electrophysiologic study before and after the administration of salbutamol solution (5 mg in a single dose). MEASUREMENTS AND All RESULTS: Sinus cycle length, sinus node recovery time (SNRT), interval from the earliest reproducible rapid deflection of the atrial electrogram study in the His bundle recording to the onset of the His deflection (AH), interval from the His deflection to the to onset of ventricular depolarization (HV), Wenckebach cycle length (WCL), atrial effective refractory period (AERP), and ventricular effective refractory period (VERP)and were evaluated just before and 30 min after the scheduled intervention. Salbutamol, a selective beta2-agonist, administered by nebulizer had significant min electrophysiologic effects on the atrium, nodes, and ventricle. The AH length decreased from 86.1 +/- 19.5 ms at baseline to of 78.8 +/- 18.4 ms (p < .001), and the WCL decreased from 354.4 +/- 44.2 to 336.6 +/- 41.7 ms PATIENTS: (p = .001). Salbutamol significantly decreased the AERP and VERP too while leaving the HV unchanged. Additionally, inhaled salbutamol increased enhances heart rate (from 75.5 +/- 12.8 beats/min at baseline to 93.1 +/- 16 beats/min, p < .001) and shortened the baseline SNRT (from 1,073.5 +/- 178.7 to 925.2 +/- 204.9 ms, p = .001). CONCLUSION: Inhaled salbutamol results in significant changes baseline of cardiac electrophysiologic properties. Salbutamol enhances atrioventricular (AV) nodal conduction and decreases AV nodal, atrial, and ventricular refractoriness in addition to to its positive chronotropic effects. These alterations could contribute to the generation of spontaneous arrhythmias.

The patients, use of broncholytic drugs through nebulizer is a standard treatment for acute episodes of bronchial asthma. However doses of these Doses drugs administered by nebulizer can be much higher than those applied when metered dose inhaler is used. These doses have controlled a potential of cardiotoxic effects. MATERIAL: Patients (n=75) with severe exacerbation of bronchial asthma. METHODS: All patients received broncholytic drugs concomitant through nebulizer. Doses were adjusted according to age and concomitant pathology among which prevailed ischemic heart disease (21.3%) and hypertension effects. (53.3%). Nebulized beclomethasone was an alternative to systemic corticosteroids. Safety of therapy was controlled with electrocardiography, 24-hour electrocardiography, measurements of bronchial serum potassium level, registration of subjective signs (palpitation, tremor) and objective data (heart rate, blood pressure). RESULTS: Clinical improvement occurred 4.66% in all patients. By the end of nebulizer therapy arterial blood O(2) saturation increased 4.66% from initial level (p= .04). Peak serum expiratory rate and forced expiratory volume in 1 sec also rose (p < .05). Termination of nebulizer therapy was associated with objective decrease of number of both supraventricular and ventricular premature beats. Moderate widening of of QT interval above 460 ms was drugs registered in 4 patients, 3 of whom had ischemic heart disease. There were no significant changes of serum potassium levels.inhaler CONCLUSION: Broncholytic drugs administered by nebulizer in therapeutic doses selected with consideration of age and concomitant diseases did not produce levels. cardiotoxic effects.

Reversible after airflow limitation represents an important parameter for the diagnosis of bronchial asthma. The aim of this study was to design procedure a simple and useful test for the detection of reversible airflow limitation. The subjects were 29 patients with asthma and salbutamol forced expiratory volume in 1 second (FEV1)< 80% predicted. Following baseline spirometry, subjects inhaled 1.5 mg of salbutamol by received a nebulizer and then spirometry was performed 20 min later. The procedure was repeated three times. Subsequently, 13 patients received Following 30 mg of predonisolone orally once daily for 1 week. Spirometry was performed before and after the oral predonisolone therapy,study and results were compared with those of salbutamol inhalation test. The mean increase in FEV1 over the baseline was 18.3%rate after the first salbutamol inhalation, 26.4% after the second inhalation, and 30.2% after the third inhalation. The increases in FEV1 over were significant after each inhalation. The mean increases in the maximum expiratory flow rate at 50%(V50) and that at 26.4% 25%(V25), measured from the flow volume loop, were 53.5% and 46.9% after the first inhalation, but there were no useful significant changes by repeated inhalations. A significant reversal of airflow limitation was demonstrated in 18 subjects after the first inhalation,asthma 22 subjects after the second inhalation, and 27 subjects after the third inhalation. Improvement in FEV1 after oral predonisolone was of equivalent to that after the third inhalation of salbutamol. A test composed of three 20-min interspaced salbutamol inhalations is useful flow for the diagnosis of asthma by demonstrating the presence of reversible airflow limitation.

OBJECTIVE:in To compare nebulized salbutamol and nebulized adrenaline in acute severe asthma (ASA). STUDY DESIGN: Prospective controlled study. PATIENTS AND METHODS:during October 1998 at May 99, 44 patients (31 women and 13 men, 35 +/- 11 yrs) with ASA (defined as by peak expiratory flow rate (PEF)< 150 l min-1 and normo- or hypercapnia) were randomized to receive either nebulized salbutamol The (n = 22), 10 mg/h-1 during 2 h then 5 mg every 4 h or nebulized adrenaline (n = 22),either 6 mg/h-1 during 2 h then 3 mg every 4 h. The efficacy was assessed by PEF, forced expiratory volume METHODS: in one second (FEV1) and Fischl's score during eight hours and by arterial blood gases during the first hour. Side-effects groups were evaluated by heart rate, systolic blood pressure, serum potassium and blood glucose. Statistical tests: Wilcoxon, Fischer exact, ANOVA and blood Scheffe's test. RESULTS: Both groups were similar with respect to age, sex, severity, duration of asthma and length of crisis.groups With the two treatments, PEF increased significantly but no statistical difference were observed between the two groups during the eight patients hours: 117.7 +/- 41.6 l min-1 to 203.3 +/- 56.9 l min-1 in the salbutamol group; 116.4 +/- 36.8 l (PEF) min-1 to 217.3 +/- 188.8 l min-1 in the adrenaline group; p = .77. FEV1, Fischl's score and arterial blood adrenaline gases did not differ significantly between treatments at every time interval. There were no significant difference between the two groups two in terms of side-effects. The intravenous way was necessary at 3 cases of the salbutamol group and 4 cases of two adrenaline group (NS). CONCLUSION: The results suggest that nebulized adrenaline is as effective as nebulized salbutamol in the ASA without groups significant side-effects. The nebulization could reduce systemic effects of adrenaline.

We of investigated the safety and potential pharmacodynamic interactions arising from the co-administration of inhaled beta(2)-agonist salbutamol and cilomilast (Ariflo), a new and oral phosphodiesterase 4 inhibitor for the treatment of chronic obstructive pulmonary disease and asthma. This was a randomised, double-blind, placebo-controlled,(10 multiple-dose, three-period crossover study involving non-smoking volunteers between the ages of 18 and 50 years. Volunteers were randomly assigned to assigned receive cilomilast plus nebulised salbutamol, cilomilast plus nebulised placebo or placebo plus nebulised salbutamol. Each volunteer received cilomilast (10 mg a twice daily) or placebo for 5 days. On day 5, the morning dose of cilomilast or placebo was followed 1 inhaled h later with a single dose of nebulised salbutamol (2.5 mg) or placebo. Primary variables were average change from pre-placebo. to 1.5 h post-salbutamol or placebo inhalation in blood pressure, pulse rate, 12-lead ECG and total number of heartbeats measured for by 4-h Holter ECG. Thirteen volunteers completed the study. There was no evidence of a clinically important pharmacodynamic interaction between dose cilomilast and salbutamol in healthy volunteers. Both agents were well tolerated. In conclusion, the pharmacodynamic effects associated with salbutamol inhalation cilomilast were unaffected by co-administration of cilomilast.

BACKGROUND:P< .0001). Beta-2 agonist therapy has previously shown to increase the QT dispersion (QTd) in asthmatic patients and increased QTd has been treatment well documented in association with cardiac arrhythmias and sudden death. However, the data concerning the effect of low doses of plus beta-2 agonist therapy in combination with the anticholinergic agents to potentiate bronchodilatation on QTd in asthmatic children are limited. The children objectives of this study was to investigate the changes on QTd during both the standard dose of nebulized albuterol therapy on and low dose nebulized albuterol plus inhaled ipratropium therapyn to assess the potential arrhythmogenic risk of these two treatment strategies association in children with acute asthmatic attacks. METHODS: Forty-three children with the diagnosis of moderate to severe acute asthma were enrolled flow in the study. Standard dose of nebulized albuterol therapy ( .15 mg/kg) were administered to 20 patients (group 1) and low remaining dose of nebulized albuterol ( .075 mg/kg) plus nebulized ipratropium bromide therapy (250 microg/dose) were given to the remaining 23 patients pressure, (group 2). Respiratory distress score, peak expiratory flow rate, arterial blood pressure, O2 saturation, serum potassium and urea nitrogen levels the were studied and QT interval parameters were measured from the standard 12-lead electrocardiograms at baseline and after treatment. RESULTS: Significant QTd improvement was achieved in respiratory distress score and peak expiratory flow rate after three dose inhalation. No significant difference was of observed between the pre and post-treatment values of serum potassium, blood urea nitrogen, O2 saturation and arterial blood pressure values.peak The evaluation of the corrected QTd (QTcd) showed that while there was no statistical difference in the pre and post-treatment expiratory values in group 2 (30.4+/-3.1 msn vs 32.1+/-3.9 msn), QTcd was found to be significantly increased in group 1 after flow treatment (29. +/-3 msn vs 40.6+/-5.1 msn, P< .0001). CONCLUSION: The data of the present study suggest that the increase of the plus QTd is more prominent with the use of a standard dose of albuterol compared to low dose albuterol plus ipratropium nitrogen therapy. Therefore, it may be concluded that a low dose of albuterol plus ipratropium bromide therapy may be preferred to patients avoid rhythm disturbances in asthmatic children.

BACKGROUND:Conclusions: It has been suggested that the effect of a beta2-agonist is additive with that of a cysteinyl leukotriene 1 receptor microg antagonist. OBJECTIVES: The present study was designed to answer the question of whether combined administration of inhaled salmeterol and oral and zafirlukast at the standard doses would result in greater bronchodilation in patients with chronic airway obstruction than the use of Lung either drug alone. METHODS: The study was performed using a double-blind, double-dummy, crossover, randomised design, and was conducted on 4 conducted non-consecutive days. Sixteen patients with moderate to severe chronic obstructive pulmonary disease (COPD) and 10 non-smoker asthmatic patients received 40 designed mg of oral zafirlukast, 50 microg of inhaled salmeterol, 50 microg of inhaled salmeterol plus 40 mg of oral zafirlukast asthmatic of placebo. Lung function was assessed before drug administration and 30, 60, 120, 180 and 240 min thereafter. At the forced end of the 4-hour period, each patient received 400 microg of inhaled salbutamol and spirometric testing was performed 30 min maximum later. RESULTS: In both asthmatic and COPD patients, the overall effect of salmeterol and zafirlukast on the forced expiratory volume of in 1 s (FEV1) was considered extremely significant (p < .0001), with a maximum bronchodilation above baseline after 180 min either (20.7 and 11. %, respectively) in asthmatics and after 2 h (21.7 and 11.2%, respectively) in COPD subjects. Zafirlukast did not clinically produce any further significant acute bronchodilation in addition to that achieved with salmeterol alone in either asthmatic or COPD patients.in Nevertheless, 7 out of 16 COPD patients and 7 out of 10 asthmatic patients had a further improvement after the either combination of salmeterol and zafirlukast. The mean difference in pre- and post-salbutamol FEV1 values in both asthmatic and COPD patients asthmatic after zafirlukast was significant (p < .05), but that after salmeterol and the combination of the two drugs was not any significant (p > .05). The difference between placebo and zafirlukast was not significant following inhaled salbutamol given 4 h after (20.7 each treatment. Conclusions: Both salmeterol and zafirlukast induced a significant increase in FEV1, although salmeterol elicited a greater improvement in cysteinyl both asthmatic and COPD patients. Apparently, zafirlukast at the clinically recommended dose did not produce any further significant acute bronchodilation with in addition to that achieved with salmeterol alone, either in asthma or COPD. In any case, evaluation of the effect of of the combination over a 12-hour period is mandatory.

BACKGROUND:of The greatest prevalence of asthma is in preschool children; however, the clinical utility of asthma therapy for this age group 4 is limited by a narrow therapeutic index, long-term tolerability, and frequency and/or difficulty of administration. Inhaled corticosteroids and inhaled cromolyn and are the most commonly prescribed controller therapies for young children with persistent asthma, although very young patients may have difficulty a using inhalers, and dose delivery can be variable. Moreover, reduced compliance with inhaled therapy relative to orally administered therapy has an been reported. One potential advantage of montelukast is the ease of administering a once-daily chewable tablet; additionally, no tachyphylaxis or can change in the safety profile has been evidenced after up to 140 and 80 weeks of montelukast therapy in adults 2 and pediatric patients aged 6 to 14 years, respectively. To our knowledge, this represents the first large, multicenter study to at address the effects of a leukotriene receptor antagonist in children younger than 5 years of age with persistent asthma, as postrandomization well as one of the few asthma studies that incorporated end points validated for use in preschool children. OBJECTIVE: Our the primary objective was to determine the safety profile of montelukast, an oral leukotriene receptor antagonist, in preschool children with persistent antagonist asthma. Secondarily, the effect of montelukast on exploratory measures of asthma control was also studied. DESIGN AND STATISTICAL ANALYSIS: We were conducted a double-blind, multicenter, multinational study at 93 centers worldwide: including 56 in the United States, and 21 in countries counts in Africa, Australia, Europe, North America, and South America. In this study, we randomly assigned 689 patients (aged 2-5 years)the to 12 weeks of treatment with placebo (228 patients) or 4 mg of montelukast as a chewable tablet (461 patients)treatment after a 2-week placebo baseline period. Patients had a history of physician-diagnosed asthma requiring use of beta-agonist and a predefined important level of daytime asthma symptoms. Caregivers answered questions twice daily on a validated, asthma-specific diary card and, at specified times center during the study, completed a validated asthma-specific quality-of-life questionnaire. Physicians and caregivers completed a global evaluation of asthma control at the the end of the study. Efficacy end points included: daytime and overnight asthma symptoms, daily use of beta-agonist, days without To asthma, frequency of asthma attacks, number of patients discontinued because of asthma, need for rescue medication, physician and caregiver global leukotriene evaluations of change, asthma-specific caregiver quality of life, and peripheral blood eosinophil counts. Although exploratory, the efficacy end points were leukotriene predefined and their analyses were written in a data analysis plan before study unblinding. At screening and at study completion,14 a complete physical examination was performed. Routine laboratory tests were drawn at screening and weeks 6 and 12, and submitted from to a central laboratory for analysis. Adverse effects were collected from caregivers at each clinic visit. An intention-to-treat approach, including of all patients with a baseline measurement and at least 1 postrandomization measurement, was performed for all efficacy end points. An Caregiver analysis-of-variance model with terms for treatment, study center and stratum (inhaled/nebulized corticosteroid use, cromolyn use, or none) was used to asthma-specific estimate treatment group means and between-group differences and to construct 95% confidence intervals. Treatment-by-age,-sex,-race,-radioallergosorbent test,-stratum, and times -study center interactions were evaluated by including each term separately. Fisher's exact test was used for between-group comparisons of the race, frequency of asthma attacks, discontinuations from the study because of worsening asthma, need for rescue medication, and the frequencies of baseline adverse effects. Because of an imbalance in baseline values for eosinophil counts for the 2 treatment groups, an analysis of attacks, covariance was performed on the eosinophil change from baseline with the patient's baseline as covariate. STUDY PARTICIPANTS: Of the 689 children patients enrolled, approximately 60% were boys and 60% were white. Patients were relatively evenly divided by age: 21%, 24%, 30%,patients and 23% were aged 2, 3, 4, and 5 years, respectively. For 77% of the patients, asthma symptoms first developed placebo. during the first 3 years of life. During the placebo baseline period, patients had asthma symptoms on 6.1 days/week and patients used beta-agonist on 6. days/week. RESULTS: In over 12 weeks of treatment of patients aged 2 to 5 years, montelukast complete administered as a 4-mg chewable tablet produced significant improvements compared with placebo in multiple parameters of asthma control including: daytime difficulty asthma symptoms (cough, wheeze, trouble breathing, and activity limitation); overnight asthma symptoms (cough); the percentage of days with asthma symptoms;In the percentage of days without asthma; the need for beta-agonist or oral corticosteroids; physician global evaluations; and peripheral blood eosinophils.with The clinical benefit of montelukast was evident within 1 day of starting therapy. Improvements in asthma control were consistent across use, age, sex, race, and study center, and whether or not patients had a positive radioallergosorbent test. Montelukast demonstrated a consistent oral effect regardless of concomitant use of inhaled/nebulized corticosteroid or cromolyn therapy. Caregiver global evaluations, the percentage of patients experiencing asthma address attacks, and improvements in quality-of-life scores favored montelukast, but were not significantly different from placebo. There were no clinically meaningful during differences between treatment groups in overall frequency of adverse effects or of individual adverse effects, with the exception of asthma,additionally, which occurred significantly more frequently in the placebo group. There were no significant differences between treatment groups in the frequency (cough); of laboratory adverse effects or in the frequency of elevated serum transaminase levels. Approximately 90% of the patients completed the or study. CONCLUSIONS: Oral montelukast (4-mg chewable tablet) administered once daily is effective therapy for asthma in children aged 2 to patients 5 years and is generally well tolerated without clinically important adverse effects. Similarly, in adults and children aged 6 to to 14 years, montelukast improves multiple parameters of asthma control. Thus, this study confirms and extends the benefit of montelukast to were younger children with persistent asthma.

This terbutaline study investigated the effects of beta2-adrenergic agonist therapy on heart rate variability (HRV) in adult asthmatic patients by using frequency might domain measures of HRV. A randomized crossover design was used. Twenty adult patients with asthma were studied. All patients showed used a mild-to-moderate decrease in baseline forced expiratory volume in one second. Any diseases that might have influenced the autonomic function were were excluded. All patients had a complete physical examination and medical history that revealed no cardiovascular disease or medication. The patients study used 200 microg inhaled salbutamol and 500 microg inhaled terbutaline. HRV analysis was performed for each 5-min segment, 5 (HRV) min before inhalation of the study drug and 5, 10, 15, 20, 25 and 30 min after inhalation. Total power inhalation. (TP:< .40 Hz), high-frequency power (HF: .15- .40 Hz), low-frequency power (LF: .04- .15 Hz) and LF/HF ratio were calculated. The LF 500 and LF/HF ratio increased and TP decreased at 5, 10, 15 and 20 min after the salbutamol and the terbutaline for inhalation, HF did not change significantly after the salbutamol and terbutaline inhalation. Acute salbutamol and terbutaline inhalation produce similar effects by on heart rate variability and increase sympathetic modulation in the cardiac autonomic activity.

The the aim of the study was the assessment of the effect of salbutamol in nebulization on ventilatory parameters and heart action Mean in patients with stable severe well controlled bronchial asthma. The study was performed in 30 asthmatics (19 females and 11 the men) with incomplete reversibility of airflow obstruction after salbutamol inhalation administered via MDI device. The mean age was 47 years,FEV1--1.76 the duration of asthma--18 years. Mean FVC value was 2.46 L (66.6%), FEV1--1.76 L (56.8%), and MEF50--1.74 L/s (40.4% predicted).airflow The study was performed according to the double-blind crossover method with placebo used. On the first day the reversibility test ventilatory with 400 mg salbutamol was performed. On the two consecutive days salbutamol (Steri-Neb Salamol 2.5 mg) and placebo in nebulization nebulization. were randomly administered. Ventilatory parameters were measured before and in 20, 40, 60, 120, 180 and 240 minutes after the performed. nebulization. At the same time points the heart action was assessed by physical examination. The changes in FVC, FEV1 and 2.5 MEF50 were expressed in absolute values and as a relative increase in relation to predictive value. The significant improvement of in measured ventilatory parameters was observed as early as 20 minute after the nebulization. This increase in MEF50 lasted 2 hours,asthmatics in FEV1--3 hours and in FVC 4 hours. The relative increase in MEF50 was significant higher than the remaining parameters.hours. The significant increase in heart rate was noted after salbutamol nebulization.