36 results on '"Beasley R"'
Search Results
2. Albuterol-Budesonide Fixed-Dose Combination Rescue Inhaler for Asthma.
- Author
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Papi A, Chipps BE, Beasley R, Panettieri RA Jr, Israel E, Cooper M, Dunsire L, Jeynes-Ellis A, Johnsson E, Rees R, Cappelletti C, and Albers FC
- Subjects
- Administration, Inhalation, Adolescent, Adult, Child, Child, Preschool, Double-Blind Method, Drug Combinations, Ethanolamines therapeutic use, Formoterol Fumarate therapeutic use, Glucocorticoids administration & dosage, Glucocorticoids adverse effects, Glucocorticoids therapeutic use, Humans, Maintenance Chemotherapy, Nebulizers and Vaporizers, Symptom Flare Up, Young Adult, Albuterol administration & dosage, Albuterol adverse effects, Albuterol therapeutic use, Asthma drug therapy, Budesonide administration & dosage, Budesonide adverse effects, Budesonide therapeutic use
- Abstract
Background: As asthma symptoms worsen, patients typically rely on short-acting β
2 -agonist (SABA) rescue therapy, but SABAs do not address worsening inflammation, which leaves patients at risk for severe asthma exacerbations. The use of a fixed-dose combination of albuterol and budesonide, as compared with albuterol alone, as rescue medication might reduce the risk of severe asthma exacerbation., Methods: We conducted a multinational, phase 3, double-blind, randomized, event-driven trial to evaluate the efficacy and safety of albuterol-budesonide, as compared with albuterol alone, as rescue medication in patients with uncontrolled moderate-to-severe asthma who were receiving inhaled glucocorticoid-containing maintenance therapies, which were continued throughout the trial. Adults and adolescents (≥12 years of age) were randomly assigned in a 1:1:1 ratio to one of three trial groups: a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide (with each dose consisting of two actuations of 90 μg and 80 μg, respectively [the higher-dose combination group]), a fixed-dose combination of 180 μg of albuterol and 80 μg of budesonide (with each dose consisting of two actuations of 90 μg and 40 μg, respectively [the lower-dose combination group]), or 180 μg of albuterol (with each dose consisting of two actuations of 90 μg [the albuterol-alone group]). Children 4 to 11 years of age were randomly assigned to only the lower-dose combination group or the albuterol-alone group. The primary efficacy end point was the first event of severe asthma exacerbation in a time-to-event analysis, which was performed in the intention-to-treat population., Results: A total of 3132 patients underwent randomization, among whom 97% were 12 years of age or older. The risk of severe asthma exacerbation was significantly lower, by 26%, in the higher-dose combination group than in the albuterol-alone group (hazard ratio, 0.74; 95% confidence interval [CI], 0.62 to 0.89; P = 0.001). The hazard ratio in the lower-dose combination group, as compared with the albuterol-alone group, was 0.84 (95% CI, 0.71 to 1.00; P = 0.052). The incidence of adverse events was similar in the three trial groups., Conclusions: The risk of severe asthma exacerbation was significantly lower with as-needed use of a fixed-dose combination of 180 μg of albuterol and 160 μg of budesonide than with as-needed use of albuterol alone among patients with uncontrolled moderate-to-severe asthma who were receiving a wide range of inhaled glucocorticoid-containing maintenance therapies. (Funded by Avillion; MANDALA ClinicalTrials.gov number, NCT03769090.)., (Copyright © 2022 Massachusetts Medical Society.)- Published
- 2022
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3. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma.
- Author
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Beasley R, Holliday M, Reddel HK, Braithwaite I, Ebmeier S, Hancox RJ, Harrison T, Houghton C, Oldfield K, Papi A, Pavord ID, Williams M, and Weatherall M
- Subjects
- Administration, Inhalation, Adrenergic beta-2 Receptor Agonists administration & dosage, Adrenergic beta-2 Receptor Agonists adverse effects, Adult, Aged, Albuterol adverse effects, Bronchodilator Agents adverse effects, Budesonide adverse effects, Drug Therapy, Combination, Female, Formoterol Fumarate adverse effects, Humans, Male, Metered Dose Inhalers, Middle Aged, Albuterol administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage, Budesonide administration & dosage, Formoterol Fumarate administration & dosage
- Abstract
Background: In double-blind, placebo-controlled trials, budesonide-formoterol used on an as-needed basis resulted in a lower risk of severe exacerbation of asthma than as-needed use of a short-acting β
2 -agonist (SABA); the risk was similar to that of budesonide maintenance therapy plus as-needed SABA. The availability of data from clinical trials designed to better reflect clinical practice would be beneficial., Methods: We conducted a 52-week, randomized, open-label, parallel-group, controlled trial involving adults with mild asthma. Patients were randomly assigned to one of three treatment groups: albuterol (100 μg, two inhalations from a pressurized metered-dose inhaler as needed for asthma symptoms) (albuterol group); budesonide (200 μg, one inhalation through a Turbuhaler twice daily) plus as-needed albuterol (budesonide maintenance group); or budesonide-formoterol (200 μg of budesonide and 6 μg of formoterol, one inhalation through a Turbuhaler as needed) (budesonide-formoterol group). Electronic monitoring of inhalers was used to measure medication use. The primary outcome was the annualized rate of asthma exacerbations., Results: The analysis included 668 of 675 patients who underwent randomization. The annualized exacerbation rate in the budesonide-formoterol group was lower than that in the albuterol group (absolute rate, 0.195 vs. 0.400; relative rate, 0.49; 95% confidence interval [CI], 0.33 to 0.72; P<0.001) and did not differ significantly from the rate in the budesonide maintenance group (absolute rate, 0.195 in the budesonide-formoterol group vs. 0.175 in the budesonide maintenance group; relative rate, 1.12; 95% CI, 0.70 to 1.79; P = 0.65). The number of severe exacerbations was lower in the budesonide-formoterol group than in both the albuterol group (9 vs. 23; relative risk, 0.40; 95% CI, 0.18 to 0.86) and the budesonide maintenance group (9 vs. 21; relative risk, 0.44; 95% CI, 0.20 to 0.96). The mean (±SD) dose of inhaled budesonide was 107±109 μg per day in the budesonide-formoterol group and 222±113 μg per day in the budesonide maintenance group. The incidence and type of adverse events reported were consistent with those in previous trials and with reports in clinical use., Conclusions: In an open-label trial involving adults with mild asthma, budesonide-formoterol used as needed was superior to albuterol used as needed for the prevention of asthma exacerbations. (Funded by AstraZeneca and the Health Research Council of New Zealand; Novel START Australian New Zealand Clinical Trials Registry number, ACTRN12615000999538.)., (Copyright © 2019 Massachusetts Medical Society.)- Published
- 2019
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4. Oxygen versus air-driven nebulisers for exacerbations of chronic obstructive pulmonary disease: a randomised controlled trial.
- Author
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Bardsley G, Pilcher J, McKinstry S, Shirtcliffe P, Berry J, Fingleton J, Weatherall M, and Beasley R
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- Aged, Aged, 80 and over, Blood Gas Monitoring, Transcutaneous, Cluster Analysis, Disease Progression, Double-Blind Method, Female, Humans, Linear Models, Male, Middle Aged, Nebulizers and Vaporizers, New Zealand, Partial Pressure, Albuterol administration & dosage, Bronchodilator Agents administration & dosage, Carbon Dioxide blood, Oxygen administration & dosage, Pulmonary Disease, Chronic Obstructive therapy
- Abstract
Background: In exacerbations of chronic obstructive pulmonary disease, administration of high concentrations of oxygen may cause hypercapnia and increase mortality compared with oxygen titrated, if required, to achieve an oxygen saturation of 88-92%. Optimally titrated oxygen regimens require two components: titrated supplemental oxygen to achieve the target oxygen saturation and, if required, bronchodilators delivered by air-driven nebulisation. The effect of repeated air vs oxygen-driven bronchodilator nebulisation in acute exacerbations of chronic obstructive pulmonary disease is unknown. We aimed to compare the effects of air versus oxygen-driven bronchodilator nebulisation on arterial carbon dioxide tension in exacerbations of chronic obstructive pulmonary disease., Methods: A parallel group double-blind randomised controlled trial in 90 hospital in-patients with an acute exacerbation of COPD. Participants were randomised to receive two 2.5 mg salbutamol nebulisers, both driven by air or oxygen at 8 L/min, each delivered over 15 min with a 5 min interval in-between. The primary outcome measure was the transcutaneous partial pressure of carbon dioxide at the end of the second nebulisation (35 min). The primary analysis used a mixed linear model with fixed effects of the baseline PtCO
2 , time, the randomised intervention, and a time by intervention interaction term; to estimate the difference between randomised treatments at 35 min. Analysis was by intention-to-treat., Results: Oxygen-driven nebulisation was terminated in one participant after 27 min when the PtCO2 rose by > 10 mmHg, a predefined safety criterion. The mean (standard deviation) change in PtCO2 at 35 min was 3.4 (1.9) mmHg and 0.1 (1.4) mmHg in the oxygen and air groups respectively, difference (95% confidence interval) 3.3 mmHg (2.7 to 3.9), p < 0.001. The proportion of patients with a PtCO2 change ≥4 mmHg during the intervention was 18/45 (40%) and 0/44 (0%) for oxygen and air groups respectively., Conclusions: Oxygen-driven nebulisation leads to an increase in PtCO2 in exacerbations of COPD. We propose that air-driven bronchodilator nebulisation is preferable to oxygen-driven nebulisation in exacerbations of COPD., Trial Registration: Australian New Zealand Clinical Trials Registry number ACTRN12615000389505 . Registration confirmed on 28/4/15.- Published
- 2018
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5. Beta-agonist overuse and delay in obtaining medical review in high risk asthma: a secondary analysis of data from a randomised controlled trial.
- Author
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Pilcher J, Patel M, Pritchard A, Thayabaran D, Ebmeier S, Shaw D, Black P, Braithwaite I, Weatherall M, and Beasley R
- Subjects
- Administration, Inhalation, Adult, Asthma diagnosis, Drug Therapy, Combination, Female, Humans, Male, Nebulizers and Vaporizers, Treatment Outcome, Albuterol administration & dosage, Anti-Asthmatic Agents administration & dosage, Asthma drug therapy, Budesonide, Formoterol Fumarate Drug Combination administration & dosage, Prescription Drug Overuse
- Abstract
Asthma mortality surveys report delays in seeking medical review and overuse of beta-agonist therapy as factors contributing to a fatal outcome. However, the strength of these associations is limited because many asthma deaths are unwitnessed. We undertook a secondary analysis of data from a 24-week randomised controlled trial of 303 patients with high-risk asthma, randomised to combination budesonide/formoterol inhaler according to a single maintenance and reliever therapy regimen or fixed dose budesonide/formoterol with salbutamol as reliever (Standard) regimen. Medication use was measured by electronic monitors. The thresholds for high, marked and extreme beta-agonist use days were defined in the single maintenance and reliever therapy arm as: >8, >12 and >16 actuations of budesonide/formoterol in excess of four maintenance doses, respectively; and in the Standard arm as: >16, >24 and >32 actuations of salbutamol, respectively. Whether a medical review was obtained within 48 h of an overuse episode was determined by review of data collected during the study by participant report. The mean (standard deviation) proportion of days in which high, marked and extreme beta-agonist overuse occurred without medical review within 48 h was 0·94(0·20), 0·94(0·15) and 0·94(0·17), and 0·92(0·19), 0·90(0·26) and 0·94(0·15) for single maintenance and reliever therapy and Standard regimens, respectively. In at least 90% of days, in which beta-agonist overuse occurred, patients did not obtain medical review within 48 h of beta-agonist overuse, regardless of the magnitude of overuse or the inhaled corticosteroid/long-acting beta-agonist regimen., Reliever Inhaler Overuse and Delay in Medical Review in Asthma: In asthma, overuse of beta-agonist reliever medication and delay in seeking medical review in an exacerbation are linked to asthma deaths. Janine Pilcher at the Medical Research Institute of New Zealand, and co-workers, conducted a review of data from a study of 303 adult patients with severe asthma, followed over 24 weeks. The patients were allocated to either a budesonide/formoterol, or a salbutamol inhaler to take for symptom relief, in addition to their maintenance treatment. Inhalers were fitted with electronic monitors, to accurately document every use. In both groups, on 90% of days when an exacerbation requiring excess use of an inhaler occurred, patients did not follow-up with medical professionals within 48 h as advised. Further, in both groups, 'extreme' reliever inhaler use was recorded at least once in around one in four patients.
- Published
- 2017
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6. Randomised, double-blind, placebo-controlled, cross-over single dose study of the bronchodilator duration of action of combination fluticasone furoate/vilanterol inhaler in adult asthma.
- Author
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Braithwaite I, Williams M, Power S, Pilcher J, Weatherall M, Baines A, Moynihan J, Kempsford R, and Beasley R
- Subjects
- Administration, Inhalation, Adolescent, Adrenal Cortex Hormones therapeutic use, Adrenergic beta-2 Receptor Agonists therapeutic use, Adult, Aged, Albuterol pharmacology, Androstadienes pharmacology, Asthma physiopathology, Benzyl Alcohols pharmacology, Bronchodilator Agents therapeutic use, Chlorobenzenes pharmacology, Cross-Over Studies, Double-Blind Method, Drug Combinations, Female, Forced Expiratory Volume drug effects, Humans, Male, Middle Aged, New Zealand epidemiology, Placebos, Pulmonary Disease, Chronic Obstructive physiopathology, Young Adult, Albuterol administration & dosage, Androstadienes administration & dosage, Asthma drug therapy, Benzyl Alcohols administration & dosage, Chlorobenzenes administration & dosage, Pulmonary Disease, Chronic Obstructive drug therapy
- Abstract
Background: Fluticasone furoate (FF)/vilanterol (VI) is a once-daily maintenance treatment for asthma and chronic obstructive pulmonary disease. The duration of bronchodilation beyond 24 h has not been determined previously., Methods: Adults aged 18-65 (n = 32), with asthma and reversibility to salbutamol (≥15% and ≥200 mL increase in forced expiratory volume in 1 s [FEV
1 ]) participated in a double-blind, placebo-controlled, crossover study. Patients were admitted to a clinical trials unit for 72 h, and inhaled, in random order, placebo or FF/VI 100/25 mcg via ELLIPTA dry powder inhaler on two occasions 7-14 days apart. FEV1 was measured at baseline, 15 and 30 min, 1, 2, 4, 12, 24, 36, 48, 60, and 72 h. The differences in change in FEV1 from baseline between treatments and corresponding two-sided 95% confidence intervals (CI) were calculated at each time point., Findings: FF/VI produced a rapid onset of bronchodilation (adjusted mean difference in change from baseline in FEV1 versus placebo at 15 min, 252 mL [95% CI 182-322]). Maximum bronchodilation was observed at 12 h (adjusted mean difference in the change from baseline in FEV1 , 383 mL [95% CI 285-481]). Bronchodilation was maintained throughout the 72-h assessment period (adjusted mean difference in the change in FEV1 from baseline at 72 h, 108 mL (95% CI 15-200]). FF/VI was well tolerated and no serious side effects were reported., Interpretation: A single dose of FF/VI 100/25 mcg showed evidence of a 72-h bronchodilator duration of action in adults with asthma., (Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.)- Published
- 2016
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7. Effect of smoking status on the efficacy of the SMART regimen in high risk asthma.
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Pilcher J, Patel M, Reddel HK, Pritchard A, Black P, Shaw D, Holt S, Weatherall M, and Beasley R
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- Administration, Inhalation, Adolescent, Adult, Aged, Asthma physiopathology, Drug Combinations, Female, Glucocorticoids administration & dosage, Humans, Male, Middle Aged, Risk, Treatment Outcome, Young Adult, Adrenergic beta-2 Receptor Agonists administration & dosage, Albuterol administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage, Budesonide administration & dosage, Formoterol Fumarate administration & dosage, Smoking physiopathology
- Abstract
Background and Objective: The optimal management of people with asthma with a significant smoking history is uncertain. The aim of this study was to determine whether the efficacy/safety profile of single combination inhaled corticosteroid (ICS)/long acting beta-agonist (LABA) inhaler maintenance and reliever therapy is influenced by smoking status., Methods: We undertook secondary analyses from an open-label 24-week randomized study of 303 high risk adult asthma patients randomized to budesonide/formoterol 200/6-µg-metred dose inhaler for maintenance (two actuations twice daily) and either budesonide/formoterol 200/6-µg-metred dose inhaler one actuation ('single ICS/LABA maintenance and reliever therapy (SMART)' regimen) or salbutamol 100 µg 1-2 actuations for symptom relief ('Standard' regimen). Smoking status was classified in to three groups, as 'current', 'ex' or 'never', and a smoking/treatment interaction term tested for each outcome variable. The primary outcome variable was number of participants with at least one severe exacerbation., Results: There were 59 current, 97 ex and 147 never smokers included in the analyses. The smoking status/treatment interaction term was not statistically significant for any of the outcome measures. With adjustment for smoking status, the number of participants with severe exacerbations was lower with the SMART regimen (OR 0.45, 95% CI: 0.26-0.77, P = 0.004; P value for interaction between smoking status and treatment 0.29)., Conclusion: We conclude that the favourable safety/efficacy profile of the SMART regimen applies to patients with high risk asthma, irrespective of smoking status., (© 2016 Asian Pacific Society of Respirology.)
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- 2016
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8. Predictors of severe exacerbations, poor asthma control, and β-agonist overuse for patients with asthma.
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Patel M, Pilcher J, Reddel HK, Qi V, Mackey B, Tranquilino T, Shaw D, Black P, Weatherall M, and Beasley R
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- Administration, Inhalation, Adrenergic beta-2 Receptor Agonists adverse effects, Adult, Albuterol adverse effects, Asthma diagnosis, Asthma physiopathology, Bronchodilator Agents adverse effects, Budesonide adverse effects, Disease Progression, Drug Combinations, Ethanolamines adverse effects, Female, Forced Expiratory Volume, Formoterol Fumarate, Glucocorticoids adverse effects, Humans, Lung physiopathology, Male, Metered Dose Inhalers, Middle Aged, Multivariate Analysis, New Zealand, Odds Ratio, Prospective Studies, Risk Factors, Severity of Illness Index, Surveys and Questionnaires, Time Factors, Treatment Outcome, Adrenergic beta-2 Receptor Agonists administration & dosage, Albuterol administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage, Budesonide administration & dosage, Ethanolamines administration & dosage, Glucocorticoids administration & dosage, Lung drug effects
- Abstract
Background: Predictors of asthma exacerbations, poor asthma control, or extreme β-agonist overuse may be of clinical utility in the management of asthma., Objective: To investigate characteristics that predict subsequent adverse outcomes in asthma., Methods: An independent 24-week, randomized controlled trial of 303 adult patients with asthma who are at risk, which compared the efficacy of SMART (single budesonide-formoterol inhaler as maintenance and reliever therapy) with a fixed-dose regimen with salbutamol as reliever ("Standard"). Inhaled medication use was measured by electronic monitoring. Baseline characteristics that were predictors of subsequent severe asthma exacerbations, poor asthma control (Asthma Control Questionnaire -5 score ≥1.5), and "extreme" β-agonist overuse (>16 budesonide-formoterol actuations/d in SMART and >32 salbutamol actuations/d in Standard) were assessed by multivariate analyses., Results: FEV₁ % predicted (rate ratio [RR] 1.14 [95% CI, 1.03-1.27] per 10% lower), more previous exacerbations (RR 1.15 [95% CI, 1.01-1.31]), Standard therapy (RR 1.62 [95% CI, 1.07-2.47]), and female sex (RR 2.18 [95% CI, 1.29-3.67]) were associated with future severe exacerbations. Asthma Control Questionnaire--5 (regression coefficient 0.20 [95% CI, 0.13-0.27] per 0.5 points higher) and age (regression coefficient 0.09 [95% CI, 0.01-0.17] per decade older) were associated with future poorly controlled asthma. Higher reliever use (RR 1.63 [95% CI, 1.36-1.95] per categorical score in Asthma Control Questionnaire question no. 6), Māori ethnicity (RR 2.20 [95% CI, 1.43-3.38]) and FEV₁ % predicted (RR 1.16 [95% CI, 1.03-1.31] per 10% lower) were associated with future extreme β-agonist overuse., Conclusion: Future severe asthma exacerbations, poor asthma control, and extreme β-agonist overuse are predicted by different baseline clinical and demographic characteristics and management approaches in at-risk asthma., (Copyright © 2014 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2014
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9. Combination budesonide/formoterol inhaler as maintenance and reliever therapy in Māori with asthma.
- Author
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Pilcher J, Patel M, Smith A, Davies C, Pritchard A, Travers J, Black P, Weatherall M, Beasley R, and Harwood M
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- Administration, Inhalation, Adolescent, Adult, Aged, Albuterol administration & dosage, Bronchodilator Agents administration & dosage, Budesonide administration & dosage, Drug Therapy, Combination, Ethanolamines administration & dosage, Female, Formoterol Fumarate, Humans, Male, Middle Aged, New Zealand, Outcome Assessment, Health Care, Prospective Studies, Risk Assessment, Time Factors, Treatment Outcome, Young Adult, Albuterol therapeutic use, Asthma drug therapy, Asthma ethnology, Bronchodilator Agents therapeutic use, Budesonide therapeutic use, Ethanolamines therapeutic use, Nebulizers and Vaporizers
- Abstract
Background and Objective: There are significant health disparities between Māori and non-Māori with asthma, a pattern seen between other ethnic populations. This study investigates outcomes for Māori in a randomized controlled trial (RCT) of combination budesonide/formoterol inhaler therapy in asthma., Methods: This 24-week multicentre RCT recruited 303 adult asthma patients, 44 of whom were Māori. Participants were randomized to the single combination budesonide/formoterol inhaler as maintenance and reliever therapy ('SMART') regimen or 'standard' regimen (combination budesonide/formoterol inhaler for maintenance and salbutamol as reliever). Outcomes included patterns of beta-agonist inhaler use including 'high use' of reliever therapy (>8 actuations of budesonide/formoterol in excess of four maintenance doses per day for SMART and >16 actuations per day of salbutamol for standard). Differences in outcomes for Māori versus non-Māori were assessed using an interaction term between ethnicity and treatment., Results: With adjustment for ethnicity, the SMART group had fewer days of high use (relative rate (RR) 0.57 (95% confidence interval (CI): 0.38-0.85)), days of high use without medical review within 48 h (RR 0.49 (95% CI: 0.32-0.75)) and severe exacerbations (RR 0.54 (95% CI: 0.36-0.81)) compared with standard. The magnitude of the benefit from the SMART regimen was similar in Māori and non-Māori. Regardless of treatment regimen, Māori demonstrated more days of high use, high use without medical review and underuse of maintenance therapy., Conclusions: The SMART regimen has a favourable risk/benefit profile in Māori. Days of high use, days of high use without medical review and underuse of maintenance treatment were greater in Māori, regardless of treatment regimen., (© 2014 Asian Pacific Society of Respirology.)
- Published
- 2014
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10. Metrics of salbutamol use as predictors of future adverse outcomes in asthma.
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Patel M, Pilcher J, Reddel HK, Pritchard A, Corin A, Helm C, Tofield C, Shaw D, Black P, Weatherall M, and Beasley R
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- Adrenergic beta-2 Receptor Agonists administration & dosage, Adrenergic beta-2 Receptor Agonists adverse effects, Adult, Albuterol administration & dosage, Albuterol adverse effects, Drug Overdose, Female, Humans, Male, Middle Aged, Odds Ratio, Prognosis, Risk Factors, Time Factors, Treatment Outcome, Adrenergic beta-2 Receptor Agonists therapeutic use, Albuterol therapeutic use, Asthma drug therapy
- Abstract
Background: Beta-agonist overuse is associated with adverse outcomes in asthma, however, the relationships between different metrics of salbutamol use and future risk are uncertain., Objective: To investigate the relationship between metrics of salbutamol use and adverse outcome., Methods: In a 24-week randomized controlled trial of 303 asthma patients at risk of severe exacerbations which compared the efficacy and safety of combination budesonide/formoterol inhaler according to a single inhaler regimen (SMART) with a fixed-dose regimen with salbutamol as reliever ('Standard'), actual medication use was measured by electronic monitoring (Australian New Zealand Clinical Trials Registry Number ACTRN12610000515099). A nested cohort study explored the relationship between metrics of baseline salbutamol use over 2 weeks and future severe asthma exacerbations, poor asthma control (ACQ-5 ≥ 1.5) or 'extreme' salbutamol overuse (> 32 salbutamol actuations/24-h period)., Results: Higher mean daily salbutamol use (per two actuations/day) [Odds ratio (OR) (95% CI) 1.24 (1.06-1.46)], higher days of salbutamol use (per 2 days in 2 weeks) [OR 1.15 (1.00-1.31)] and higher maximal 24-h use (per two actuations/day) [OR 1.09 (1.02-1.16)] were associated with future severe exacerbations. Higher mean daily salbutamol use was associated with future poor asthma control [OR 1.13 (1.02-1.26)]. Higher mean daily salbutamol use [OR 2.73 (1.84-4.07)], number of days of use [OR 1.46 (1.24-1.71)], and maximal daily use [OR 1.57 (1.31-1.89)] were associated with an increased risk of future extreme salbutamol overuse., Conclusion and Clinical Relevance: Electronically recorded frequency of current salbutamol use is a strong predictor of risk of future adverse outcomes in asthma, with average daily use performing the best. These findings provide new information for clinicians considering metrics of salbutamol as predictors of future adverse outcomes in asthma., (© 2013 John Wiley & Sons Ltd.)
- Published
- 2013
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11. Short-acting β-agonist use as a marker of current asthma control.
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Patel M, Pilcher J, Munro C, Hosking A, Pritchard A, Shaw D, Black P, Weatherall M, and Beasley R
- Subjects
- Adult, Female, Humans, Male, Middle Aged, Prospective Studies, ROC Curve, Adrenergic beta-2 Receptor Agonists therapeutic use, Albuterol therapeutic use, Asthma drug therapy
- Abstract
Background: The relationship between current asthma symptoms and rescue bronchodilator (reliever) use is uncertain, leading to different recommendations about the preferred reliever metric to use when assessing asthma control. In a 6-month randomized controlled trial of combination budesonide/formoterol as maintenance and reliever therapy versus combination budesonide/formoterol as maintenance treatment with albuterol as reliever, we measured inhaler use by electronic monitoring., Objective: To determine the agreement between current asthma symptoms and different metrics of albuterol use for patients randomly assigned to maintenance budesonide/formoterol treatment., Methods: Data on albuterol use were extracted for the 7-day period before visit 2 (at week 3) from 150 adult patients with asthma. Current asthma symptoms were measured by Asthma Control Questionnaire-5 (ACQ-5) score at the clinic visit., Results: The number of days of albuterol use, the average number of albuterol actuations/day, and the highest number of albuterol actuations/day in the 1-week period were all positively associated with ACQ-5 score (r = 0.41-0.45, P < .001) and had moderate discrimination for well-controlled and not well-controlled asthma (ACQ-5 scores ≤0.75 and ≥1.5, respectively), with receiver operator characteristic area under the curve of 0.80 to 0.82 and 0.70 to 0.77, respectively. Cut points of ≥3 days of albuterol use, average albuterol use of ≥1 actuation/day, and highest albuterol use of ≥4 actuations/day in the 1-week period had 73% sensitivity and 62% specificity, 78% sensitivity and 67% specificity, and 78% sensitivity and 66% specificity, respectively, for predicting an ACQ-5 ≥1.5., Conclusion: Our findings support the use of the number of days of albuterol use, the average number of albuterol actuations per day, and the highest number of albuterol actuations per day over a 1-week period of observation as comparable markers of current asthma control., (Copyright © 2013 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2013
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12. Effect of addition of salmeterol versus doubling the dose of fluticasone propionate on specific airway resistance in children with asthma.
- Author
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Murray CS, Custovic A, Lowe LA, Aldington S, Williams M, Beasley R, and Woodcock A
- Subjects
- Adrenergic beta-Agonists therapeutic use, Albuterol administration & dosage, Albuterol therapeutic use, Androstadienes therapeutic use, Asthma physiopathology, Bronchodilator Agents therapeutic use, Child, Child, Preschool, Dose-Response Relationship, Drug, Double-Blind Method, Drug Therapy, Combination, Female, Fluticasone, Humans, Male, Plethysmography, Respiratory Function Tests, Salmeterol Xinafoate, Treatment Outcome, Adrenergic beta-Agonists administration & dosage, Airway Resistance drug effects, Albuterol analogs & derivatives, Androstadienes administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage
- Abstract
Based primarily on extrapolation from adult studies, current pediatric asthma guidelines advise the addition of long-acting beta₂-agonists for children symptomatic on low/moderate-dose inhaled corticosteroids before increasing the corticosteroid dose. This study was designed to compare the effect of combination salmeterol/fluticasone propionate (SFC) with doubling the dose of fluticasone propionate (FP) on specific airway resistance (sR(aw)) in moderate/severe persistent asthmatic children. A double-blind, randomized, controlled study was performed; children with asthma (4-11 years old; sR(aw) > 1.3 kPa·s) were randomized after a 2-week run-in (FP, 100 μg, b.i.d.) to either SFC (50 μg/100 μg b.i.d.) or FP (200 μg b.i.d.) via Diskus (GlaxoSmithKline, Stockley Park, U.K.) for 6 weeks. Lung function (sR(aw)-plethysmography and forced expiratory volume in 1 second [FEV₁]) was measured before run-in, at randomization, after 3 weeks, at the end of 6-week treatment, and after 48-hour washout. Symptom scores and rescue medication use were recorded throughout. Thirty-five children entered run-in and 24 were randomized (mean age, 7.3 ± 2.2 years; 50% boys). All children showed an improvement in sR(aw). After adjusting for age, gender, and baseline sR(aw,) children receiving SFC had a significantly greater improvement in sR(aw) compared with those receiving FP (adjusted means ratio [95% confidence interval {CI}], 0.81 [0.68-0.97]; p = 0.021). There was a significant interaction between treatment and gender (sR(aw), adjusted geometric mean [95% CI ]kPa·s, SFC versus FP: boys, 1.25 [1.10-1.41] [n = 7] versus 1.87 [1.61-2.17] [n = 5]; girls, 1.29 [1.10-1.52] [n = 5] versus 1.29 [1.13-1.47] [n = 7]; p = 0.008). There were no differences in FEV₁, symptoms, or rescue medication use between the groups. Addition of salmeterol provides greater improvement in sR(aw) than doubling the dose of FP in children with moderate/severe persistent asthma.
- Published
- 2010
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13. Meta-analysis of the risk of mortality with salmeterol and the effect of concomitant inhaled corticosteroid therapy.
- Author
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Weatherall M, Wijesinghe M, Perrin K, Harwood M, and Beasley R
- Subjects
- Administration, Inhalation, Adrenergic beta-Agonists administration & dosage, Albuterol administration & dosage, Albuterol adverse effects, Androstadienes administration & dosage, Asthma mortality, Bronchodilator Agents administration & dosage, Drug Therapy, Combination adverse effects, Epidemiologic Methods, Fluticasone, Humans, Randomized Controlled Trials as Topic, Salmeterol Xinafoate, Albuterol analogs & derivatives, Asthma drug therapy, Bronchodilator Agents adverse effects
- Abstract
Background: There is concern that long-acting beta agonist (LABA) drugs may increase the risk of asthma mortality., Methods: A meta-analysis was conducted of asthma deaths in randomised controlled clinical trials from the GlaxoSmithKline database that compared salmeterol with a non-LABA comparator treatment in asthma. The Peto one-step method was used to determine the risk overall (all studies) and in derived datasets based on inhaled corticosteroid (ICS) use., Results: There were 35 asthma deaths in 215 studies with 106,575 subjects. Two studies (SMART and SNS) contributed 30/35 (86%) asthma deaths, the overall findings largely reflecting the characteristics of these studies. The odds ratio for risk of asthma mortality with salmeterol was 2.7 (95% CI 1.4 to 5.3). In 54 placebo controlled studies the risk of death from asthma in patients not prescribed ICS was 7.3 (95% CI 1.8 to 29.4). In 127 studies in which patients were prescribed ICS, the risk of asthma death was 2.1 (95% CI 0.6 to 7.9). In 63 studies in which patients were randomised to receive the combination salmeterol/fluticasone propionate inhaler or ICS, there were no asthma deaths among 22,600 patients., Conclusions: Salmeterol monotherapy in asthma increases the risk of asthma mortality and this risk is reduced with concomitant ICS therapy. There is no evidence that combination salmeterol/fluticasone propionate therapy is associated with an increased risk of asthma mortality, although this interpretation is limited by the low statistical power of available studies.
- Published
- 2010
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14. Safety of long-acting beta-agonists: urgent need to clear the air remains.
- Author
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Beasley R, Martinez FD, Hackshaw A, Rabe KF, Sterk PJ, and Djukanovic R
- Subjects
- Adrenergic beta-Agonists administration & dosage, Albuterol administration & dosage, Albuterol adverse effects, Ethanolamines administration & dosage, Formoterol Fumarate, Glucocorticoids therapeutic use, Humans, Salmeterol Xinafoate, Adrenergic beta-Agonists adverse effects, Albuterol analogs & derivatives, Asthma drug therapy, Asthma mortality, Ethanolamines adverse effects
- Published
- 2009
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- View/download PDF
15. The risk of asthma mortality with inhaled long acting beta-agonists.
- Author
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Wijesinghe M, Perrin K, Harwood M, Weatherall M, and Beasley R
- Subjects
- Administration, Inhalation, Adolescent, Adult, Albuterol administration & dosage, Asthma mortality, Child, Child, Preschool, Formoterol Fumarate, Humans, Meta-Analysis as Topic, Mortality trends, Pulmonary Disease, Chronic Obstructive drug therapy, Randomized Controlled Trials as Topic, Risk Factors, Salmeterol Xinafoate, Young Adult, Adrenergic beta-Agonists administration & dosage, Albuterol analogs & derivatives, Anti-Asthmatic Agents administration & dosage, Asthma drug therapy, Ethanolamines administration & dosage
- Abstract
This article reviews the available evidence as to whether inhaled long acting beta-agonists (LABA) increase the risk of asthma mortality and considers the implications for the use of this treatment in the management of asthma. Randomised controlled trials suggest that LABAs prescribed as monotherapy may increase the risk of asthma death in certain circumstances, such as the unsupervised "off-label" use without concomitant inhaled corticosteroid (ICS) treatment in patients with unstable asthma. However, there is also evidence that the use of LABAs in conjunction with ICS treatment in adult asthma as recommended in current guidelines is not associated with an increased risk of asthma mortality. The only way in which a prescriber can ensure that a patient with asthma takes LABA treatment in conjunction with ICS is through a combination ICS/LABA product, an approach which may have additional therapeutic advantages. We propose that in the management of asthma, a case can now be made to limit the availability of LABAs to combination LABA/ICS therapy.
- Published
- 2008
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16. Duration of action of the salmeterol/fluticasone combination inhaler administered in the evening: a randomized controlled trial in childhood asthma.
- Author
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Aldington S, Williams M, Weatherall M, and Beasley R
- Subjects
- Administration, Inhalation, Albuterol administration & dosage, Asthma physiopathology, Child, Cross-Over Studies, Double-Blind Method, Female, Fluticasone, Humans, Male, Pulmonary Ventilation, Salmeterol Xinafoate, Albuterol analogs & derivatives, Androstadienes administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage
- Abstract
Objective and Background: To investigate the duration of bronchodilator action of a salmeterol/fluticasone combination (SFC) inhaler when administered in the evening to children with asthma., Design: A double-blind, placebo-controlled, cross-over study., Setting: Hospital inpatient., Subjects: Fourteen children aged between 4 and 11 years with mild to moderate asthma (FEV(1) > 60% predicted) who exhibited a 15% increase in FEV(1) with bronchodilator., Interventions: SUBJECTS inhaled, in random order, either SFC (100/50 microg) or placebo, via accuhaler, at 20.00 hours on two separate occasions with at least 3 days between study days., Outcome Measures: Lung function measurements including FEV(1), PEF, specific airways conductance (sGaw) and maximum expiratory flow at 25-75% of vital capacity were measured at baseline, 2, 12, 16, 20 and 24 h., Results: For all lung function parameters SFC resulted in significantly greater bronchodilation than placebo for at least 20 h after inhalation. At 24 h, the increase in FEV(1) and PEF compared with placebo was 0.08 L (95% confidence interval: -0.18 to 0.02, P = 0.16) and 27 L/min (95% confidence interval: -47 to -6, P = 0.004), respectively., Conclusions: The single administration of SFC via an accuhaler in the evening resulted in significant bronchodilation for at least 20 h in children with asthma.
- Published
- 2006
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17. Moderate dose inhaled corticosteroids plus salmeterol versus higher doses of inhaled corticosteroids in symptomatic asthma.
- Author
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Masoli M, Weatherall M, Holt S, and Beasley R
- Subjects
- Administration, Inhalation, Albuterol administration & dosage, Dose-Response Relationship, Drug, Double-Blind Method, Fluticasone, Forced Expiratory Volume drug effects, Humans, Odds Ratio, Randomized Controlled Trials as Topic, Salmeterol Xinafoate, Treatment Outcome, Adrenal Cortex Hormones administration & dosage, Albuterol analogs & derivatives, Androstadienes administration & dosage, Anti-Asthmatic Agents administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage
- Abstract
Background: There is uncertainty as to the dose of inhaled corticosteroids (ICS) at which to start concomitant long acting beta agonist (LABA) treatment in patients with asthma not adequately controlled by ICS alone., Methods: A meta-analysis was carried out of randomised, double blind clinical trials that compared the efficacy of adding salmeterol to moderate doses of ICS (fluticasone propionate 200 mug/day or equivalent) with increasing the ICS dose by at least twofold in symptomatic adult patients with asthma. The main outcome measures were the number of subjects withdrawn from the study due to asthma and the number of subjects with at least one moderate or severe exacerbation., Results: Twelve studies with a total of 4576 subjects met the inclusion criteria for the analyses. The number of subjects withdrawn due to asthma and with at least one moderate or severe exacerbation was higher in the high dose ICS group (odds ratios 1.58, 95% CI 1.12 to 2.24 and 1.35, 95% CI 1.10 to 1.66, respectively). For the secondary outcome variables (forced expiratory volume in 1 second, morning and evening peak expiratory flow, and daytime beta agonist use) there was significantly greater benefit in the salmeterol group., Conclusions: This meta-analysis shows that the addition of salmeterol to moderate doses of ICS (fluticasone 200 mug/day or equivalent) in patients with asthma symptomatic at that dose results in significantly greater clinical benefit than increasing the dose of ICS by twofold or more.
- Published
- 2005
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18. The 24 h duration of bronchodilator action of the salmeterol/fluticasone combination inhaler.
- Author
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Masoli M, Weatherall M, Ayling J, Williams M, and Beasley R
- Subjects
- Administration, Inhalation, Adolescent, Adult, Albuterol therapeutic use, Asthma physiopathology, Bronchodilator Agents therapeutic use, Circadian Rhythm, Drug Administration Schedule, Drug Combinations, Epidemiologic Methods, Female, Fluticasone, Humans, Male, Middle Aged, Respiratory Function Tests, Salmeterol Xinafoate, Albuterol administration & dosage, Albuterol analogs & derivatives, Androstadienes therapeutic use, Asthma drug therapy, Bronchodilator Agents administration & dosage
- Abstract
Introduction: The duration of bronchodilator action of the long-acting beta agonist salmeterol when administered in the evening has not been investigated. In this study we have investigated whether a single evening dose of salmeterol, administered from the combination salmeterol/fluticasone (SFC) Accuhaler significantly attenuates the circadian rhythm in airway tone over 24 h., Methods: Eighteen subjects with mild to moderate asthma (mean FEV1 84% predicted) participated in a double-blind, double dummy, placebo controlled, cross-over study. Subjects inhaled, in random order, placebo, salbutamol (200 microg) or SFC (50/100 microg) administered in the evening (2000 h) on three separate occasions. Lung function measurements including FEV1, specific airways conductance (sGaw) and maximum expiratory flow at 25-75% of vital capacity (MEF(25-75%)) were assessed at baseline, at 1 h and subsequently every 4 h post-dose for 24 h., Results: Compared with placebo, SFC significantly improved the three measures of airways function throughout the 24 h period, with a difference in FEV1 at 24 h of 0.24 l (0.00-0.47 l). SFC abolished the biphasic pattern of the circadian rhythm in airway tone. In contrast, salbutamol had a significant bronchodilator action of 4-8 h, depending on the lung function parameter measured., Conclusion: The single evening administration of SFC via the Accuhaler resulted in a duration of bronchodilation of at least 24 h, with the abolition of the accentuated biphasic circadian variation in airway tone observed in asthma.
- Published
- 2005
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19. Metered dose inhalers: a need for dose counters.
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Holt S, Holt A, Weatherall M, Masoli M, and Beasley R
- Subjects
- Administration, Inhalation, Adult, Asthma drug therapy, Drug Packaging, Equipment Design, Humans, Albuterol administration & dosage, Bronchodilator Agents administration & dosage, Metered Dose Inhalers classification
- Abstract
Objectives: This study investigated the ability of patients to assess when a metered dose inhaler (MDI) is empty., Methodology: A total of 17 patients assessed, by shaking, the number of doses remaining in a salbutamol MDI that had been partially emptied. Another 100 patients were asked to collect all salbutamol MDIs they considered to be empty and would have thrown away. These MDI canisters were weighed and the number of doses that had been used was estimated., Results: Using the 'shaking method', patients overestimated the amount remaining by around 40 doses. The mean number of doses delivered from an MDI labelled to contain 200 doses before it was discarded was 224 (range, 155-289)., Conclusions: These findings confirm that patients are unable to determine when an MDI should be discarded, resulting in insufficient drug delivery at the end of the life of an MDI for the majority of patients, and wastage of the drug for others.
- Published
- 2005
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20. The pulmonary and extra-pulmonary effects of high-dose formoterol in COPD: a comparison with salbutamol.
- Author
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Goldkorn A, Diotto P, Burgess C, Weatherall M, Holt S, Beasley R, and Siebers R
- Subjects
- Adrenergic beta-Agonists administration & dosage, Adrenergic beta-Agonists therapeutic use, Aged, Albuterol administration & dosage, Albuterol therapeutic use, Blood Pressure drug effects, Cross-Over Studies, Double-Blind Method, Ethanolamines administration & dosage, Ethanolamines therapeutic use, Female, Forced Expiratory Volume, Formoterol Fumarate, Heart Rate drug effects, Humans, Male, Middle Aged, Peak Expiratory Flow Rate, Pulmonary Disease, Chronic Obstructive physiopathology, Adrenergic beta-Agonists pharmacology, Albuterol pharmacology, Ethanolamines pharmacology, Pulmonary Disease, Chronic Obstructive drug therapy
- Abstract
Objectives: Formoterol, a beta(2) agonist with a rapid onset of effect and long duration of action, can be used as maintenance and reliever medication for asthma and COPD. We compared the pulmonary and extra-pulmonary effects of cumulative doses of formoterol and salbutamol in patients with COPD to assess efficacy and safety., Methodology: In a randomized, double-blind, cross-over study, 12 patients with moderate to severe COPD inhaled, via Turbuhaler, 10 doses of formoterol (total metered dose, 120 microg, equivalent to a 90- microg delivered dose), salbutamol (total metered dose 2000 microg) or placebo at 2-min intervals on separate days. The effects on lung function (FEV(1) and PEF), heart rate, blood pressure, oxygen saturation, corrected QT interval (QTc), T-wave height and plasma potassium were assessed before each dose, 15 min after each dose, and at half-hourly intervals for 3 h following the final dose., Results: Inhalation of formoterol or salbutamol resulted in significant improvement in lung function (measured 30 min after the last dose) when compared with placebo. There were no clinically important or statistically significant changes in heart rate, QTc, T-wave height, plasma potassium, oxygen saturation, or systolic and diastolic blood pressures with formoterol or salbutamol. One patient developed ventricular trigeminy after both formoterol and salbutamol. She had had ventricular ectopics on her screening electrocardiogram., Conclusion: Formoterol and salbutamol both produced significant improvement in lung function and were similarly well tolerated in high doses, as might be taken by a patient for relief of COPD symptoms.
- Published
- 2004
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21. Increasing compliance with inhaled corticosteroids through the use of combination therapy.
- Author
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Holt S, Masoli M, and Beasley R
- Subjects
- Administration, Inhalation, Adrenal Cortex Hormones administration & dosage, Albuterol administration & dosage, Albuterol therapeutic use, Androstadienes administration & dosage, Androstadienes therapeutic use, Anti-Asthmatic Agents administration & dosage, Drug Therapy, Combination, Fluticasone, Humans, Salmeterol Xinafoate, Treatment Outcome, Adrenal Cortex Hormones therapeutic use, Albuterol analogs & derivatives, Anti-Asthmatic Agents therapeutic use, Asthma drug therapy, Bronchodilator Agents therapeutic use, Nebulizers and Vaporizers, Patient Compliance
- Published
- 2004
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22. Use of isotonic nebulised magnesium sulphate as an adjuvant to salbutamol in treatment of severe asthma in adults: randomised placebo-controlled trial.
- Author
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Hughes R, Goldkorn A, Masoli M, Weatherall M, Burgess C, and Beasley R
- Subjects
- Administration, Inhalation, Adolescent, Adult, Aged, Asthma physiopathology, Chemotherapy, Adjuvant, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Nebulizers and Vaporizers, Albuterol administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage, Calcium Channel Blockers administration & dosage, Magnesium Sulfate administration & dosage
- Abstract
Background: Intravenous magnesium can cause bronchodilation in treatment of severe asthma, however its effect by the nebulised route is uncertain. We aimed to assess the effectiveness of isotonic magnesium sulphate as an adjuvant to nebulised salbutamol in severe attacks of asthma., Methods: We enrolled 52 patients with severe exacerbations of asthma presenting to the emergency departments at two hospitals in New Zealand. A severe exacerbation was defined as a forced expiratory volume at 1 s (FEV(1)) of less than 50% predicted 30 min after initial administration of 2.5 mg salbutamol via nebulisation. In this randomised double-blind placebo-controlled trial patients received 2.5 mg nebulised salbutamol mixed with either 2.5 mL isotonic magnesium sulphate or isotonic saline on three occasions at 30 min intervals. The primary outcome measure was FEV(1) at 90 min. Analysis was per protocol., Findings: At 90 min the mean FEV1 in the magnesium group was 1.96 L (95% CI 1.68-2.24) and in the saline group 1.55 L (1.24-1.87). The difference in the mean FEV(1) between the magnesium and saline groups was 0.37 L (0.13-0.61, p=0.003)., Interpretation: Use of isotonic magnesium as an adjuvant to nebulised salbutamol results in an enhanced bronchodilator response in treatment of severe asthma.
- Published
- 2003
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23. Cumulative and single-dose design to assess the bronchodilator effects of beta2-agonists in individuals with asthma.
- Author
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Fishwick D, Bradshaw L, Macdonald C, Beasley R, Gash D, Bengtsson T, Bondesson E, and Borgström L
- Subjects
- Administration, Inhalation, Adrenergic beta-Agonists adverse effects, Adult, Albuterol adverse effects, Bronchodilator Agents adverse effects, Cross-Over Studies, Dose-Response Relationship, Drug, Double-Blind Method, Drug Administration Schedule, Female, Forced Expiratory Volume drug effects, Humans, Male, Middle Aged, Adrenergic beta-Agonists administration & dosage, Albuterol administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage
- Abstract
With the development of different chlorofluorocarbon (CFC)-free metered dose aerosol and dry powder devices, it is necessary to study and validate the methods used for assessing and comparing their efficacy. This study evaluated the cumulative dose design by determining the bronchodilator response to salbutamol given according to either a high or a low cumulative dose regimen. Adults with asthma (n = 24) were studied in a placebo-controlled, randomized, double-blind, cross-over design. On separate days, cumulative doses of salbutamol (50+50+100+200 or 100+100+ 200+400 or 400+0+0+0 or 0+0+0+0 microg) were given via Turbuhaler with 30 min between doses. The two cumulative dose regimens produced almost identical bronchodilator responses at each time point. The relative dose-potency between the 800- and 400- microg cumulative dose regimens was 0.7 with a 95% confidence interval of 0.5-1.0, excluding the true value of 2. The 400-microg cumulative dose regimen resulted in a higher FEV1 at 115 min than the 400-microg single-dose regimen. There was no difference in the bronchodilator response to the single dose of 50, 100, or 400 microg of salbutamol after either 5 or 25 min. Thus, care should be exercised when using either a cumulative or single-dose design for comparing different beta2-agonists, or different inhalation devices, with respect to their relative dose-potency. In addition, this study provides further evidence that for short-acting beta2-agonists such as salbutamol, lower doses than those normally recommended may be used, and that repeated self-administration of low doses over a period of 60 min may give a better bronchodilator response than a single administration of a high dose.
- Published
- 2001
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24. Case-control study of salmeterol and near-fatal attacks of asthma.
- Author
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Williams C, Crossland L, Finnerty J, Crane J, Holgate S, Pearce N, and Beasley R
- Subjects
- Adolescent, Adrenergic beta-Agonists therapeutic use, Adult, Albuterol adverse effects, Albuterol therapeutic use, Asthma drug therapy, Case-Control Studies, Child, Child, Preschool, Chronic Disease, Female, Fenoterol adverse effects, Fenoterol therapeutic use, Humans, Male, Middle Aged, Odds Ratio, Risk, Salmeterol Xinafoate, Adrenergic beta-Agonists adverse effects, Albuterol analogs & derivatives, Asthma chemically induced
- Abstract
Background: A case-control study was undertaken to investigate the hypothesis that the use of the long acting beta agonist salmeterol increases the risk of a near-fatal attack of asthma., Methods: The cases comprised admissions to the intensive care unit (ICU) for asthma in 14 major hospitals within the Wessex region in 1992. For each of the cases four age-matched controls were selected from asthma admissions to the same hospital during the same period. Information on prescribed drug therapy for the 48 cases and 185 controls was collected from the hospital admission records., Results: The patients admitted to the ICU had greater chronic asthma severity and had generally been prescribed more asthma drugs than the control admissions to hospital. The relative risk of a near-fatal attack of asthma in patients prescribed inhaled salmeterol was 2.32 (95% CI 1.05 to 5.16), p = 0.04. However, the salmeterol relative risk decreased to 1.42 (95% CI 0.49 to 4.10), p = 0.52 when the analysis was restricted to the more chronically severe patients (those in the subgroup of patients with a hospital admission for asthma in the previous 12 months). These findings suggest that the increased unadjusted relative risk with salmeterol is predominantly due to confounding by severity--that is, the increased relative risk is due to patients with more severe asthma (at greatest risk of a near-fatal asthma attack) being preferentially prescribed salmeterol. This interpretation is supported by the finding in this study that, within the control group (selected from the population of asthmatics requiring hospital admission), salmeterol was preferentially prescribed to the most severe patients (a threefold greater prescription of salmeterol to control patients if they had been admitted to hospital in the 12 months prior to the index admission). There was no increased risk of a near-fatal attack of asthma in patients prescribed a beta agonist by metered dose inhaler (OR 0.75 (95% CI 0.31 to 1.78), p = 0.51). In contrast, the relative risks for beta agonists delivered by nebulisation (OR 3.86 (95% CI 1.99 to 7.50), p < 0.001) and oral theophylline (OR 2.45 (95% CI 1.26 to 4.78), p < 0.01) were increased and did not markedly decrease when the analysis was restricted to the more severe asthmatic subjects., Conclusions: Although these findings are not conclusive, particularly because of the small numbers involved in some subgroup analyses, they suggest that the use of salmeterol by patients with chronic severe asthma is not associated with a significantly increased risk of a near-fatal attack of asthma. If a near-fatal asthma attack is considered to be an intermediate step in a process by which a severe attack of asthma may become fatal, these results would suggest that salmeterol is unlikely to be associated with an increased risk of death, at least by this mechanism.
- Published
- 1998
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25. Partial vs full beta-receptor agonism. A clinical study of inhaled albuterol and fenoterol.
- Author
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Bremner P, Siebers R, Crane J, Beasley R, and Burgess C
- Subjects
- Administration, Inhalation, Adrenergic beta-Agonists administration & dosage, Adult, Aged, Albuterol administration & dosage, Anti-Asthmatic Agents therapeutic use, Asthma drug therapy, Blood Pressure drug effects, Bronchodilator Agents administration & dosage, Cross-Over Studies, Cyclic AMP blood, Dose-Response Relationship, Drug, Double-Blind Method, Female, Fenoterol administration & dosage, Heart drug effects, Heart Rate drug effects, Humans, Male, Middle Aged, Potassium blood, Risk Factors, Systole drug effects, Time Factors, Adrenergic beta-Agonists pharmacology, Albuterol pharmacology, Bronchodilator Agents pharmacology, Fenoterol pharmacology
- Abstract
Study Objective: To compare the maximal extrapulmonary effects of the beta-agonists albuterol and fenoterol in eight healthy volunteers., Subjects and Methods: In this double-blind study, we have examined the maximum cardiac effects (electromechanical systole [QS2I]--a measure of inotropy, heart rate, BP) and metabolic effects (plasma K+ and cyclic adenosine monophosphate [cAMP]) of repeated inhalation of albuternol and fenoterol. In eight healthy volunteers, 400 microg of each drug was administered every 10 min until QS2I and plasma K+ had reached a plateau (+/- 0.1 mmo l/L for K+, and +/- 10 ms for QS2I). The maximum response (Emax) and the dose of albuterol required to produce 50% of the maximum response to fenoterol (ED50F) were calculated., Results: The Emax for fenoterol was significantly greater than albuterol for plasma K+ (-1.4 vs -1.03 mmol/L; p<0.002), QS2I (-71.8 vs 57.5 ms; p=0.047), and cAMP (33.8 vs 18.1 nmol/L; p<0.002). The dose required to produce the ED50f was significantly greater for albuterol than for fenoterol with potency ratios of 1.75, 1.61, and 2.26 for plasma K+, QS2I, and cAMP, respectively. There were no significant differences between fenoterol and albuterol with respect to heart rate (Emax, 44.9 vs 32.5 beats/min; p=0.19; potency ratio, 1.98; p=0.052)., Conclusions: These findings suggest that albuterol behaves as a partial agonist at beta-receptors when compared with fenoterol, and that when inhaled in doses currently recommended for severe asthma, albuterol will result in lesser maximum cardiac and metabolic effects than fenoterol. These findings are consistent with the hypothesis that the property of full receptor agonism may contribute to the increased risk of death associated with fenoterol.
- Published
- 1996
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26. Extrapulmonary effects of fenoterol and salbutamol in normal subjects.
- Author
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Crane J, Burgess C, Beasley R, and Wong C
- Subjects
- Atenolol pharmacology, Humans, Albuterol pharmacology, Fenoterol pharmacology, Heart Rate drug effects
- Published
- 1994
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27. A comparison of the cardiovascular and metabolic effects of formoterol, salbutamol and fenoterol.
- Author
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Bremner P, Woodman K, Burgess C, Crane J, Purdie G, Pearce N, and Beasley R
- Subjects
- Administration, Inhalation, Adrenergic beta-Agonists administration & dosage, Adult, Albuterol administration & dosage, Double-Blind Method, Ethanolamines administration & dosage, Female, Fenoterol administration & dosage, Formoterol Fumarate, Humans, Male, Adrenergic beta-Agonists pharmacology, Albuterol pharmacology, Ethanolamines pharmacology, Fenoterol pharmacology, Hemodynamics drug effects
- Abstract
The cardiovascular and metabolic effects of the long-acting beta 2-agonist formoterol were compared with those of salbutamol, fenoterol and placebo in 12 healthy volunteers, using a randomised, double-blind, cross-over design. On the study days, the subjects inhaled either formoterol (24 micrograms), salbutamol (400 micrograms), fenoterol (400 micrograms) or placebo, at 30 min intervals for five doses. Heart rate (HR) total electromechanical systole (Q-S2I) (a measure of inotropy), the corrected QT interval (QTc), systolic and diastolic blood pressure, plasma glucose and plasma potassium (K+) were measured prior to drug administration, 10 min after each inhalation and at 30 min intervals for 3 h after the last inhalation. All of the active agents significantly increased HR, QTc and plasma glucose, and decreased Q-S2I, diastolic blood pressure and plasma K+ compared to placebo. Fenoterol had a significantly greater maximum effect on HR, QTc and Q-S2I than either salbutamol or formoterol. Formoterol and fenoterol caused a similar maximum reduction in plasma K+, greater than that due to salbutamol. We conclude that formoterol is a more selective beta 2-agonist than fenoterol, and has similar cardiovascular effects to salbutamol when inhaled repeatedly by normal volunteers.
- Published
- 1993
28. The extrapulmonary effects of inhaled hexoprenaline and salbutamol in healthy individuals.
- Author
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Bremner P, Burgess C, Purdie G, Beasley R, and Crane J
- Subjects
- Administration, Inhalation, Adult, Albuterol administration & dosage, Blood Pressure drug effects, Female, Heart Rate drug effects, Hexoprenaline administration & dosage, Humans, Male, Albuterol pharmacology, Hemodynamics drug effects, Hexoprenaline pharmacology, Potassium blood
- Abstract
We have investigated the cardiovascular and metabolic effects of multiple inhaled doses of salbutamol and hexoprenaline in 12 healthy volunteers. They inhaled 200 micrograms of salbutamol or hexoprenaline at 15 min intervals for 60 min from a metered dose inhaler (total dose 1000 micrograms). We measured heart rate, blood pressure, total electromechanical systole (as a measure of inotropic response), QTc interval on the ECG, and plasma potassium at baseline, 10 min after each inhalation, and 30 and 60 min after the last inhalation. There was no difference in the effects of the two drugs on blood pressure, total electromechanical systole, or QTc interval. Salbutamol significantly increased heart rate compared with hexoprenaline. Hexoprenaline caused a significantly greater fall in plasma potassium compared with salbutamol.
- Published
- 1993
- Full Text
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29. Nebulized fenoterol causes greater cardiovascular and hypokalaemic effects than equivalent bronchodilator doses of salbutamol in asthmatics.
- Author
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Bremner P, Burgess C, Beasley R, Woodman K, Marshall S, Crane J, and Pearce N
- Subjects
- Adult, Double-Blind Method, Female, Fenoterol adverse effects, Forced Expiratory Volume drug effects, Heart Rate drug effects, Humans, Male, Stimulation, Chemical, Systole drug effects, Albuterol pharmacology, Asthma physiopathology, Cardiovascular System drug effects, Fenoterol pharmacology, Hypokalemia chemically induced
- Abstract
The pulmonary and extrapulmonary effects of two doses of nebulized fenoterol (5 mg) salbutamol (5 mg) and ipratropium bromide (0.5 mg) at 60 min intervals were compared in nine patients with asthma in a double-blind, randomized study. Measurements of heart rate, blood pressure, electromechanical systole (QS2I), QTc interval, FEV1 and plasma potassium were made at baseline and at 15, 30 and 60 min after each nebulization. Both beta-agonists caused significantly greater inotropic (QS2I), chronotropic (HR), electrocardiographic (QTc) and hypokalaemic effects than ipratropium bromide (IB), with fenoterol being more potent than salbutamol. Fenoterol had no greater effect on FEV1 than salbutamol although both were superior to IB. Only the first four subjects had two doses as originally intended, because the second administration of fenoterol resulted in marked cardiovascular effects and hypokalaemia. The observed differences in extrapulmonary effects between fenoterol and salbutamol provide a plausible group of mechanisms which may explain the increased risk of death associated with fenoterol in severe asthmatics.
- Published
- 1992
- Full Text
- View/download PDF
30. Albuterol and deaths from asthma in New Zealand from 1969 to 1976: a case-control study.
- Author
-
Woodman K, Pearce N, Beasley R, Burgess C, and Crane J
- Subjects
- Adolescent, Adult, Case-Control Studies, Child, Child, Preschool, Fenoterol therapeutic use, Humans, New Zealand epidemiology, Albuterol therapeutic use, Asthma drug therapy, Asthma mortality
- Abstract
It has been suggested that the association between inhaled fenoterol and deaths from asthma in New Zealand occurred because patients with unstable asthma were switched to fenoterol after its introduction in 1976. If so, a similar pattern might also have occurred after the introduction of albuterol (salbumatol) in 1969. This hypothesis has been investigated in a case-control study of 17 deaths from asthma during the period from 1969 to 1976 in patients whose ages ranged from 5 to 45 years; as in a previous study in New Zealand, two control groups were used. The inhaled albuterol odds ratio was 0.88 (95% confidence interval, 0.29 to 2.62) using control group A and 1.40 (95% confidence interval, 0.48 to 4.09) using control group B. The major problem with this study is the very small number of cases, but the findings nevertheless indicate that albuterol was not associated with deaths from asthma after its introduction.
- Published
- 1992
- Full Text
- View/download PDF
31. The effect of benzalkonium chloride on the bronchodilator response to salbutamol nebuliser solution.
- Author
-
Kwong T, Flatt A, Crane J, and Beasley R
- Subjects
- Albuterol therapeutic use, Asthma physiopathology, Forced Expiratory Volume drug effects, Humans, Nebulizers and Vaporizers, Albuterol administration & dosage, Asthma drug therapy, Benzalkonium Compounds pharmacology, Bronchi drug effects
- Published
- 1990
32. A comparison of the haemodynamic and hypokalaemic effects of inhaled pirbuterol and salbutamol.
- Author
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Windom H, Grainger J, Burgess C, Crane J, Pearce N, and Beasley R
- Subjects
- Administration, Inhalation, Adult, Dose-Response Relationship, Drug, Double-Blind Method, Female, Humans, Male, Reference Values, Adrenergic beta-Agonists pharmacology, Albuterol pharmacology, Bronchodilator Agents pharmacology, Ethanolamines pharmacology, Hemodynamics drug effects, Hypokalemia chemically induced
- Abstract
In this double blind study, the cardiovascular and hypokalaemic effects of equal doses of inhaled pirbuterol and salbutamol were compared in eight healthy volunteers. Increasing doses of 200, 400, 600 and 800 micrograms (total dose 2000 micrograms) were given from a metered dose inhaler at 15 min intervals, followed by measurement of heart rate, blood pressure, total electromechanical systole (QS2I) (as a measure of inotropic response) and plasma potassium (K+) concentration 15 min after each inhalation. After inhalation of the highest concentration, salbutamol resulted in a greater increase in heart rate (10.5 bpm vs 4.4 bpm, p less than 0.0007), and reduction in QS2I (-25.4 ms vs -9.6 ms, p less than 0.0001) than pirbuterol. There were no significant differences in changes in systolic blood pressure (1.9 mmHg vs 6 mmHg, p = 0.27), diastolic blood pressure (-5.8 mmHg vs -3.9 mmHg, p = 0.64) or plasma K+ (-0.21 mmol/L vs -0.15 mmol/L, p = 0.57). We conclude that the new beta-2 adrenergic agonist pirbuterol is at least as beta-2 selective as salbutamol when administered by repeated inhalation in healthy volunteers.
- Published
- 1990
33. The cardiovascular effects of beta adrenergic agonist drugs administered by nebulisation.
- Author
-
Flatt A, Crane J, Purdie G, Kwong T, Beasley R, and Burgess C
- Subjects
- Adult, Blood Pressure drug effects, Double-Blind Method, Electrocardiography drug effects, Female, Heart Rate drug effects, Humans, Male, Nebulizers and Vaporizers, Systole drug effects, Time Factors, Albuterol pharmacology, Fenoterol pharmacology, Heart drug effects, Terbutaline pharmacology
- Abstract
The cardiovascular effects of equal doses (5 mg) of nebulised fenoterol, salbutamol and terbutaline were compared in 12 healthy individuals in a double-blind, placebo-controlled study. Measurements of heart rate, blood pressure, systolic time intervals, QTc interval and T-wave amplitude were made at baseline and at 15, 30, 45, 60 and 90 minutes after nebulisation. Fenoterol caused significantly greater chronotropic electrocardiographic and inotropic effects than either salbutamol or terbutaline. The peak effects after terbutaline occurred later than those after fenoterol or salbutamol.
- Published
- 1990
- Full Text
- View/download PDF
34. Cardiovascular and hypokalaemic effects of inhaled salbutamol, fenoterol, and isoprenaline.
- Author
-
Crane J, Burgess C, and Beasley R
- Subjects
- Administration, Inhalation, Adult, Blood Pressure drug effects, Double-Blind Method, Heart drug effects, Heart Rate drug effects, Humans, Male, Albuterol pharmacology, Fenoterol pharmacology, Hemodynamics drug effects, Isoproterenol pharmacology, Potassium blood
- Abstract
The cardiovascular and hypokalaemic effects of equal doses of inhaled fenoterol, isoprenaline and salbutamol were compared in eight healthy male volunteers, in a double blind, placebo controlled study. Increasing doses of 400, 600, and 800 micrograms were given from a metered dose inhaler at 15 minute intervals, followed by measurements of heart rate, blood pressure, total electromechanical systole (as a measure of inotropic response), QTc interval, and plasma potassium concentration. After repeated inhalation, fenoterol resulted in significantly greater chronotropic, electrocardiographic, and hypokalaemic effects than either isoprenaline or salbutamol. The maximum inotropic effect of fenoterol was similar to that of isoprenaline.
- Published
- 1989
- Full Text
- View/download PDF
35. A comparison of the cardiovascular and metabolic effects of formoterol, salbutamol and fenoterol
- Author
-
Bremner, P., Woodman, K., Burgess, C., Crane, J., Purdie, G., Neil Pearce, and Beasley, R.
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,Double-Blind Method ,Ethanolamines ,Formoterol Fumarate ,Administration, Inhalation ,Hemodynamics ,Humans ,Albuterol ,Female ,Adrenergic beta-Agonists ,Fenoterol - Abstract
The cardiovascular and metabolic effects of the long-acting beta 2-agonist formoterol were compared with those of salbutamol, fenoterol and placebo in 12 healthy volunteers, using a randomised, double-blind, cross-over design. On the study days, the subjects inhaled either formoterol (24 micrograms), salbutamol (400 micrograms), fenoterol (400 micrograms) or placebo, at 30 min intervals for five doses. Heart rate (HR) total electromechanical systole (Q-S2I) (a measure of inotropy), the corrected QT interval (QTc), systolic and diastolic blood pressure, plasma glucose and plasma potassium (K+) were measured prior to drug administration, 10 min after each inhalation and at 30 min intervals for 3 h after the last inhalation. All of the active agents significantly increased HR, QTc and plasma glucose, and decreased Q-S2I, diastolic blood pressure and plasma K+ compared to placebo. Fenoterol had a significantly greater maximum effect on HR, QTc and Q-S2I than either salbutamol or formoterol. Formoterol and fenoterol caused a similar maximum reduction in plasma K+, greater than that due to salbutamol. We conclude that formoterol is a more selective beta 2-agonist than fenoterol, and has similar cardiovascular effects to salbutamol when inhaled repeatedly by normal volunteers.
36. Beta-agonists and death from asthma
- Author
-
Neil Pearce, Crane J, Burgess C, Beasley R, and Jackson R
- Subjects
Dose-Response Relationship, Drug ,Case-Control Studies ,Humans ,Albuterol ,Adrenergic beta-Agonists ,Asthma ,Fenoterol
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