Search

Patients with chronic obstructive pulmonary disease (COPD) are often treated with high dose inhalations of beta 2-agonists. We compared domiciliary therapy with terbutaline administered by the Turbuhaler and by a jet nebulizer. Forty nebulizer users with severe COPD were included in the randomized, double-blind, cross-over study. Terbutaline was inhaled t.i.d. for 2 weeks as dry powder (5 doses = 2.5 mg) by Turbuhaler or as solution (2 ml = 5 mg) by jet nebulizer (Pari Inhalierboy). The mean age of the 25 completing patients was 66 years (range: 54-81), the mean FEV1 was 0.73 l or 29% of predicted (range: 11-55%). The period where the Turbuhaler delivered the active drug was preferred by 16 patients, the nebulizer period by seven (P = 0.09). The median score concerning feeling of control over the disease--according to the Chronic Respiratory Disease Questionnaire--was better after the Turbuhaler period (P = 0.01). Other scores concerning disease related quality of life, the daily peak expiratory flow rates, the additional use of a metered dose inhaler were not significantly different for the two types of treatment. It is concluded that high dose domiciliary terbutaline treatment by Turbuhaler can replace nebulizer treatment in most patients with severe COPD.

A total of 140 patients with chronic obstructive pulmonary disease was included in this multicentre parallel group investigation with the object of assessing whether poor inhalation technique results in increased consumption of beta 2-agonist. On the basis of measurements of pulmonary function, the patients were stratified into two groups with good and poor inhalation techniques, respectively, and these were subdivided at random to inhalation of terbutaline via either a freon spray (aerosol) or Turbohaler (powder). During a period of four weeks the daily terbutaline consumption, the symptoms and pulmonary function were noted. Patients with poor inhalation technique did not have significantly increased terbutaline consumption. The consumption of terbutaline was independent of the method of administration. The Turbohaler was just as effective as the spray and the patients preferred this method, (p less than 0.05).

During recent years, in assessment of the therapeutic effect of medicinal treatment, measurement of the general condition of health or quality of life has been extensively employed. This holds true particularly in patients with chronic disease, including patients with chronic obstructive pulmonary disease. In this patient category, several controlled investigations have been carried out in which one or more questionnaires concerning general health have been employed. The questionnaires employed and reviewed are the Sickness impact profile (SIP), Mcmaster's chronic respiratory disease questionnaire (CRQ), Quality of well-being scale (QWB), General health questionnaire (GHQ), Minnesota multiphasic personality inventory (MMPI) and Profile of mood states (POMS). The questionnaires contain questions regarding many aspects of the existence of the patients and have been tested to varying extents for reproducibility, sensitivity and validity. No patent method exists for measurement of quality of life. It is therefore important for interpretation of investigations that the aspects of quality of life which have been measured are clearly defined and that the questionnaire method employed is quoted.