1,142 results on '"Albuterol adverse effects"'
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2. Giant lung cavity due to three different pathogens in a patient receiving inhaled salmeterol plus fluticasone propionate for asthma.
- Author
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Güner Zırıh NM, Yılmaz Kara B, Özyurt S, Okçu O, İlgar T, and Şahin Ü
- Subjects
- Humans, Female, Middle Aged, Administration, Inhalation, Albuterol adverse effects, Albuterol administration & dosage, Androstadienes administration & dosage, Androstadienes adverse effects, Candidiasis drug therapy, Candidiasis diagnosis, Candidiasis microbiology, Fluticasone adverse effects, Fluticasone administration & dosage, Sputum microbiology, Bronchodilator Agents adverse effects, Bronchodilator Agents administration & dosage, Staphylococcal Infections drug therapy, Staphylococcal Infections microbiology, Bronchoalveolar Lavage Fluid microbiology, Bronchoalveolar Lavage Fluid cytology, Lung pathology, Lung microbiology, Lung diagnostic imaging, Mycobacterium tuberculosis isolation & purification, Fluticasone-Salmeterol Drug Combination adverse effects, Fluticasone-Salmeterol Drug Combination administration & dosage, Asthma drug therapy, Staphylococcus aureus isolation & purification, Candida albicans isolation & purification
- Abstract
Introduction: High-dose and long-term use of inhaled corticosteroids may cause systemic and local side effects such as opportunistic infections. Here we report a patient with asthma who developed a giant cavity in the lung while using inhaled salmeterol plus fluticasone propionate., Case Study: A 57-year-old female patient presented with a three-week history of cough, hemoptysis, and dyspnea. She had a diagnosis of asthma for 4 years and was using an inhaled salmeterol plus fluticasone treatment intermittently for 2 years. A giant cavity was detected in the patient's chest X-ray. As a result of further investigations, three different microorganisms were isolated from the samples of sputum, bronchial lavage and lung biopsy., Results: Staphylococcus aureus was the first microorganism that was isolated from the sputum and the bronchial lavage. Afterwards, Candida albicans was detected in both the bronchial lavage fluid and the histologic examination of the tissue samples obtained by percutaneous lung biopsy. Appropriate antibiotics and antifungals were prescribed. Moderate clinical and radiological response to the treatment was obtained. During the outpatient follow-up, Mycobacterium tuberculosis growth which was sensitive to all of the major anti-tuberculosis drugs was reported in the mycobacterial culture, and the patient was started on anti-tuberculosis treatment., Conclusion: Tuberculosis and other opportunistic infections are a potential consequences of inhaled corticosteroids. Clinicians overseeing such patients need to be vigilant about the need for timely investigations about tuberculosis before and during prescribing medications containing inhaled corticosteroids.
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- 2024
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3. Efficacy and safety of fluticasone propionate/salmeterol and fluticasone propionate monotherapy in step-up treatment of childhood asthma: A systematic review and meta-analysis.
- Author
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Li H, Dong T, and Luan J
- Subjects
- Adult, Child, Humans, Fluticasone therapeutic use, Fluticasone-Salmeterol Drug Combination therapeutic use, Albuterol adverse effects, Salmeterol Xinafoate therapeutic use, Treatment Outcome, Bronchodilator Agents adverse effects, Administration, Inhalation, Randomized Controlled Trials as Topic, Androstadienes adverse effects, Asthma drug therapy
- Abstract
Background: Asthma is a chronic respiratory disease that affects millions of children worldwide and can impair their quality of life and development. Inhaled glucocorticoids are the mainstay of asthma treatment, but some children require step-up therapy with additional drugs to achieve symptom control. Fluticasone propionate and salmeterol (FSC) has been shown to reduce asthma exacerbations and improve lung function in adults. However, the evidence for its efficacy and safety in children is limited., Objective: This study aims to provide a comprehensive basis for treatment selection by summarizing existing clinical randomized controlled trials (RCTs) on the efficacy of FSC compared to fluticasone propionate (FP) monotherapy in children with asthma who require step-up treatment., Methods: Five online databases and three clinical trial registration platforms were systematically searched. The effect size and corresponding 95% confidence interval (CI) were calculated based on the heterogeneity among the included studies., Results: Twelve RCTs were identified and a total of 9, 859 patients were involved. The results of the meta-analysis revealed that the use of FSC was associated with a greater reduction in the incidence of asthma exacerbations than FP alone when the dose of FP was the same or when the duration of treatment exceeded 12 weeks. In addition, FSC resulted in a greater proportion of time with asthma-free and without the use of albuterol compared to FP alone when the duration of treatment exceeded 12 weeks. No significant differences were observed between FSC and FP alone in the incidence of drug-related adverse events and other adverse events., Conclusion: Both FSC and FP alone are viable options for the initial selection of step-up treatment in asthmatic children. While, FSC treatment demonstrates a greater likelihood of reducing asthma exacerbations which is particularly important for reducing the personnel, social and economic burden in children requiring step-up asthma treatment., Competing Interests: Declaration of Competing Interest All the authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier Inc.)
- Published
- 2024
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4. Safety outcomes of salbutamol: A systematic review and meta-analysis.
- Author
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Ma LH, Jia L, and Bai L
- Subjects
- Humans, Albuterol adverse effects, Tachycardia
- Abstract
Purpose: Salbutamol has been used to alleviate bronchospasm in airway disease for decades, while its potential risks have not been systematically investigated yet. The risk of any potential adverse events (AEs) in patients treated with salbutamol was assessed through systematic review and meta-analysis., Methods: A systematic search of the literature was conducted, using EMBASE, PubMed and Cochrane library, until 3 April 2023. Once the AE incidence was evaluated, randomized controlled trials (RCTs) were eligible for review. The endpoints included the incidence of total AEs, severe AEs, treatment discontinuation and specific AEs. The pooled AEs incidence was analysed via random-effects model in a single-arm meta-analysis. A subgroup study was carried out to examine whether the pooled incidence of AE differed by indications or formulations., Results: Of the 8912 studies that were identified, 58 RCTs met the inclusion criteria and involved 12 961 participants. The analysis showed the pooled incidences of total AEs, severe AEs and treatment discontinuation in patients treated with salbutamol were 34%, 2% and 3%, respectively. Subgroup analysis indicated that premature labour users and intravenous salbutamol users were more likely associated with total AEs. The most frequently observed specific AEs were palpitations or tachycardia., Conclusion: This meta-analysis indicated that salbutamol was associated with a very common risk of palpitations or tachycardia. Clinical vigilance and research efforts are needed to optimize the safe use of salbutamol., (© 2023 The Authors. The Clinical Respiratory Journal published by John Wiley & Sons Ltd.)
- Published
- 2023
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5. Rebound hyperkalemia in a dog with albuterol toxicosis after cessation of potassium supplementation.
- Author
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Guida SJ and Bazzle L
- Subjects
- Humans, Female, Dogs, Animals, Potassium, Albuterol adverse effects, Tachycardia, Sinus complications, Tachycardia, Sinus drug therapy, Tachycardia, Sinus veterinary, Electrolytes therapeutic use, Dietary Supplements, Hyperkalemia chemically induced, Hyperkalemia therapy, Hyperkalemia veterinary, Hypokalemia chemically induced, Hypokalemia therapy, Hypokalemia veterinary, Dog Diseases
- Abstract
Objective: To describe the presentation of rebound hyperkalemia as a delayed side effect of albuterol toxicity in a dog., Case Summary: A 3-year-old female neutered mixed-breed dog was presented for albuterol toxicosis that led to a severe hypokalemia, hyperlactatemia, and hyperglycemia. The dog also experienced sinus tachycardia and generalized weakness. Treatment was instituted with intravenous fluid therapy and potassium supplementation, and the dog was monitored with a continuous electrocardiogram. Resolution of hypokalemia was documented 12 hours after initial presentation, at which time fluid therapy and potassium supplementation were discontinued. There were no further periods of sinus tachycardia, but instead the dog developed ventricular ectopy with rapid couplets (instantaneous rates of 300/min). An echocardiogram revealed normal cardiac size and function. Twenty-four hours after presentation, the patient developed severe hyperkalemia, despite discontinuation of fluids and potassium supplementation for 12 hours. Serial venous and urinary electrolytes were performed for determination of the fractional excretion of electrolytes. These data confirmed rebound hyperkalemia (7.0 mmol/L), consistent with a markedly increased fractional excretion of potassium, and secondary to the release of potassium from inside the cells. Fluid therapy with dextrose supplementation was provided until 36 hours postpresentation. The hyperkalemia resolved, and the dog was discharged after 44 hours of hospitalization., New or Unique Information Provided: This case documents rebound hyperkalemia following treatment of albuterol toxicosis in a dog. This case highlights the importance of understanding the distribution of total body potassium when treating serum hypokalemia. Transcellular shifts of potassium, as in the case of albuterol toxicosis, can lead to rebound hyperkalemia even after discontinuation of potassium supplementation. This case further explores the utility of fractional excretion of electrolytes in elucidating the etiology and management of electrolyte disturbances., (© 2023 The Authors. Journal of Veterinary Emergency and Critical Care published by Wiley Periodicals LLC on behalf of Veterinary Emergency and Critical Care Society.)
- Published
- 2023
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6. The Potential Synergistic Risk of Albuterol and Vasoactives in Acute Lung Injury Trials.
- Author
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Almuntashiri S, Chase A, Sikora A, and Zhang D
- Subjects
- Humans, Administration, Intravenous, Albuterol adverse effects, Intensive Care Units, Acute Lung Injury drug therapy, Drug-Related Side Effects and Adverse Reactions
- Abstract
Background: Critically ill patients are often prescribed both inhaled beta-agonists and intravenous vasoactive; however, the interaction of the additive beta-agonist effects of these 2 agents remains largely uncharacterized., Objective: The purpose of this study was to evaluate how concomitant use of albuterol and vasoactive or inotropes affected ventilator-free days (VFDs) by re-analyzing the data from the Albuterol to Treat Acute Lung Injury (ALTA) trial., Methods: In this study, subjects were grouped to albuterol-vasoactive (n = 84) versus (vs) placebo-vasoactive (n = 62). Ventilator-free days, intensive care unit (ICU)-free days, organ failure-free days, cardiovascular adverse events, and 90-day mortality were compared. The primary outcome was VFDs., Results: Patients in the albuterol-vasoactive group had significantly fewer VFDs than patients in the placebo-vasoactive group (11 vs 19, P = 0.05). Patients in the albuterol-vasoactive group also had significantly fewer ICU-free days (9.5 vs 18.5, P = .006). The 90-day mortality was similar between groups (36.9% vs 27.4%, P = .20). Similarly, no significant difference in cardiac adverse events between the groups (14.3% vs 11.3%, P = 0.59)., Conclusion and Relevance: This study has shown fewer VFDs for patients who received both vasoactive and albuterol. There were also fewer ICU-free days when compared to those on vasoactive only. Given the common use of both agents, a prospective evaluation of the additive adverse effects of beta-agonism is warranted.
- Published
- 2023
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7. Regular formoterol plus inhaled corticosteroid vs. salmeterol plus inhaled corticosteroid for asthma.
- Author
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Steward M and Sheth S
- Subjects
- Humans, Formoterol Fumarate therapeutic use, Salmeterol Xinafoate, Albuterol adverse effects, Adrenal Cortex Hormones adverse effects, Administration, Inhalation, Drug Combinations, Asthma drug therapy, Anti-Asthmatic Agents adverse effects
- Published
- 2023
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8. [Evaluation of the efficacy and safety of a combination drug containing ambroxol, guaifenesin, and levosalbutamol versus a fixed-dose combination of bromhexine/guaifenesin/salbutamol in the treatment of productive cough in adult patients with acute bronchitis].
- Author
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Zaitsev AA, Leshchenko IV, Esaulova NA, and Viktorova IA
- Subjects
- Humans, Adult, Cough drug therapy, Cough etiology, Expectorants adverse effects, Albuterol adverse effects, Treatment Outcome, Levalbuterol therapeutic use, Drug Combinations, Acute Disease, Guaifenesin adverse effects, Ambroxol adverse effects, Bronchitis diagnosis, Bronchitis drug therapy, Bronchitis chemically induced, Bromhexine adverse effects
- Abstract
Aim: To evaluate the efficacy and safety of a combination drug containing ambroxol, guaifenesin, and levosalbutamol, oral solution, versus Ascoril Expectorant, syrup (combination of bromhexine, guaifenesin, and salbutamol) in the treatment of productive cough in adult patients with acute bronchitis., Materials and Methods: This open-label, randomized, phase III study included patients with acute bronchitis who had a productive cough with difficulty in sputum expectoration. 244 patients were randomized in a 1:1 ratio and received 10 mL of the study drug or reference drug 3 times daily for 2 weeks. After 7 and 14 days of treatment, the physician evaluated patient's subjective complaints and the efficacy of therapy. The primary endpoint was the proportion of patients with high and very high efficacy., Results: The primary endpoint was reached by 70 (0.5738) patients in the study drug group and 54 (0.4426) in the reference drug group ( p =0.04). The intergroup difference was 0.1311 [95% confidence interval: 0.0057; 0.2566]. The lower limit of the 95% confidence interval was above zero, which confirms the superiority of therapy with the study drug over therapy with Ascoril Expectorant. The proportion of patients with a 1-point total score reduction and with complete resolution of all symptoms according to the Modified Cough Relief and Sputum Expectoration Questionnaire after 7 and 14 days was numerically higher in the study drug group versus the reference drug group. There were no statistically significant differences between the groups in the incidence of adverse events., Conclusion: The efficacy of a new combination drug containing ambroxol, guaifenesin, and levosalbutamol in the treatment of productive cough in adult patients with acute bronchitis is superior to the efficacy of Ascoril Expectorant. The safety profiles of the study drug and the reference drug were comparable.
- Published
- 2023
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9. Comparative Efficacy of Levosalbutamol and Racemic Salbutamol in the Treatment of Acute Exacerbation of Asthma.
- Author
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Rabbany MA, Saha BK, Subha N, Sultana I, Islam MS, Hossain AJ, Seraj S, Farzana S, Sharmin M, Ali MM, Nahar A, and Siddiqui KA
- Subjects
- Adult, Humans, Child, Bangladesh, Levalbuterol therapeutic use, Administration, Inhalation, Double-Blind Method, Bronchodilator Agents therapeutic use, Acute Disease, Albuterol therapeutic use, Albuterol adverse effects, Asthma drug therapy
- Abstract
Asthma is a major noncommunicable disease (NCD), affecting both children and adults, and is the most common chronic disease among children. It is common in all ages and the prevalence is increasing in most countries, especially among children as because of urbanization. Multiple therapeutic modalities are available for management of acute asthma. The commonly used formulation is Racemic Salbutamol which contains equal amounts of both R and S isomers. Levosalbutamol contains only R isomer. The aim of the study was to compare the efficacy of levosalbutamol and racemic salbutamol for the treatment of acute exacerbation of asthma in children (5 to 15 years). A randomized double blind clinical trial was conducted in the Department of Paediatrics, Sylhet MAG Osmani Medical College Hospital, Sylhet, Bangladesh from October 2013 to March 2014. In this study randomization was done in two groups. Group A received nebulized levosalbutamol (LEV) and Group B received nebulized racemic salbutamol (RAC). The study parameters were respiratory rate (RR), heart rate (HR), oxygen saturation in room air (SpO₂), PEFR, asthma score and serum K+ level. The results of treatment outcome were compared between two groups. After treatment the respiratory rate was 24.4±5.6 per minute versus 27.6±5.3 per minute (p<0.05); heart rate was 115.5±16.4 per minute versus 124.5±12.0 per minute (p<0.05); SpO₂ was 97.2±1.8% vs 95.0±1.6% (p<0.05); PEFR was found 159.6±30.7L/min versus 143.8±27.1L/min (p<0.05) in the LEV and RAC group respectively. LEV is more effective than RAC in respect to significant improvement of asthma score. Regarding adverse events racemic salbutamol causes significant tachycardia. The study concluded that nebulized levosalbutamol is superior to racemic salbutamol in children in the treatment of acute exacerbation of asthma.
- Published
- 2023
10. Albuterol-Associated Hallucinations: A Case Report and Literature Review.
- Author
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Erickson J
- Subjects
- Humans, Albuterol adverse effects, Hallucinations chemically induced
- Published
- 2022
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11. Is Seizure an Adverse Effect of Salbutamol in the Pediatric Population?
- Author
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Uysalol M, Yıldız R, and Özünal ZG
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- Albuterol adverse effects, Child, Humans, Retrospective Studies, Seizures diagnosis, Seizures drug therapy, Seizures etiology, Asthma complications, Asthma drug therapy, Epilepsy complications
- Abstract
Background: Although studies on epileptic seizures occurring during acute asthma attacks are limited, there is widespread belief among families and physicians that salbutamol causes seizures., Aims: To investigate whether salbutamol triggers seizures in patients with epilepsy and asthma., Study Design: A retrospective cohort study., Methods: Epilepsy and asthma in patients aged 2-18 years who were admitted to the pediatric emergency department because of asthma attacks between January 2016 and December 2016 in a university hospital were evaluated retrospectively. The inclusion criteria were age 2–18 years, previous diagnosis of epilepsy and asthma, and admission to the pediatric emergency department due to asthma attacks., Results: 276 medical records were evaluated. The seizure group had a longer period of diagnosis for epilepsy than the seizure absent group in the pediatric emergency department (5.4 years and 3.1, respectively). According to the logistic regression analysis, the duration of seizures in the emergency department, duration of asthma diagnosis, duration of epilepsy diagnosis, uncontrolled asthma, and severity of asthma attack in the pediatric emergency department have significantly increased the possibility of having a seizure during an asthma attack in our study population., Conclusion: This study shows that patients using salbutamol have a lower risk of epileptic seizures than those who do not use salbutamol. This result should be verified by studies containing a large number of patients.
- Published
- 2022
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12. [Pharmacoeconomics analysis of using a fixed combination of budesonide/formoterol in patients with asthma in the health care system of the Russian Federation].
- Author
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Zyryanov SK, Dyakov IN, and Aisanov ZR
- Subjects
- Humans, Formoterol Fumarate therapeutic use, Budesonide adverse effects, Bronchodilator Agents therapeutic use, Economics, Pharmaceutical, Ethanolamines adverse effects, Drug Combinations, Albuterol adverse effects, Fluticasone-Salmeterol Drug Combination therapeutic use, Delivery of Health Care, Administration, Inhalation, Budesonide, Formoterol Fumarate Drug Combination therapeutic use, Asthma drug therapy
- Abstract
Aim: To evaluate the budgetary impact of using budesonide + formoterol (Symbicort Turbuhaler) as maintenance therapy in real clinical practice compared with standard therapy for asthma of varying severity: for mild asthma with on-demand salbutamol; for moderate and severe asthma with the drug salmeterol + fluticasone and salbutamol on demand., Materials and Methods: A static mathematical model was built to assess the impact on the budget when introducing the drug budesonide + formoterol (Symbicort Turbuhaler) in the treatment of asthma into clinical practice from the point of view of the state. Demographic data was taken from the official data of the Federal State Statistics Service. Direct medical costs included the cost of medicines, the cost of hospitalization of patients associated with the development of asthma exacerbations, and the cost of scheduled outpatient visits. Indirect costs considered the loss of GDP due to hospitalization of patients against the background of asthma exacerbations. A one-way sensitivity analysis was performed to confirm the robustness of the study results., Results: Assessment of direct costs in the treatment of mild, moderate and severe asthma showed that a gradual increase in the proportion of patients receiving the drug budesonide + formoterol (Symbicort Turbuhaler) over the years to 5.5, 7.7 and 9.7% accordingly, led to an increase in the cost of pharmacotherapy over 3 years by 1.7 billion rubles, while direct non-drug costs associated with the treatment of complications that developed during the treatment of asthma decreased by 8.3 billion rubles. Thus, the reduction in total direct costs amounted to RUB 6.7 billion. At the same time, indirect costs decreased by 6.0 billion rubles. The total reduction in all costs (direct and indirect) when switching patients to budesonide + formoterol (Symbicort Turbuhaler) amounted to 12.5 billion rubles. In addition, the use of the drug budesonide + formoterol (Symbicort Turbuhaler) resulted in a decrease in the number of exacerbations: in the first year by 3137, in the second by 4393 and in the third by 5534 cases. A total of 13 064 asthma exacerbations were prevented over 3 years., Conclusion: Increasing the proportion of patients with asthma of varying severity receiving therapy with budesonide + formoterol (Symbicort Turbuhaler) will reduce the financial burden on both the healthcare system and the budgetary system.
- Published
- 2022
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13. Retrospective evaluation of acute salbutamol (albuterol) exposure in dogs: 501 cases.
- Author
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Crouchley J and Bates N
- Subjects
- Albuterol adverse effects, Animals, Arrhythmias, Cardiac drug therapy, Arrhythmias, Cardiac veterinary, Dogs, Potassium, Retrospective Studies, Dog Diseases chemically induced, Dog Diseases drug therapy, Hypokalemia chemically induced, Hypokalemia veterinary
- Abstract
Objective: To determine the common clinical signs, with onset and duration, treatments given, and outcome in dogs with acute, accidental exposure to salbutamol., Design: Retrospective study., Animals: Five hundred and one canine cases reported to the UK's Veterinary Poisons Information Service (VPIS)., Measurements and Main Results: A review of all records in the VPIS database for dogs exposed to salbutamol was carried out. After applying inclusion and exclusion criteria, the records of 501 dogs were further analyzed. The most common clinical signs were tachycardia (80.6%), tachypnea (32.9%), depression (21.0%), and vomiting (19.2%). The dose was unknown in most cases as the dogs typically pierced a salbutamol inhaler. The blood potassium concentration was measured in at least 142 dogs and hypokalemia was reported in 21.2% (106/501), 18 (17%) of which had associated weakness, twitching, or collapse. Three dogs had paralysis probably as a result of hypokalemia, although no potassium concentration was reported in these cases. Arrhythmias occurred in 17 dogs (3.4%), and 7 required pharmacological intervention. There were no reports of persistent cardiac injury or thermal injury from the compressed gas present in some salbutamol products. Signs were rapid in onset, generally within 1-3 h, and, where time to outcome was recorded (n = 172), 78% of dogs recovered within 24 h. Of the 501 dogs, no treatment was required in 27.9%. Beta-blockers were used in 39.5%, intravenous fluids in 28.7%, and potassium supplementation in 15.8%. Overall, 30 dogs remained asymptomatic (6.0%), 469 recovered (93.6%), and 2 dogs (0.4%) died., Conclusions: Most dogs exposed to salbutamol rapidly develop clinical signs; these were commonly increased heart and respiration rates. Hypokalemia and arrhythmias (particularly ventricular arrhythmias) are potential complications. Any dog that chews a salbutamol inhaler should be assessed promptly for signs of toxicosis. Prognosis in dogs with acute salbutamol exposure is good, but more guarded in those with severe tachycardia and at risk of cardiac injury., (© Veterinary Emergency and Critical Care Society 2022.)
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- 2022
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14. 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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15. Salbutamol for analgesia in renal colic: study protocol for a prospective, randomised, placebo-controlled phase II trial (SARC).
- Author
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Johnson G, Tabner A, Fakis A, Sherman R, Chester V, Bedford E, Jackson R, Ratan H, and Mason S
- Subjects
- Albuterol adverse effects, Analgesics adverse effects, Clinical Trials, Phase II as Topic, Humans, Nausea chemically induced, Pain drug therapy, Prospective Studies, Randomized Controlled Trials as Topic, Analgesia methods, Renal Colic chemically induced, Renal Colic diagnosis, Renal Colic drug therapy
- Abstract
Background: Renal colic is the pain experienced by a patient when a renal calculus (kidney stone) causes partial or complete obstruction of part of the renal outflow tract. The standard analgesic regimes for renal colic are often ineffective; in some studies, less than half of patients achieve complete pain relief, and a large proportion of patients require rescue analgesia within 4 h. Current analgesic regimes are also associated with significant side effects including nausea, vomiting, drowsiness and respiratory depression. It has been hypothesised that beta adrenoreceptor agonists, such as salbutamol, may reduce the pain of renal colic. They have been shown to impact a number of factors that target the physiological causes of pain in renal colic (ureteric spasm and increased peristalsis, increased pressure at the renal pelvis and prostaglandin release with inflammation). There is biological plausibility and a body of evidence sufficient to suggest that this novel treatment for the pain of renal colic should be taken to a phase II clinical trial. The aim of this trial is to test whether salbutamol is an efficacious analgesic adjunct when added to the standard analgesic regime for patients presenting to the ED with subsequently confirmed renal colic., Methods: A phase II, randomised, placebo-controlled trial will be performed in an acute NHS Trust in the East Midlands. Patients presenting to the emergency department with pain requiring IV analgesia and working diagnosis of renal colic will be randomised to receive standard analgesia ± a single intravenous injection of Salbutamol. Secondary study objectives will explore the feasibility of conducting a larger, phase III trial., Discussion: The trial will provide important information about the efficacy of salbutamol as an analgesic adjunct in renal colic. It will also guide the development of a definitive phase III trial to test the cost and clinical effectiveness of salbutamol as an analgesic adjunct in renal colic. Salbutamol benefits from widespread use across the health service for multiple indications, extensive staff familiarity and a good side effect profile; therefore, its potential use for pain relief may have significant benefits for patient care., Trial Registration: ISRCTN Registry ISRCTN14552440 . Registered on 22 July 2019., (© 2022. The Author(s).)
- Published
- 2022
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16. Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report.
- Author
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Colombo M, Plebani A, Bosco A, and Agosti M
- Subjects
- Administration, Inhalation, Albuterol adverse effects, Bronchodilator Agents therapeutic use, Child, Family, Humans, Male, Acidosis, Lactic, Asthma drug therapy, Hypotension chemically induced, Hypotension drug therapy
- Abstract
Background: Salbutamol is a selective β2-receptor agonist widely used to treat asthma in both emergency and outpatient settings. However, it has been associated with a broad spectrum of side effects. Lactic acidosis and diastolic hypotension are rarely reported together following intermittent salbutamol nebulization in children, even less so at standard therapeutic doses., Case Presentation: We present the case of a 12-year-old Italian boy, 34 kg body weight, who experienced a serious drug reaction during a moderate asthma exacerbation with associated dehydration (blood urea nitrogen/creatinine 0.25), following intermittent inhaled (0.2 mg at 3-hour intervals-overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg at 20-minute intervals in 60 minutes, overall 11.25 mg in our emergency department). The patient developed hyperglycemia (peak concentration 222 mg/dL), hypokalemia (lowest concentration 2.6 mEq/L), electrocardiogram alterations (corrected QT interval 467 ms), long-lasting arterial hypotension despite fluid boluses (lowest value 87/33 mmHg), and elevated blood lactate levels (peak concentration 8.1 mmol/L), following the third nebulized dose. Infections, liver dysfunction, and toxicity following other medications were ruled out. The aforementioned alterations improved within 24 hours after discontinuation of salbutamol., Conclusions: We reinforce the message that even the use of intermittent nebulized salbutamol for acute moderate asthma can lead to severe transient complications in children. Then, healthcare providers should pay attention not only in emergency settings, to achieve prompt recognition and proper management of this adverse reaction. Careful reassessment could prevent similar reactions., (© 2022. The Author(s).)
- Published
- 2022
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17. Effectiveness and safety of salmeterol/fluticasone fixed-dose combination delivered through Synchrobreathe ® in patients with asthma: the real-world EVOLVE study.
- Author
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Balamurugan S, Sonia D, Vikrant D, Monotosh K, Raj Shyam S, Shamim A, Vinay K, Velayuthaswamy N, Masood A, Manohar Lal G, Ajay G, Sushmeeta C, Meena L, Sandesh S, Sonali J, Abhijit V, and Jaideep G
- Subjects
- Humans, Prospective Studies, Forced Expiratory Volume, Drug Combinations, Fluticasone-Salmeterol Drug Combination, Androstadienes, Albuterol adverse effects, Treatment Outcome, Administration, Inhalation, Double-Blind Method, Bronchodilator Agents, Asthma diagnosis, Asthma drug therapy
- Abstract
Background: Inhalation therapy with corticosteroids and long-acting β
2 -agonists has been the mainstay of asthma management. However, choosing the correct inhaler technique is essential to effectively deliver the medication to the lungs to attain good asthma control., Objective: This study aimed to evaluate asthma control and device usability with salmeterol/fluticasone fixed-dose combination (FDC) administered through Synchrobreathe® , a breath-actuated inhaler (BAI), in Indian patients with persistent asthma (EVOLVE study)., Design: The present study was a prospective, open-label, non-comparative, multi-center, observational study., Methods: The study enrolled 490 patients with documented diagnoses of asthma who were treatment-naive or uncontrolled due to poor inhaler technique associated with a previous device. The primary endpoint was a change from baseline in the Asthma Control Questionnaire-6 (ACQ-6) score at week 12., Results: Mean ACQ-6 score reduced from 2.2 ± 1.07 (baseline) to 0.4 ± 0.49 (mean change: -1.9 ± 1.12, p < 0.0001) at week 12 in the intention-to-treat (ITT) population, and minimal clinically important difference of 0.5 was observed from week 4 onwards. Peak expiratory flow rate improved by 82.5 ± 75.74 ml/min ( p < 0.0001) at week 12 in the ITT population. The proportion of well-controlled responders increased from 39.9% (week 4) to 77.1% (week 12). Most (91%) patients preferred the Synchrobreathe® and rated it very high for usability, portability, patient confidence, and satisfaction. Salmeterol/fluticasone FDC administered through Synchrobreathe® was well tolerated., Conclusion: Treatment with salmeterol/fluticasone FDC administered through Synchrobreathe® for 12 weeks persistently improved asthma control and lung function and was well tolerated. Most patients were satisfied with it and preferred Synchrobreathe® BAI over their previous device., Registration: The study was registered with the Clinical Trial Registry of India (CTRI/2018/12/016629).- Published
- 2022
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18. Acute nontraumatic rhabdomyolysis in a Greyhound after albuterol toxicosis.
- Author
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Granfone M and Walker JM
- Subjects
- Albuterol adverse effects, Animals, Dogs, Male, Acute Kidney Injury veterinary, Dog Diseases chemically induced, Hyperkalemia veterinary, Hypokalemia veterinary, Rhabdomyolysis chemically induced, Rhabdomyolysis veterinary
- Abstract
Objective: To describe the clinical features of rhabdomyolysis due to albuterol toxicosis in a Greyhound., Case Summary: A 4-year-old neutered male Greyhound was presented for albuterol toxicosis leading to severe hypokalemia and respiratory paralysis. After 3 hours of mechanical ventilation, pigmenturia and marked enlargement, firmness, and pain of the left thigh muscles were noted. Severe hyperkalemia and cardiac arrhythmias were identified after turning the patient. After discontinuation of mechanical ventilation, other muscles became involved, and the patient developed acute kidney injury and concern for multiple organ dysfunction syndrome over the next 5 days. On day 6, the patient was euthanized, and necropsy revealed myocardial and skeletal muscle necrosis, myoglobinuria, and acute tubular degeneration., New or Unique Information Provided: To the authors' knowledge, this is the first case of albuterol toxicosis leading to rhabdomyolysis., (© Veterinary Emergency and Critical Care Society 2021.)
- Published
- 2021
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19. Salbutamol and salt-sensitive hypertension.
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Bailey MA
- Subjects
- Albuterol adverse effects, Animals, Humans, Kidney Tubules, Distal, Mice, Sodium Chloride, Solute Carrier Family 12, Member 3, Hypertension chemically induced, Hypertension drug therapy, Sodium Chloride, Dietary
- Abstract
Salbutamol activates the NaCl cotransporter of the distal convoluted tubule. Salbutamol, in conjunction with high salt intake, induced hypertension in mice, rescued by thiazide therapy. Phosphoproteomics identified protein phosphatase 1/inhibitor 1 as a distinct regulatory node for NaCl cotransporter activation by salbutamol, which did not activate the transporter in inhibitor 1 knockout mice. Salbutamol is widely used in respiratory medicine, and the acquisition of salt sensitivity may be relevant to understanding cardiovascular risk in certain patients., (Copyright © 2021 International Society of Nephrology. Published by Elsevier Inc. All rights reserved.)
- Published
- 2021
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20. Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children.
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Woodward S, Mundorff M, Weng C, Gamboa DG, and Johnson MD
- Subjects
- Adrenergic beta-2 Receptor Agonists therapeutic use, Albuterol adverse effects, Body Mass Index, Child, Child, Preschool, Female, Humans, Incidence, Infant, Levalbuterol adverse effects, Male, Racial Groups, Risk Factors, Tachycardia, Supraventricular physiopathology, Adrenergic beta-2 Receptor Agonists adverse effects, Asthma drug therapy, Tachycardia, Supraventricular chemically induced
- Abstract
Introduction: Albuterol can trigger supraventricular tachycardia (SVT). The clinical characteristics, incidence, and risk factors of SVT after inhaled SABA treatment in children are currently unknown. Through review of regional care delivery, we will describe cases of SVT during asthma treatment in hospital-based settings, define the incidence of SVT in our population, and evaluate risk factors of SABA-induced SVT., Methods: We identified hospital-based care episodes of children 0-18 years old between 2006 and 2015 recorded in the Intermountain Healthcare EDW with either 1) diagnosis codes for both asthma and SVT or 2) both SABA and adenosine listed as billed medications. Controls were matched with cases by age and sex to determine risk factors for SVT after SABA using conditional logistic regression., Results: Of 93 care episodes meeting criteria, we found 7 cases of SVT after SABA treatment in 6 patients over 10 years. In our population, the incidence of SVT is 3.9 per 10,000 episodes of SABA treatment, and 5.1 per 10,000 children with asthma receiving hospital-based asthma care. Two episodes of SVT followed treatment with only levalbuterol, three after only albuterol, and two after both albuterol and levalbuterol treatment. Five cases of SVT were converted to sinus rhythm with adenosine, one converted with synchronized electrical cardioversion, and one resolved spontaneously. No cases of SVT led to death. No examined variables were associated with SABA-induced SVT., Conclusions: SVT is rare during hospital-based treatment for acute asthma using inhaled SABAs and has low morbidity and mortality.
- Published
- 2021
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21. Inhaled Albuterol Use and Impaired Lactate Clearance in Patients With Sepsis: A Retrospective Cohort Study.
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Maeda T, Paralkar J, Kuno T, and Patrawalla P
- Subjects
- Administration, Inhalation, Adult, Albuterol administration & dosage, Hospital Mortality, Humans, Lactic Acid blood, Retrospective Studies, Albuterol adverse effects, Lactic Acid metabolism, Sepsis metabolism
- Abstract
Background: Lactate clearance has become important in the management of sepsis. However, factors unrelated to sepsis-induced hyperlactatemia, including β-2 adrenergic agonists, can interfere with lactate clearance., Objectives: To investigate the association of inhaled albuterol with lactate clearance in patients with sepsis., Methods: This was a single-center retrospective cohort study. Adult patients with sepsis diagnosed in the emergency department from May 2015 to May 2016 with initial lactate levels >2 mmol/L and serial lactate measurements 2 to 6 hours apart were included. Patients were divided into 2 groups based on whether they received inhaled albuterol between lactate measurements. The primary end point was lactate clearance of 10%. Secondary end points included intensive care unit (ICU) consultation and in-hospital mortality. A multivariate logistic regression analysis was performed to assess the effect of inhaled albuterol on lactate clearance., Results: Of 269 patients included, 58 (22%) received inhaled albuterol between lactate measurements. This group had a significantly higher prevalence of pulmonary disease and a lower initial lactate compared to those who did not receive inhaled albuterol. They had a significantly lower rate of lactate clearance (45% vs 77%, P < .001); however, ICU consultation (71% vs 57%, P = .066) and in-hospital mortality (19% vs 22%, P = .64) were not significantly different. A multivariate logistic regression analysis adjusting for age, sex, chronic kidney disease, cirrhosis, cancer, septic shock or severe sepsis, and the amount of intravenous fluids received showed that inhaled albuterol was independently associated with impaired lactate clearance (adjusted odds ratio: 0.26, 95% confidence interval: 0.14-0.50, P < .001)., Conclusions: Inhaled albuterol in patients with sepsis was associated with impaired lactate clearance without an increase in ICU consultation or in-hospital mortality. Impaired lactate clearance in patients with sepsis who receive inhaled albuterol should be interpreted with caution.
- Published
- 2021
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22. Belly dancer syndrome induced by salbutamol.
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Wong CK, Ng CF, Tan HJ, and Wan Yahya WNN
- Subjects
- Humans, Syndrome, Albuterol adverse effects
- Abstract
Competing Interests: Competing interests: None declared.
- Published
- 2021
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23. Paediatric patients receiving salbutamol inhalation before general anaesthesia are associated with a reduced risk of perioperative adverse respiratory events.
- Author
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Huang HF, Chiu YC, and Hunag CJ
- Subjects
- Administration, Inhalation, Anesthesia, General adverse effects, Child, Humans, Albuterol adverse effects, Anesthesiology
- Published
- 2021
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24. Case report: Paradoxical responses to short acting beta-agonists in a pediatric patient.
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Graden A, Gandhi S, and Joshi AY
- Subjects
- Adrenergic beta-2 Receptor Agonists therapeutic use, Albuterol therapeutic use, Bronchodilator Agents administration & dosage, Bronchodilator Agents adverse effects, Child, Female, Humans, Ipratropium therapeutic use, Levalbuterol therapeutic use, Adrenergic beta-2 Receptor Agonists adverse effects, Albuterol adverse effects, Asthma drug therapy, Bronchodilator Agents therapeutic use, Levalbuterol adverse effects
- Abstract
Introduction: Asthma is one of the most common airway diseases that nearly all pediatricians will encounter in their clinical practice. Using spirometry to compare a patient's forced expiratory volume in one second (FEV1) both pre- and post-bronchodilator administration is the ideal way to document a paradoxical bronchodilator response. Case Study: Here, we present a patient who experienced paradoxical responses to short acting beta-2 agonists (SABAs; albuterol and levalbuterol). Results: This patient responded to an anti-cholinergic agent (ipratropium bromide) with both subjective as well as objective response. Conclusion: This case highlights the need to include paradoxical response to SABAs in the differential of a patient with poorly controlled asthma. It also provides an example of successful treatment of a pediatric patient with a class of medications previously reserved for adults with chronic obstructive pulmonary disease.
- Published
- 2021
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25. Salbutamol-induced lactic acidosis in status asthmaticus survivor.
- Author
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Phoophiboon V, Singhagowinta P, Boonkaya S, and Sriprasart T
- Subjects
- Acidosis metabolism, Acidosis therapy, Acidosis, Lactic blood, Acidosis, Respiratory metabolism, Acidosis, Respiratory therapy, Adult, Bronchial Spasm drug therapy, Bronchial Spasm metabolism, Humans, Hypoxia metabolism, Hypoxia therapy, Male, Status Asthmaticus metabolism, Ventilation-Perfusion Ratio, Acidosis, Lactic chemically induced, Adrenergic beta-2 Receptor Agonists adverse effects, Albuterol adverse effects, Lactic Acid blood, Status Asthmaticus drug therapy
- Abstract
Background: Salbutamol-induced lactic acidosis is a rare presentation that could manifest in specific clinical context as acute asthmatic attack treatment. An increase of glycolysis pathway leading to pyruvate escalation is the mechanism of hyperlactatemia in β2-adrenergic agonist drug., Case Presentation: A 40-year-old man who had poor-controlled asthma, presented with progressive dyspnea with coryza symptom for 6 days. He was intubated and admitted into medical intensive care unit due to deteriorated respiratory symptom. Severe asthmatic attack was diagnosed and approximate 1.5 canisters of salbutamol inhaler was administrated within 24 h of admission. Initial severe acidosis consisted of acute respiratory acidosis from ventilation-perfusion mismatch and acute metabolic acidosis resulting from bronchospasm and hypoxia-related lactic acidosis, respectively. The lactate level was normalized in 6 h after hypoxemia and ventilation correction. Given the lactate level re-elevated into a peak of 4.6 mmol/L without signs of tissue hypoxia nor other possible etiologies, the salbutamol toxicity was suspected and the inhaler was discontinued that contributed to rapid lactate clearance. The patient was safely discharged on the 6th day of admission., Conclusion: The re-elevation of serum lactate in status asthmaticus patient who had been administrated with the vast amount of β2-adrenergic agonist should be considered for salbutamol-induced lactic acidosis and promptly discontinued especially when there were no common potentials.
- Published
- 2021
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26. Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial.
- Author
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Ashoor TM, Hasseb AM, and Esmat IM
- Subjects
- Adult, Humans, Nebulizers and Vaporizers, Respiration, Artificial, Albuterol administration & dosage, Albuterol adverse effects, Bronchodilator Agents administration & dosage, Bronchodilator Agents adverse effects, Heparin administration & dosage, Heparin adverse effects, Pulmonary Disease, Chronic Obstructive diagnosis, Pulmonary Disease, Chronic Obstructive drug therapy
- Abstract
Background: Nebulized heparin has been effectively used in the management of many pulmonary diseases. However, its effect on mechanically ventilated patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) has never been studied. This study aimed to assess the efficacy of nebulized heparin and salbutamol to increase ventilator-free days (VFD) in mechanically ventilated AECOPD patients and the effect of nebulized heparin on respiratory and coagulation functions., Methods: In this double-blind controlled study, 60 mechanically ventilated adult patients with AECOPD were randomly allocated into two groups; heparin and salbutamol (HS) group and salbutamol only (S) group. In the HS group, patients received nebulized heparin (25,000 IU) and salbutamol (5 mg) every 6 hours. Patients in the S group received nebulized salbutamol only (5 mg). The treatment was continued while patients remained ventilated for a maximum of 14 days. The primary outcome was VFDs at day 14. PaCO2, PaO2/FiO2 ratio, number of nebulizations withheld, C-reactive protein (CRP) titer and activated partial thromboplastin time (APTT) were secondary outcomes., Results: Patients in the Group HS had significantly more VFDs 4.7 ± 3.3 compared with those in the Group S 2.4 ± 2.6, P = 0.007. PaCO2 levels, PaO2/FiO2, the decrease in the CRP level and the increase in the APTT from the baseline showed no evidence of difference in both groups., Conclusions: The co-administration of nebulized heparin and salbutamol, compared with salbutamol alone, significantly increased (VFDs) among mechanically ventilated AECOPD patients without increasing bleeding risks.
- Published
- 2020
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27. Oral Manifestations of Commonly Prescribed Drugs.
- Author
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Glick A, Sista V, and Johnson C
- Subjects
- Albuterol adverse effects, Amlodipine adverse effects, Anticonvulsants adverse effects, Atorvastatin adverse effects, Bisphosphonate-Associated Osteonecrosis of the Jaw etiology, Bronchodilator Agents adverse effects, Deprescriptions, Fluorides therapeutic use, Gingival Overgrowth therapy, Humans, Hyperpigmentation therapy, Lisinopril adverse effects, Losartan adverse effects, Metformin adverse effects, Metoprolol adverse effects, Mouth Diseases chemically induced, Mouth Diseases therapy, Omeprazole adverse effects, Oral Hygiene, Proton Pump Inhibitors adverse effects, Simvastatin adverse effects, Thyroxine adverse effects, Toothpastes therapeutic use, Xerostomia therapy, Antihypertensive Agents adverse effects, Drug Hypersensitivity etiology, Gingival Overgrowth chemically induced, Hydroxymethylglutaryl-CoA Reductase Inhibitors adverse effects, Hyperpigmentation chemically induced, Hypoglycemic Agents adverse effects, Xerostomia chemically induced
- Abstract
Drugs are being prescribed with more frequency and in higher quantities. A serious adverse drug event from prescribed medications constitutes 2.4% to 16.2% of all hospital admissions. Many of the adverse drug events present intraorally or periorally in isolation or as a clinical symptom of a systemic effect. Clinical recognition and treatment of adverse drug events are important to increase patient adherence, manage drug therapy, or detect early signs of potentially serious outcomes. Oral manifestations of commonly prescribed medications include gingival enlargement, oral hyperpigmentation, oral hypersensitivity reaction, medication-related osteonecrosis, xerostomia, and other oral or perioral conditions. To prevent dose-dependent adverse drug reactions, physicians should prescribe medications judiciously using the lowest effective dose with minimal duration. Alternatively, for oral hypersensitivity reactions that are not dose dependent, quick recognition of clinical symptoms associated with time-dependent drug onset can allow for immediate discontinuation of the medication without discontinuation of other medications. Physicians can manage oral adverse drug events in the office through oral hygiene instructions for gingival enlargement, medication discontinuation for oral pigmentation, and prescription of higher fluoride toothpastes for xerostomia.
- Published
- 2020
28. Comparison of two continuous nebulized albuterol doses in critically ill children with status asthmaticus.
- Author
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Lin AT, Moore-Clingenpeel M, and Karsies TJ
- Subjects
- Administration, Inhalation, Albuterol adverse effects, Bronchodilator Agents adverse effects, Child, Child, Preschool, Combined Modality Therapy methods, Combined Modality Therapy statistics & numerical data, Critical Care statistics & numerical data, Dose-Response Relationship, Drug, Drug Administration Schedule, Female, Fluid Therapy statistics & numerical data, Humans, Intensive Care Units, Pediatric statistics & numerical data, Length of Stay statistics & numerical data, Male, Nebulizers and Vaporizers, Prospective Studies, Resuscitation statistics & numerical data, Retrospective Studies, Status Asthmaticus diagnosis, Albuterol administration & dosage, Bronchodilator Agents administration & dosage, Critical Care methods, Resuscitation methods, Status Asthmaticus drug therapy
- Abstract
Objectives : Continuous nebulized albuterol is frequently used to treat children with status asthmaticus in the pediatric intensive care unit (PICU) but can have cardiovascular side effects. Limited data exist comparing different dosages. The purpose of this study was to compare hemodynamic side effects of two continuous albuterol doses (10 vs. 25 mg/h). Our hypothesis was that lower dose albuterol would be associated with lower toxicity without increased need for adjunctive therapies. Methods : We conducted a retrospective cohort study of all children over 2 years old receiving continuous nebulized albuterol for status asthmaticus in our PICU from 2011 to 2013. Standard initial therapy was intravenous steroids and continuous nebulized albuterol. Patients receiving 10 mg/h albuterol were compared to those receiving 25 mg/h. Clinical outcomes, including the need for additional asthma therapies as well as hypotension requiring fluid resuscitation, were evaluated. Results : About 632 patients were studied (342 received 10 mg/h, 290 received 25 mg/h). Children in the lower-dose group received less fluid resuscitation without increased adjunctive therapies when adjusted for confounders. Those in the 25 mg/h group receiving 17% higher bolus volume. Those receiving lower-dose albuterol had shorter adjusted PICU and hospital lengths of stay. Conclusions : In our PICU cohort of children with status asthmaticus, use of 10 mg/h continuous albuterol was associated with lower fluid bolus resuscitation without more adjunctive therapies. These findings support the safety of lower doses in this population. Prospective studies evaluating the efficacy and toxicity of specific continuous albuterol dosages in critically ill children with status asthmaticus are warranted.
- Published
- 2020
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29. Acute salbutamol bronchoprotection against methacholine: Asthma compared with chronic obstructive pulmonary disease.
- Author
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Cockcroft DW, Davis BE, Tollefson G, and Yurach Pikaluk M
- Subjects
- Albuterol administration & dosage, Albuterol adverse effects, Asthma diagnosis, Bronchoconstrictor Agents administration & dosage, Bronchoconstrictor Agents adverse effects, Disease Management, Female, Humans, Male, Methacholine Chloride administration & dosage, Methacholine Chloride adverse effects, Pulmonary Disease, Chronic Obstructive diagnosis, Treatment Outcome, Albuterol therapeutic use, Asthma drug therapy, Bronchoconstrictor Agents therapeutic use, Methacholine Chloride therapeutic use, Pulmonary Disease, Chronic Obstructive drug therapy
- Published
- 2020
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30. Global Initiative for Asthma 2019 Guidelines: New Changes to the Treatment of Mild Asthmatics 12 Years and Older.
- Author
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Stone RG, McDonald M, and Elnazir B
- Subjects
- Administration, Inhalation, Adolescent, Adult, Age Factors, Albuterol administration & dosage, Albuterol adverse effects, Child, Drug Therapy, Combination, Female, Humans, Maintenance Chemotherapy, Male, Middle Aged, Risk Factors, Severity of Illness Index, Terbutaline administration & dosage, Terbutaline adverse effects, Young Adult, Adrenal Cortex Hormones administration & dosage, Adrenergic beta-2 Receptor Agonists administration & dosage, Asthma drug therapy, Formoterol Fumarate administration & dosage, Global Health, Practice Guidelines as Topic
- Published
- 2020
31. Rebound of Involuted Infantile Hemangioma After Administration of Salbutamol.
- Author
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Knöpfel N, Oesch V, Theiler M, Szello P, and Weibel L
- Subjects
- Adrenergic beta-2 Receptor Agonists administration & dosage, Albuterol administration & dosage, Bronchitis drug therapy, Child, Preschool, Female, Hemangioma drug therapy, Humans, Infusions, Intravenous, Propranolol therapeutic use, Skin Neoplasms drug therapy, Vasodilator Agents therapeutic use, Adrenergic beta-2 Receptor Agonists adverse effects, Albuterol adverse effects, Hemangioma pathology, Neoplasm Recurrence, Local chemically induced, Skin Neoplasms pathology
- Abstract
Since the discovery of propranolol in the treatment of infantile hemangioma (IH), there has been emergent investigation of β-adrenergic receptor (β-AR) signaling in IH and the mechanisms of action for which β-AR blockers regulate hemangioma cell proliferation. However, β-AR agonists and antagonists are known to act antithetically via the same intracellular β-AR-driven proangiogenic pathways. We present the case of a patient with involuted IH treated with propranolol that showed a full and rapid regrowth during the intravenous administration of salbutamol, a selective β2-adrenergic agonist, for an episode of severe obstructive bronchitis. This observation brings forward the clinical implication of β-signaling effects in IH and raises awareness of the potential proliferative response of IH to β-AR agonists such as salbutamol., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2020 by the American Academy of Pediatrics.)
- Published
- 2020
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32. Lessons of the month 1: Salbutamol induced lactic acidosis: clinically recognised but often forgotten.
- Author
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Pearmain L, Gupta R, and Bright-Thomas RJ
- Subjects
- Administration, Inhalation, Aged, 80 and over, Albuterol adverse effects, Female, Humans, Acidosis, Lactic chemically induced, Acidosis, Lactic drug therapy, Asthma drug therapy
- Abstract
We present the case of an 83-year-old woman, with known asthma, admitted with increasing dyspnoea, wheeze and a productive cough. In addition to maintenance inhaled therapy, the patient was also on long-term mirtazapine and furosemide. Following acute treatment with nebulised salbutamol she became increasingly dyspnoeic and developed a metabolic acidosis with a significantly raised blood lactate level. After cessation of ß
2 -adrenergic medication, the patient's clinical condition improved with resolution of her lactic acidosis; salbutamol induced lactic acidosis was diagnosed. This clinical scenario is common but not well described. Here we discuss the mechanisms, investigation and management of raised serum lactate and lactic acidosis in the context of acute asthma and the possible interactions of polypharmacy and comorbidities in the acute medical setting., (© Royal College of Physicians 2020. All rights reserved.)- Published
- 2020
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33. ]Risk of dental caries in pediatric asthmatic patients undergoing treatment with salbutamol and budesonide inhalation therapy, Peru.]
- Author
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Carhuamaca-Salvador M, Bustos de la Cruz J, Chávez-Rimache L, and Chumpitaz-Cerrate V
- Subjects
- Administration, Inhalation, Albuterol administration & dosage, Anti-Asthmatic Agents administration & dosage, Budesonide administration & dosage, Case-Control Studies, Child, Child, Preschool, Dental Caries epidemiology, Female, Humans, Incidence, Male, Oral Hygiene, Peru epidemiology, Pilot Projects, Risk Factors, Albuterol adverse effects, Anti-Asthmatic Agents adverse effects, Asthma drug therapy, Budesonide adverse effects, Dental Caries chemically induced
- Abstract
Introduction: Asthma is related to caries but the risk factors are not completely determined. Therefore, the objective of the study was to determine the risk of dental caries in pediatric asthmatic patients in inhalation treatment with salbutamol and budesonide who went to the National Hospital Arzobispo Loayza., Methods: Case-control study that consisted of 184 pediatric patients, between 5 and 12 years old, who attended the pneumology and pediatric dentistry service of the National Hospital Arzobispo Loayza during the years 2016-2017. The group of cases (n = 92) was composed of patients with moderate asthma medicated with inhaled salbutamol and budesonide, while the control group (n = 92) was composed of healthy patients. The risk of dental caries was evaluated with the dietary record, oral hygiene index and number of carious lesions., Results: The risk according to the type of cariogenic diet was moderate in both groups (p = 0.768). The oral hygiene index in the control group was regular in 63% (n = 58) and in the case group, bad in 60.9% (n = 56); p=0.001. The number of carious lesions in the control group was moderate in 50% (n = 46) and in the case group, high in 47.8% (n = 44); p = 0.001. Therefore, the risk of dental caries in the case group was high in 50% (n = 46) and in the control group it was moderate in 72.8% (n = 67); p = 0.001., Conclusion: The risk of dental caries in asthmatic patients on inhaled therapy with salbutamol and budesonide is significantly higher than that of healthy patients., (Universidad Nacional de Córdoba)
- Published
- 2019
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34. Safety and Efficacy of C-reactive Protein-guided Antibiotic Use to Treat Acute Respiratory Infections in Tanzanian Children: A Planned Subgroup Analysis of a Randomized Controlled Noninferiority Trial Evaluating a Novel Electronic Clinical Decision Algorithm (ePOCT).
- Author
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Keitel K, Samaka J, Masimba J, Temba H, Said Z, Kagoro F, Mlaganile T, Sangu W, Genton B, and D'Acremont V
- Subjects
- Albuterol adverse effects, Albuterol therapeutic use, Algorithms, Anti-Bacterial Agents adverse effects, C-Reactive Protein metabolism, Female, Fever drug therapy, Fever microbiology, Humans, Infant, Logistic Models, Male, Primary Health Care statistics & numerical data, Respiratory Tract Infections metabolism, Respiratory Tract Infections microbiology, Tanzania, Anti-Bacterial Agents therapeutic use, Respiratory Tract Infections drug therapy
- Abstract
Background: The safety and efficacy of using C-reactive protein (CRP) to decide on antibiotic prescription among febrile children at risk of pneumonia has not been tested., Methods: This was a randomized (1:1) controlled noninferiority trial in 9 primary care centers in Tanzania (substudy of the ePOCT trial evaluating a novel electronic decision algorithm). Children aged 2-59 months with fever and cough and without life-threatening conditions received an antibiotic based on a CRP-informed strategy (combination of CRP ≥80 mg/L plus age/temperature-corrected tachypnea and/or chest indrawing) or current World Health Organization standard (respiratory rate ≥50 breaths/minute). The primary outcome was clinical failure by day (D) 7; the secondary outcomes were antibiotic prescription at D0, secondary hospitalization, or death by D30., Results: A total of 1726 children were included (intervention: 868, control: 858; 0.7% lost to follow-up). The proportion of clinical failure by D7 was 2.9% (25/865) in the intervention arm vs 4.8% (41/854) in the control arm (risk difference, -1.9% [95% confidence interval {CI}, -3.7% to -.1%]; risk ratio [RR], 0.60 [95% CI, .37-.98]). Twenty of 865 (2.3%) children in the intervention arm vs 345 of 854 (40.4%) in the control arm received antibiotics at D0 (RR, 0.06 [95% CI, .04-.09]). There were fewer secondary hospitalizations and deaths in the CRP arm: 0.5% (4/865) vs 1.5% (13/854) (RR, 0.30 [95% CI, .10-.93])., Conclusions: CRP testing using a cutoff of ≥80 mg/L, integrated into an electronic decision algorithm, was able to improve clinical outcome in children with respiratory infections while substantially reducing antibiotic prescription., Clinical Trials Registration: NCT02225769., (© The Author(s) 2019. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)
- Published
- 2019
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35. Implementing a Respiratory Therapist-Driven Continuous Albuterol Weaning Protocol in the Pediatric ICU.
- Author
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Maue DK, Tori AJ, Beardsley AL, Krupp NL, Hole AJ, Moser EA, and Rowan CM
- Subjects
- Bronchodilator Agents administration & dosage, Bronchodilator Agents adverse effects, Child, Clinical Protocols, Drug-Related Side Effects and Adverse Reactions prevention & control, Female, Humans, Intensive Care Units, Pediatric statistics & numerical data, Length of Stay statistics & numerical data, Male, Patient Care Team, Time Factors, Treatment Outcome, United States epidemiology, Albuterol administration & dosage, Albuterol adverse effects, Respiratory Therapy methods, Status Asthmaticus diagnosis, Status Asthmaticus therapy
- Abstract
Background: Status asthmaticus is one of the most frequent admission diagnoses in the pediatric ICU (PICU). Collaboration between respiratory therapists (RTs) and physicians may help efficiently deliver care to a patient in status asthmaticus. The Pediatric Asthma Severity Score (PASS) is a measure of severity of a patient's asthma exacerbation at a point in time. The aim of this quality improvement initiative was to establish an RT-driven continuous albuterol weaning protocol using the PASS score. We hypothesized that this would decrease the duration of continuous albuterol without increasing adverse events., Methods: This was a single-center implementation study in the PICU of a quaternary care children's hospital. Patients with a diagnosis of status asthmaticus who met criteria on continuous albuterol between September 2015 and September 2017 were included. An interdisciplinary team established the protocol, order sets, documentation, and education for involved staff. Qualifying subjects were assessed by an RT per protocol and assigned a PASS score, and the albuterol dose was adjusted on the basis of the PASS score., Results: We compared 104 subjects studied before the implementation of this protocol (September 2015 to August 2016) to 117 subjects after the implementation of this protocol (September 2016 to October 2017). Median (interquartile range) duration of continuous albuterol in the PICU post-implementation was unchanged compared to pre-implementation: 12.1 (7.2-21.0) h versus 11.1 (6-19) h ( P = .22). Median PICU length of stay was also unchanged post-implementation compared to pre-implementation: 19.5 (14.3-29.7) h versus 23.2 (15.2-31.3) h ( P = .16). Using control charts, these processes were stable. There was no difference in adverse events., Conclusions: An interprofessionally-developed, RT-driven continuous albuterol weaning protocol can be implemented without negatively impacting duration of continuous albuterol or PICU length of stay and without increasing adverse events., Competing Interests: The authors have disclosed no conflicts of interest., (Copyright © 2019 by Daedalus Enterprises.)
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- 2019
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36. Albuterol Delivery Efficiency in a Pediatric Model of Noninvasive Ventilation With a Single-Limb Circuit.
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Berlinski A and Velasco J
- Subjects
- Bronchodilator Agents administration & dosage, Bronchodilator Agents adverse effects, Bronchodilator Agents analysis, Child, Preschool, Humans, Monitoring, Physiologic methods, Nebulizers and Vaporizers standards, Noninvasive Ventilation methods, Outcome and Process Assessment, Health Care, Research Design, Spectrophotometry methods, Treatment Outcome, Albuterol administration & dosage, Albuterol adverse effects, Albuterol analysis, Drug Delivery Systems instrumentation, Drug Delivery Systems methods, Respiratory Therapy instrumentation, Respiratory Therapy methods
- Abstract
Background: Pediatric patients treated with noninvasive ventilation (NIV) are frequently given aerosol therapy. Limited pediatric data are available on the efficiency of aerosol delivery efficiency. We evaluated the effect of different nebulizers, positions in the single-limb ventilator circuit, and ventilator settings on the efficiency of aerosol delivery in a model of pediatric NIV. We hypothesized that using a vibrating mesh nebulizer, placing the nebulizer after the circuit leak, and not using the highest inspiratory positive airway pressure would increase aerosol delivery efficiency., Methods: We connected a breathing simulator in series to a low-dead-space filter holder (lung dose) and to an anatomically correct face/airway model of a 5-y-old child. A mask with an entrainment elbow was connected to a ventilator operated in a NIV bi-level mode and assembled with a single-limb heated-wired circuit. Inspiratory/expiratory pressures of either 15/5 or 20/5 cm H
2 O were used. We studied 3 different jet nebulizers and 2 vibrating mesh nebulizers loaded with albuterol solution (2.5 mg/3 mL). Albuterol was measured with spectrophotometry. The outcome measure was the efficiency of aerosol delivery (ie, lung dose expressed as percentage of the nominal dose)., Results: Vibrating mesh nebulizers placed after the exhalation port of the circuit had the highest delivery efficiency, even compared with a vibrating mesh nebulizer integrated into the mask. Placing the nebulizer after the exhalation port of the circuit increased efficiency for all nebulizers. Vibrating mesh nebulizers were more efficient than jet nebulizers, regardless of their position in the circuit. Increasing the inspiratory pressure resulted in a variable effect on aerosol-delivery efficiency., Conclusions: In a model of pediatric NIV using a single-limb circuit, aerosol delivery devices were more efficient when placed after the exhalation port of the ventilator circuit. Vibrating mesh nebulizers were more efficient than jet nebulizers., (Copyright © 2019 by Daedalus Enterprises.)- Published
- 2019
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37. Albuterol-Induced Lactic Acidosis.
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Ramakrishna KN, Virk J, and Gambhir HS
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- Acidosis, Lactic blood, Acidosis, Lactic diagnosis, Asthma diagnosis, Female, Humans, Lactic Acid blood, Middle Aged, Severity of Illness Index, Acidosis, Lactic chemically induced, Albuterol adverse effects, Asthma drug therapy, Bronchodilator Agents adverse effects
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- 2019
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38. Jailhouse self-induced lesions by misuse of salbutamol inhaler.
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Charlier P, Deo S, and Kluger N
- Subjects
- Black or African American, Asthma drug therapy, Cold Temperature adverse effects, Humans, Hypopigmentation etiology, Nebulizers and Vaporizers, Prisoners, Self-Injurious Behavior etiology, Skin drug effects, Skin Pigmentation drug effects, Young Adult, Aerosols adverse effects, Albuterol adverse effects, Hypopigmentation diagnosis, Prescription Drug Misuse adverse effects, Self-Injurious Behavior diagnosis
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- 2019
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39. Acute effects of salbutamol on systemic vascular function in people with asthma.
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Moore LE, Kapoor K, Byers BW, Brotto AR, Ghods-Esfahani D, Henry SL, St James RB, and Stickland MK
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- Administration, Inhalation, Adrenergic beta-2 Receptor Agonists adverse effects, Adult, Albuterol adverse effects, Blood Pressure, Cardiovascular Diseases etiology, Female, Humans, Male, Risk, Vascular Stiffness, Young Adult, Adrenergic beta-2 Receptor Agonists administration & dosage, Albuterol administration & dosage, Asthma drug therapy, Asthma physiopathology
- Abstract
Background: Asthmatics are at increased cardiovascular disease risk, which has been linked to beta2(β
2 )-agonist use. Inhalation of β2 -agonists increases sympathetic nerve activity (SNA) in healthy individuals, however the systemic impact of salbutamol in asthmatics using β2 -agonists regularly is unknown., Objectives: This study compared the systemic vascular responses to a clinical dose of salbutamol (Phase I) and following an acute increase in SNA (Phase II) in asthmatics and controls., Methods: Fourteen controls and 14 asthmatics were recruited for Phase I. On separate days, flow-mediated dilation (FMD) and peripheral arterial stiffness (pPWV) were evaluated at baseline and following either 400 μg inhaled salbutamol or a placebo inhaler. For Phase II, heart rate, blood pressure, vascular conductance, pPWV, and central (c)PWV were evaluated in response to a large increase in SNA brought on by cold-water hand immersion (i.e. cold-pressor test) or body-temperature water hand immersion (i.e. control) in 10 controls and 10 asthmatics., Results: Following salbutamol, asthmatics demonstrated reduced FMD (-3.0%, p < 0.05) and increased pPWV (+0.7 m/s, p < 0.05); however, salbutamol had no effect in controls. The cold-pressor test resulted in similar increases in blood pressure, vascular flow rates and conductance, pPWV, and cPWV in both asthmatics and controls, suggesting similar neurovascular transduction in asthmatics and controls., Conclusion: Inhaled Salbutamol leads to increased arterial stiffness and reduced FMD in asthmatics. As asthmatics and controls had similar vascular responses to an increase in SNA, these findings suggest asthmatics have heightened sympathetic responses to β2 -agonists which may contribute to the increased cardiovascular risk in asthma., (Copyright © 2019 Elsevier Ltd. All rights reserved.)- Published
- 2019
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40. Low-dose l-isoproterenol versus salbutamol in hospitalized pediatric patients with severe acute exacerbation of asthma: A double-blind, randomized controlled trial.
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Katsunuma T, Fujisawa T, Maekawa T, Akashi K, Ohya Y, Adachi Y, Hashimoto K, Mizuno M, Imai T, Oba MS, Sako M, Ohashi Y, and Nakamura H
- Subjects
- Administration, Inhalation, Albuterol administration & dosage, Albuterol adverse effects, Bronchodilator Agents administration & dosage, Bronchodilator Agents adverse effects, Child, Child, Preschool, Double-Blind Method, Drug Administration Schedule, Female, Humans, Infant, Isoproterenol administration & dosage, Isoproterenol adverse effects, Lung drug effects, Lung physiopathology, Male, Treatment Outcome, Albuterol therapeutic use, Asthma drug therapy, Asthma physiopathology, Bronchodilator Agents therapeutic use, Isoproterenol therapeutic use
- Abstract
Background: Although the guidelines in most countries do not recommend continuous inhalation of l-isoproterenol to treat pediatric patients with acute severe exacerbation of asthma, lower dose of l-isoproterenol has been widely used in Japan. To determine whether the efficacy of low-dose l-isoproterenol was superior to that of salbutamol, we conducted a double-blind, randomized controlled trial., Methods: Hospitalized patients aged 1-17 years were eligible if they had severe asthma exacerbation defined by the modified pulmonary index score (MPIS). Patients were randomly assigned (1:1) to receive inhalation of l-isoproterenol (10 μg/kg/h) or salbutamol (500 μg/kg/h) for 12 hours via a large-volume nebulizer with oxygen. The primary outcome was the change in MPIS from baseline to 3 hours after starting inhalation. Trial registration number UMIN000001991., Results: From December 2009 to October 2013, 83 patients (42 in the l-isoproterenol group and 41 in the salbutamol group) were enrolled into the study. Of these, one patient in the l-isoproterenol group did not receive the study drug and was excluded from the analysis. Compared with salbutamol, l-isoproterenol reduced MPIS more rapidly. Mean (SD) changes in MPIS at 3 hours were -2.9 (2.5) in the l-isoproterenol group and -0.9 (2.3) in the salbutamol group (difference -2.0, 95% confidence interval -3.1 to -0.9; P < 0.001). Adverse events occurred in 1 (2%) and 11 (27%) patients in the l-isoproterenol and salbutamol groups, respectively (P = 0.003). Hypokalemia and tachycardia occurred only in the salbutamol group., Conclusions: Low-dose l-isoproterenol has a more rapid effect with fewer adverse events than salbutamol., (Copyright © 2019 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.)
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- 2019
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41. Salbutamol tolerability and efficacy in patients with spinal muscular atrophy type II.
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Frongia AL, Natera-de Benito D, Ortez C, Alarcón M, Borrás A, Medina J, Vigo M, Padrós N, Moya O, Armas J, Carrera-García L, Expósito-Escudero J, Cuadras D, Bernal S, Martorell L, Colomer J, and Nascimento A
- Subjects
- Adolescent, Age of Onset, Child, Child, Preschool, Female, Hospitalization statistics & numerical data, Humans, Infant, Longitudinal Studies, Male, Movement, Orthopedic Procedures statistics & numerical data, Prospective Studies, Scoliosis etiology, Spinal Muscular Atrophies of Childhood physiopathology, Treatment Outcome, Young Adult, Adrenergic beta-Agonists adverse effects, Adrenergic beta-Agonists therapeutic use, Albuterol adverse effects, Albuterol therapeutic use, Spinal Muscular Atrophies of Childhood drug therapy
- Abstract
Spinal muscular atrophy (SMA) is an autosomal recessive disease caused by homozygous deletions or loss-of-function mutations in SMN1, which result in a degeneration of motor neurons in the spinal cord and brain stem. Even without a randomized placebo-controlled trial, salbutamol has been offered to patients with SMA in the neuromuscular clinics of most of hospitals for many years. We describe the response to salbutamol in 48 patients with SMA type II who were not taking any other medication. We investigate the changes over an eighteen-month period in motor functional scales and we analyze side effects and subjective response to treatment. Our results suggest that oral administration of salbutamol might be helpful in the maintenance of motor function in patients with SMA type II. An apparent beneficial effect was observed in functional scales of children under the age of 6, especially during the first 6 months of therapy. The majority of patients of all ages referred some kind of subjective positive effect associated with therapy intake. Salbutamol seemed safe and was well tolerated without serious side effects., (Copyright © 2019 Elsevier B.V. All rights reserved.)
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- 2019
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42. Controlled Trial of Budesonide-Formoterol as Needed for Mild Asthma.
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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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43. Descriptive study of drug-drug interactions attributed to prescriptions written upon discharge from the emergency department.
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Jawaro T, Bridgeman PJ, Mele J, and Wei G
- Subjects
- Acetaminophen adverse effects, Adrenergic beta-2 Receptor Agonists adverse effects, Adult, Albuterol adverse effects, Analgesics adverse effects, Ciprofloxacin adverse effects, Drug Combinations, Female, Glucocorticoids adverse effects, Humans, Ibuprofen adverse effects, Male, Oxycodone adverse effects, Prednisone adverse effects, Retrospective Studies, Drug Interactions, Emergency Service, Hospital, Patient Discharge
- Abstract
Objective: The primary purpose of this study was to identify the most common drug-drug interactions (DDI'S) in patients prescribed medications upon discharge from the emergency department., Methods: We conducted a respective chart review of patients discharged home with a prescription from an academic emergency department. The study period was from August 1, 2015 to August 31, 2015. Patients will be excluded if they meet the following criteria: age under 20 years; discharge home without a prescription; inpatient hospital admission; transfer to another inpatient facility; or sign out against medical advice. The primary endpoint is the identification and characterization of drug-drug interactions caused by discharge prescriptions written by the treating physician., Results: A total of 500 patient charts were included, with 38% having at least one DDI. Overall, there were 429 DDIs among 858 prescriptions written. 15.6% (n = 67) of the DDI's were classified as B, no modification of therapy needed. 60% (n = 260) of the DDIs were risk-rating category C, requiring monitoring of therapy. 22% (n = 95) of the DDI's identified were category D, which are consider modification of therapy. Lastly, we identified 1.6% (n = 7) category X DDI's. The top 3 most commonly associated drugs were oxycodone/acetaminophen, ibuprofen, and ciprofloxacin., Conclusion: DDIs are occurring upon discharge from a large, urban, tertiary care, academic medical center. Many of the DDI's identified do not require any modification to therapy. However, 23.6% of identified DDI's required modification or were contraindicated. A majority of the category X drug interactions involved QT prolongation., (Copyright © 2019. Published by Elsevier Inc.)
- Published
- 2019
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44. The β-Adrenergic Agonist Albuterol Improves Pulmonary Vascular Reserve in Heart Failure With Preserved Ejection Fraction.
- Author
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Reddy YNV, Obokata M, Koepp KE, Egbe AC, Wiley B, and Borlaug BA
- Subjects
- Administration, Inhalation, Adrenergic beta-2 Receptor Agonists adverse effects, Aged, Aged, 80 and over, Albuterol adverse effects, Double-Blind Method, Exercise Tolerance drug effects, Female, Heart Failure diagnosis, Heart Failure physiopathology, Humans, Male, Middle Aged, Recovery of Function, Time Factors, Treatment Outcome, Vasodilator Agents adverse effects, Adrenergic beta-2 Receptor Agonists administration & dosage, Albuterol administration & dosage, Heart Failure drug therapy, Pulmonary Circulation drug effects, Stroke Volume, Vascular Resistance drug effects, Vasodilation drug effects, Vasodilator Agents administration & dosage, Ventricular Function, Left
- Abstract
Rationale: Pulmonary vascular resistance fails to decrease appropriately during exercise in patients with heart failure with preserved ejection fraction (HFpEF). Interventions that enhance pulmonary vasodilation might be beneficial in this cohort but could also worsen left atrial hypertension, exacerbating lung congestion. Intravenous β-agonists reduce pulmonary vascular resistance but are not suitable for chronic use., Objective: We hypothesized that the inhaled β-adrenergic agonist albuterol would improve pulmonary vasodilation during exercise in patients with HFpEF, without increasing left heart filling pressures., Methods and Results: We performed a randomized, double-blind, placebo-controlled trial testing the effects of inhaled albuterol on resting and exercise hemodynamics in subjects with HFpEF using high-fidelity micromanometer catheters and expired gas analysis. The primary end point was pulmonary vascular resistance during exercise. Subjects with HFpEF (n=30) underwent resting and exercise hemodynamic assessment and were then randomized 1:1 to inhaled, nebulized albuterol or placebo. Rest and exercise hemodynamic testing was then repeated. Albuterol improved the primary end point of exercise pulmonary vascular resistance as compared with placebo (-0.6±0.5 versus +0.1±0.7 WU; P=0.003). Albuterol enhanced cardiac output reserve and right ventricular pulmonary artery coupling, reduced right atrial and pulmonary artery pressures, improved pulmonary artery compliance, and enhanced left ventricular transmural distending pressure (all P <0.01), with no increase in pulmonary capillary hydrostatic pressures., Conclusions: Albuterol improves pulmonary vascular reserve in patients with HFpEF without worsening left heart congestion. Further study is warranted to evaluate the chronic efficacy of β-agonists in HFpEF and other forms of pulmonary hypertension., Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT02885636.
- Published
- 2019
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45. Randomized Clinical Trial Comparing Breath-Enhanced to Conventional Nebulizers in the Treatment of Children with Acute Asthma.
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Gardiner MA and Wilkinson MH
- Subjects
- Adolescent, Albuterol adverse effects, Bronchodilator Agents adverse effects, Child, Female, Forced Expiratory Volume drug effects, Humans, Length of Stay statistics & numerical data, Male, Spirometry methods, Albuterol administration & dosage, Asthma drug therapy, Bronchodilator Agents administration & dosage, Nebulizers and Vaporizers statistics & numerical data
- Abstract
Objective: To compare the efficacy of a breath-enhanced and a conventional jet nebulizer in the treatment of children with moderate to severe acute asthma., Study Design: We enrolled subjects between 6 and 18 years of age presenting to the emergency department (ED) with acute asthma and an initial forced expiratory volume in 1 second (FEV
1 ) <70% of predicted. We excluded patients with chronic disease, who required immediate resuscitation, or failed spirometry. Subjects were randomized to breath-enhanced or conventional jet delivery of a 5-mg albuterol treatment. Our primary outcome was change in FEV1 , and secondary outcomes included change in clinical asthma scores, ED length of stay, disposition, and side effects. Student t test and multivariable linear regression were used to evaluate the primary outcome., Results: In total, 497 patients were assessed for eligibility with 118 enrolled and 107 subjects available for analysis of the primary outcome. Improvement in FEV1 was significantly greater with conventional jet nebulizer (mean ΔFEV1 +13.8% vs +9.1%, P = .04). This difference remained significant after adjustment for baseline differences. Subgroup analysis of 57 subjects with spirometry meeting American Thoracic Society/European Respiratory Society guidelines yielded similar results (mean ΔFEV1 +14.5% vs +8.5%, P=.03). There were no significant differences in clinical asthma scores, ED length of stay, disposition, or side effects., Conclusions: Albuterol delivered via conventional jet nebulizer resulted in significantly greater improvement in FEV1 than albuterol delivered by breath-enhanced nebulizer, without significant differences in clinical measures. Conventional jet nebulizers may deliver albuterol to children with acute asthma more effectively than breath-enhanced nebulizers., Trial Registration: ClinicalTrials.gov: NCT02566902., (Copyright © 2018 Elsevier Inc. All rights reserved.)- Published
- 2019
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46. Bronchodilator responsiveness as a predictor of success for bronchial thermoplasty.
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Langton D, Ing A, Fielding D, Wang W, Plummer V, and Thien F
- Subjects
- Adrenal Cortex Hormones therapeutic use, Airway Remodeling, Bronchoconstriction drug effects, Bronchodilator Agents administration & dosage, Bronchodilator Agents adverse effects, Female, Humans, Male, Middle Aged, Predictive Value of Tests, Respiratory Function Tests methods, Treatment Outcome, Albuterol administration & dosage, Albuterol adverse effects, Asthma diagnosis, Asthma physiopathology, Asthma therapy, Bronchial Thermoplasty methods, Spirometry methods, Spirometry statistics & numerical data
- Abstract
Background and Objective: A characteristic feature of asthma is hypertrophied airway smooth muscle, responsible for bronchoconstriction. This is the target of bronchial thermoplasty (BT). It is known that with increasing time and severity some patients develop remodelled airways with fixed airflow obstruction. The question arises whether these patients will still respond to BT., Methods: Forty-nine consecutive severe asthmatic patients were prospectively evaluated at baseline and then 6 months after BT. The characteristics recorded included medication usage, exacerbation history, spirometry and the Asthma Control Questionnaire 5-Item Version score (ACQ-5). Seven patients were excluded as they did not demonstrate airflow obstruction at baseline (forced expiratory ratio (forced expiratory volume in 1 s (FEV
1 )/forced vital capacity (FVC)) < 70%). The remaining 42 patients were divided into two cohorts based on their response to bronchodilator. Eighteen patients in whom the FEV1 improved by at least 12% and 200 mL following bronchodilator were allocated to Group 1 (reversible). The remaining patients were allocated to Group 2 (fixed). The outcomes following BT in these two groups were then compared., Results: The patient age was 57.2 ± 12.4 years, the ACQ-5 was 3.2 ± 1.0 and the FEV1 56.0 ± 16.4% predicted. At baseline, the patient cohorts were very similar, save for the response to bronchodilator, which was 28.1 ± 12.5% in Group 1 and 4.1 ± 5.3% in Group 2. Both groups responded to BT equally well, with significant improvements in ACQ-5, salbutamol usage, exacerbation frequency and the weaning of oral corticosteroids., Conclusion: In patients with severe asthma, the presence or absence of variable airflow obstruction as measured by spirometry does not appear to influence outcomes from BT., (© 2018 Asian Pacific Society of Respirology.)- Published
- 2019
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47. Inhaled steroids with and without regular salmeterol for asthma: serious adverse events.
- Author
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Cates CJ, Schmidt S, Ferrer M, Sayer B, and Waterson S
- Subjects
- Adolescent, Adrenal Cortex Hormones administration & dosage, Adrenergic beta-2 Receptor Agonists administration & dosage, Adult, Age Factors, Albuterol administration & dosage, Albuterol adverse effects, Anti-Asthmatic Agents administration & dosage, Asthma drug therapy, Cause of Death, Child, Humans, Randomized Controlled Trials as Topic, Salmeterol Xinafoate, Young Adult, Adrenal Cortex Hormones adverse effects, Adrenergic beta-2 Receptor Agonists adverse effects, Albuterol analogs & derivatives, Anti-Asthmatic Agents adverse effects, Asthma mortality
- Abstract
Background: Epidemiological evidence has suggested a link between use of beta₂-agonists and increased asthma mortality. Much debate has surrounded possible causal links for this association, and whether regular (daily) long-acting beta₂-agonists (LABAs) are safe, particularly when used in combination with inhaled corticosteroids (ICSs). This is an update of a Cochrane Review that now includes data from two large trials including 11,679 adults and 6208 children; both were mandated by the US Food and Drug Administration (FDA). OBJECTIVES: To assess risks of mortality and non-fatal serious adverse events (SAEs) in trials that randomised participants with chronic asthma to regular salmeterol and ICS versus the same dose of ICS., Search Methods: We identified randomised trials using the Cochrane Airways Group Specialised Register of trials. We checked websites of clinical trials registers for unpublished trial data. We also checked FDA submissions in relation to salmeterol. The date of the most recent search was 10 October 2018., Selection Criteria: We included parallel-design randomised trials involving adults, children, or both with asthma of any severity who were randomised to treatment with regular salmeterol and ICS (in separate or combined inhalers) versus the same dose of ICS of at least 12 weeks in duration., Data Collection and Analysis: We conducted the review according to standard procedures expected by Cochrane. We obtained unpublished data on mortality and SAEs from the sponsors, from ClinicalTrials.gov, and from FDA submissions. We assessed our confidence in the evidence according to current GRADE recommendations., Main Results: We have included in this review 41 studies (27,951 participants) in adults and adolescents, along with eight studies (8453 participants) in children. We judged that the overall risk of bias was low for all-cause events, and we obtained data on SAEs from all study authors. All except 542 adults (and none of the children) were given salmeterol and fluticasone in the same (combination) inhaler.DeathsEleven of a total of 14,233 adults taking regular salmeterol and ICS died, as did 13 of 13,718 taking regular ICS at the same dose. The pooled Peto odds ratio (OR) was 0.80 (95% confidence interval (CI) 0.36 to 1.78; participants = 27,951; studies = 41; I² = 0%; moderate-certainty evidence). In other words, for every 1000 adults treated for 25 weeks, one death occurred among those on ICS alone, and the corresponding risk among those taking salmeterol and ICS was also one death (95% CI 0 to 2 deaths).No children died, and no adults or children died of asthma, so we remain uncertain about mortality in children and about asthma mortality in any age group.Non-fatal serious adverse eventsA total of 332 adults receiving regular salmeterol with ICS experienced a non-fatal SAE of any cause, compared to 282 adults receiving regular ICS. The pooled Peto OR was 1.14 (95% CI 0.97 to 1.33; participants = 27,951; studies = 41; I² = 0%; moderate-certainty evidence). For every 1000 adults treated for 25 weeks, 21 adults on ICS alone had an SAE, and the corresponding risk for those on salmeterol and ICS was 23 adults (95% CI 20 to 27).Sixty-five of 4229 children given regular salmeterol with ICS suffered an SAE of any cause, compared to 62 of 4224 children given regular ICS. The pooled Peto OR was 1.04 (95% CI 0.73 to 1.48; participants = 8453; studies = 8; I² = 0%; moderate-certainty evidence). For every 1000 children treated for 23 weeks, 15 children on ICS alone had an SAE, and the corresponding risk for those on salmeterol and ICS was 15 children (95% CI 11 to 22).Asthma-related serious adverse eventsEighty and 67 adults in each group, respectively, experienced an asthma-related non-fatal SAE. The pooled Peto OR was 1.15 (95% CI 0.83 to 1.59; participants = 27,951; studies = 41; I² = 0%; low-certainty evidence). For every 1000 adults treated for 25 weeks, five receiving ICS alone had an asthma-related SAE, and the corresponding risk among those on salmeterol and ICS was six adults (95% CI 4 to 8).Twenty-nine children taking salmeterol and ICS and 23 children taking ICS alone reported asthma-related events. The pooled Peto OR was 1.25 (95% CI 0.72 to 2.16; participants = 8453; studies = 8; I² = 0%; moderate-certainty evidence). For every 1000 children treated for 23 weeks, five receiving an ICS alone had an asthma-related SAE, and the corresponding risk among those receiving salmeterol and ICS was seven children (95% CI 4 to 12)., Authors' Conclusions: We did not find a difference in the risk of death or serious adverse events in either adults or children. However, trial authors reported no asthma deaths among 27,951 adults or 8453 children randomised to regular salmeterol and ICS or ICS alone over an average of six months. Therefore, the risk of dying from asthma on either treatment was very low, but we remain uncertain about whether the risk of dying from asthma is altered by adding salmeterol to ICS.Inclusion of new trials has increased the precision of the estimates for non-fatal SAEs of any cause. We can now say that the worst-case estimate is that at least 152 adults and 139 children must be treated with combination salmeterol and ICS for six months for one additional person to be admitted to the hospital (compared to treatment with ICS alone). These possible risks still have to be weighed against the benefits experienced by people who take combination treatment.However more than 90% of prescribed treatment was taken in the new trials, so the effects observed may be different from those seen with salmeterol in combination with ICS in daily practice.
- Published
- 2018
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48. Changes in biomarkers of cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease.
- Author
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Shafuddin E, Chang CL, Cooray M, Tuffery CM, Hopping SJ, Sullivan GD, Jacobson GA, and Hancox RJ
- Subjects
- Administration, Inhalation, Adrenergic beta-2 Receptor Agonists administration & dosage, Adrenergic beta-2 Receptor Agonists blood, Aged, Albuterol administration & dosage, Albuterol blood, Biomarkers blood, Bronchodilator Agents administration & dosage, Bronchodilator Agents blood, Disease Progression, Female, Humans, Male, Nebulizers and Vaporizers, Severity of Illness Index, Adrenergic beta-2 Receptor Agonists adverse effects, Albuterol adverse effects, Bronchodilator Agents adverse effects, Heart Diseases diagnosis, Heart Diseases etiology, Natriuretic Peptide, Brain blood, Peptide Fragments blood, Pulmonary Disease, Chronic Obstructive complications, Pulmonary Disease, Chronic Obstructive drug therapy, Troponin T blood
- Abstract
Background: Cardiac dysfunction is associated with a higher mortality in exacerbations of chronic obstructive pulmonary disease (COPD). It is unknown how the heart responds to treatment of COPD exacerbations. We followed cardiac biomarker levels during hospital admissions for exacerbations of COPD and hypothesised that these biochemical markers of cardiac dysfunction might be affected the severity and treatment of exacerbations of COPD., Methods: N-terminal pro-B-type natriuretic peptide (NT-proBNP) and troponin T were measured at admission, 12 h, 72 h, and clinical stability in 176 patients. In a second cohort (n = 93), associations between blood salbutamol concentrations and biomarker changes at 12 h were analysed., Results: NT-proBNP increased from a geometric mean of 43 pmol/L at admission to 56 pmol/L at 12 h (p < 0.001), 53 pmol/L at 72 h (p = 0.045), and decreased to 25 pmol/L (p < 0.001) at stability. Troponin T levels decreased at 12 h (p < 0.001), but 15/174 (9%) patients had a clinically significant rise. Nebulised bronchodilator treatment and blood salbutamol concentrations were associated with greater increases in NT-proBNP rise at 12 h independently of baseline COPD or exacerbation severity and other treatments (p < 0.05). Nebulised bronchodilator and blood salbutamol concentrations also predicted rises in troponin T in univariate analyses (p < 0.05)., Conclusions: NT-proBNP continues to rise after admission to hospital for COPD exacerbations and a minority of patients have clinically significant rises in cardiac troponins. These rises were associated with nebulised beta
2 -agonist treatment. These findings suggest that high doses of beta2 -agonists may exacerbate cardiac dysfunction in COPD., (Copyright © 2018 Elsevier Ltd. All rights reserved.)- Published
- 2018
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49. Pharmacokinetics and safety of salbutamol/ambroxol fixed-dose combination granules in healthy Chinese subjects .
- Author
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Wang Y, Lu J, Li T, Zhao S, Yang W, Liu L, Shi X, Michael M, and Ding L
- Subjects
- Administration, Oral, Adrenergic beta-2 Receptor Agonists administration & dosage, Adrenergic beta-2 Receptor Agonists adverse effects, Adrenergic beta-2 Receptor Agonists blood, Adult, Albuterol administration & dosage, Albuterol adverse effects, Albuterol blood, Ambroxol administration & dosage, Ambroxol adverse effects, Ambroxol blood, China, Chromatography, Liquid, Dosage Forms, Drug Administration Schedule, Expectorants administration & dosage, Expectorants adverse effects, Female, Healthy Volunteers, Humans, Male, Models, Biological, Tandem Mass Spectrometry, Young Adult, Adrenergic beta-2 Receptor Agonists pharmacokinetics, Albuterol pharmacokinetics, Ambroxol pharmacokinetics, Expectorants pharmacokinetics
- Abstract
Objectives: The aim of the study was to investigate the pharmacokinetics and tolerability of salbutamol/ambroxol fixed-dose combination granules following single and multiple dosing in healthy Chinese subjects., Materials and Methods: This was a randomized, open-label, two-period, one-sequence study (n = 12). Each subject received a single oral dose in period 1 and multiple doses in period 2. Plasma concentrations of these two components were determined using a validated LC-MS/MS method. Adverse events (AEs) were documented throughout the study. Investigators evaluated AEs in terms of frequency, duration, intensity, seriousness, outcome, and relationship to study drugs., Results: Following single dosing, C
max values were 8.07 ± 1.31 ng/mL and 25.7 ± 6.5 ng/mL for salbutamol and ambroxol, respectively. The corresponding T1/2 values were 8.15 ± 3.13 hours and 9.31 ± 2.27 hours, respectively. Moreover, no statistical differences in the pharmacokinetics of salbutamol and ambroxol in subjects receiving single or multiple dosage were observed. Single- and multiple-dose oral administration of fixed-dose combination granules were safe and well tolerated in healthy Chinese subjects. Drug hypersensitivity syndrome did not occur during our study., Conclusion: The pharmacokinetics of salbutamol and ambroxol in the fixed-dose combination granules were not affected by dosing duration, and gender differences seemed to have no effect on the pharmacokinetics of salbutamol and ambroxol after a single dose and multiple doses of the medication. .- Published
- 2018
- Full Text
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50. Safety and effectiveness of albuterol solutions with and without benzalkonium chloride when administered by continuous nebulization.
- Author
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Orth LE, Kelly BJ, Lagasse CA, Collins SW, and Ryan MF
- Subjects
- Administration, Inhalation, Adolescent, Albuterol administration & dosage, Albuterol therapeutic use, Benzalkonium Compounds administration & dosage, Benzalkonium Compounds therapeutic use, Bronchodilator Agents administration & dosage, Bronchodilator Agents therapeutic use, Child, Female, Humans, Male, Nebulizers and Vaporizers, Preservatives, Pharmaceutical administration & dosage, Preservatives, Pharmaceutical therapeutic use, Retrospective Studies, Status Asthmaticus drug therapy, Treatment Outcome, Albuterol adverse effects, Benzalkonium Compounds adverse effects, Bronchodilator Agents adverse effects, Preservatives, Pharmaceutical adverse effects
- Abstract
Purpose: The results of a study to determine if rates of poor response differ in patients receiving continuous nebulized albuterol (CNA) therapy with or without the preservative benzalkonium chloride are presented., Methods: A retrospective analysis of the records of all patients who received CNA therapy at a large academic medical center from July 2015 to January 2016 was conducted. Data from patient evaluations performed before and after a change to benzalkonium chloride-containing albuterol were collected. The primary outcome was the rate of poor patient response, defined as a composite endpoint. Secondary outcomes included duration of therapy, dosing requirements, and duration of supplemental oxygen therapy., Results: There was no significant difference in rates of poor response between patients exposed ( n = 80) and patients not exposed ( n = 48) to benzalkonium chloride (16% and 17%, respectively; p = 0.95). The cohort not exposed to benzalkonium chloride had a median CNA duration of 7.0 hours, as compared with 10.5 hours for the cohort exposed to benzalkonium chloride, but this difference was not significant ( p = 0.19). There were no significant differences between the benzalkonium chloride-exposed and nonexposed cohorts in the maximum dosing requirement (12.6 mg/hr versus 12.8 mg/hr, p = 0.89) or median duration of supplemental oxygen use (27.5 hours versus 16.5 hours, p = 0.77)., Conclusion: A study of hospitalized patients receiving CNA detected no significant difference in the frequency of poor response to therapy between groups receiving benzalkonium chloride-free versus benzalkonium chloride-containing albuterol products., Competing Interests: DisclosuresThe authors have declared no potential conflicts of interest., (Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.)
- Published
- 2018
- Full Text
- View/download PDF
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