Bronchodilator effects of fenoterol and salbutamol administered by intermittent positive pressure breathing to patients with asthma or chronic obstructive bronchitis

11 patients with asthma and 3 with chronic bronchitis participated in a comparison, over 15 treatment periods, of the efficacy of 0.5 mg fenoterol and 5 mg of salbutamol, administered using intermittent positive pressure breathing. Both drugs produced marked bronchodilation. No differences could be detected between their effects. There were no drug-related side effects.     

Albuterol and isoproterenol in bronchial asthma. Efficacy and toxicity of drugs administered via intermittent positive pressure breathing.

This study compared the efficacy and side effects of 1.25, 2.5, 5, 10, and 15 mg of albuterol and isoproterenol hydrochloride administered by intermittent positive pressure breathing (IPPB) to 12 patients with reversible airway obstruction. Equal doses of the two medications induced similar peak increases in pulmonary function, but the increase following albuterol persisted longer. The degree of bronchodilation was impressive; 15 mg of albuterol induced a mean increase over six hours of 82% in the forced expiratory volume in one second. Significant cardiovascular side effects were more common after isoproterenol than after albuterol. Albuterol is superior to isoproterenol as a bronchodilator when administered by IPPB because, for a given peak bronchodilation, cardiovascular side effects are fewer and bronchodilation persists longer with albuterol. The optimal dose of isoproterenol hydrochloride is 2.5 to 5.0 mg and the optimal dose of albuterol is 10 mg when these drugs are given by IPPB.     

Bronchial response to nebulized antibiotics in children with cystic fibrosis

Nebulized antibiotics are being used increasingly in children with cystic fibrosis. We assessed the effect of nebulized antibiotic solutions of varying tonicity on lung function in 12 children aged 5-15 yrs with cystic fibrosis. Baseline forced expiratory volume in one second and (FEV1) was measured, followed by a single nebulization of normal saline (272 mosmol.kg-1), tobramycin (248 mosmol.kg-1), or ticarcillin (3,080 mosmol.kg-1). All children received each of these, administered randomly, one per day. FEV1 was remeasured 5, 15 and 30 min after completion of the nebulization. Ticarcillin (mean fall 10.7% (SD 8.9)) caused a larger fall in FEV1 than normal saline (4.8% (4.3), p less than 0.05). The fall in FEV1 for ticarcillin was greater than for tobramycin (1.2% (2.0), p less than 0.05). Normal saline did not result in a significantly larger fall in FEV1 than tobramycin (p greater than 0.05). Bronchoconstriction to ticarcillin persisted at 30 min. We conclude that nebulized antibiotics can affect lung function in children with cystic fibrosis if the solutions are hypertonic.     

Oscillometric and spirometric bronchodilator response in preschool children with and without asthma

BACKGROUND:

Bronchodilator responses (BDR) are routinely used in the diagnosis and management of asthma; however, their acceptability and repeatability have not been evaluated using quality control criteria for preschool children.

OBJECTIVES:

To compare conventional spirometry with an impulse oscillometry system (IOS) in healthy and asthmatic preschool children.

METHODS:

Data from 30 asthmatic children and 29 controls (two to six years of age) who underwent IOS and spirometry before and after salbutamol administration were analyzed.

RESULTS:

Stable asthmatic subjects significantly differed versus controls in their spirometry-assessed BDR (forced expiratory volume in 1 s [FEV₁], forced vital capacity and forced expiratory flow at 25% to 75% of forced vital capacity) as well as their IOS-assessed BDR (respiratory resistance at 5 Hz [Rrs₅], respiratory reactance at 5 Hz and area under the reactance curve). However, comparisons based on the area under the ROC curve for ΔFEV₁ % initial versus ΔRrs₅ % initial were 0.82 (95% CI 0.71 to 0.93) and 0.75 (95% CI 0.62 to 0.87), respectively. Moreover, the sensitivity and specificity for ΔFEV₁ ≥9% were 0.53 and 0.93, respectively. Importantly, sensitivity increased to 0.63 when either ΔFEV₁ ≥9% or ΔRrs₅ ≥29% was considered as an additional criterion for the diagnosis of asthma.

CONCLUSION:

The accuracy of asthma diagnosis in preschool children may be increased by combining spirometry with IOS when measuring BDR.     

Effect of nebulized albuterol on blood glucose in patients with diabetes mellitus with and without cystic fibrosis

Over 90% of cystic fibrosis (CF) patients are treated with bronchodilators, and 6% have diabetes. Some with asthma also have diabetes, and most are treated with bronchodilators. Systemic administration of adrenergic agents can cause increases in blood glucose, but the effect of inhaled agents is unclear. A double-blind study was performed on 10 patients with type 1 diabetes mellitus (DM) without CF (3 male, 7 female, mean age 25.5 years) and 9 patients with insulin-dependent CF-related diabetes (CFRD) (8 male, 1 female, mean age 21.9 years). On 2 separate days before 9 AM fasting and the morning dose of insulin, 2.5 mg of albuterol or nebulized placebo were given. Blood glucose was measured by finger stick with a glucose reflectance meter before and 15, 30, 45, and 60 min after treatment. No significant changes from baseline or differences between placebo and albuterol occurred in either group. The mean maximum increase from baseline in DM was 20 mg/dl on placebo, and 38 mg/dl on albuterol; in the CFRD, the respective changes were 7 and 7 mg/dl. Two DM patients had a > 50 mg/dl increase on albuterol vs. placebo; no CFRD patients had differences of such magnitude. DM patients had greater increases from baseline than CFRD patients on placebo and albuterol. Differences reached statistical significance at 30 and 45 min on placebo, and 45 min on albuterol. Albuterol 2.5 mg by nebulizer causes no clinically significant increases in blood glucose in DM or CFRD patients. Diabetes patients without CF have a significantly greater increase of glucose with time (placebo or albuterol) than CFRD patients.     

Mechanics and energetics of breathing in newly diagnosed infants with cystic fibrosis: effect of combined bronchodilator and chest physical therapy

Response to bronchodilator (BD) and chest physical therapy (CPT) was evaluated in newly diagnosed infants with cystic fibrosis (n = 13; age, 6.9 +/- 1.5 SE months) who were asymptomatic for lung disease at the time of the study. Lung function was assessed from the mechanics and energetics of breathing prior to and following combined BD and CPT. After therapy, respiratory rate, tidal volume, minute ventilation, and pulmonary compliance were not statistically different from values under baseline conditions. In contrast, there was a significant decrease in pulmonary resistance (-34%; P less than 0.05) and the resistive work of breathing (-26%; P less than 0.05) following the combined treatment. The effect of combined BD and CPT in decreasing the resistive respiratory load may be related to relief of subclinical bronchospasm, reduction in mucosal edema, and mobilization of mucous secretions.     

The effect of nebulized bronchodilator therapy on intraocular pressures in patients with glaucoma

A controlled double-blind crossover study of ocular complications associated with nebulized ipratropium bromide and salbutamol therapy for respiratory distress was undertaken in 46 chronic bronchitis patients. There was no significant rise in intraocular pressure or change in anterior chamber angle in patients with open-angle glaucoma, narrow-angle glaucoma or control subjects following treatment with either drug. However, when the two drugs were used in combination, intraocular pressure rose in patients with narrow-angle glaucoma but not in patients with open-angle glaucoma or in control subjects. Transient angle closure was seen in five of these patients. Intraocular pressures did not rise when swimming goggles were used to protect the eyes or when antiglaucoma treatment was continued. Nebulized bronchodilator therapy is safe in nonglaucomatous patients and those with open-angle glaucoma. Ocular complications can follow combined ipratropium bromide and salbutamol nebulization in patients with narrow-angle glaucoma, but can be prevented by using the drugs separately, protecting the eyes and ensuring continued antiglaucoma measures.     

Use of intermittent positive pressure breathing combined with nebulization in pulmonary disease

The use of IPPB with a nebulizer offers a method by which an aerosol can be distributed in the lungs more effectively in some patients than was usually possible by other technics. Fluoroscopy shows increased ventilation of the lungs, especially at the bases, with IPPB. Since IPPB increases the effective alveolar air, the value of vasodilator substances, chemotherapeutic and antibiotic agents thus administered in pulmonary disease would be enhanced. The combined use of the nebulizer containing an aqueous solution with IPPB apparatus tends to prevent irritation of the throat by the dry gas. In anthrasilicotic patients with dyspnea promotion of better drainage from the bronchi and bronchioles appears to be the most beneficial effect of IPPB combined with a nebulized vasodilator agent.     

间断无创正压通气联合雾化吸入支气管扩张剂及糖皮质激素治疗AECOPD依从性及疗效分析

目的探讨间断无创正压通气(NIPPV)联合雾化吸入治疗AECOPD的临床疗效。方法选择入院AECOPD患者随机分为治疗组和对照组各30例,治疗组使用氧动雾化器吸入气管扩张剂及糖皮质激素后使用NIPPV。根据情况可反复交替,观察组单纯使用NIPPV,观察两组的依从性、气管插管率、带机时间、住院时间。结果治疗组各项指标均优于对照组(P0.05)。结论间断NIPPV联合雾化吸入气管扩张剂及糖皮质激素疗效显著。     

Trapped gas and airflow limitation in children with cystic fibrosis and asthma

Trapped gas (TG) has been shown to be present in cystic fibrosis (CF) and asthma, but its relationship with airflow limitation (AL) has not been explored. TG was defined as the difference between the functional residual capacity measured by body plethysmography [FRC(BP)] and that measured by helium dilution [FRC(He)] expressed as a percentage of total lung capacity (TLC). We studied 21 children with CF and 15 with asthma who had a similar degree of AL and hyperinflation, however the children with CF had greater amounts of TG compared with asthma [15% +/- 2 (mean +/- 1 SE) vs 8 +/- 2, P less than 0.05]. Mixing efficiency (ME), an index of the distribution of ventilation, was found to be lower in the CF children than in those with asthma (34 +/- 4 vs 54 +/- 4). In CF, TG correlated with forced expiratory flow between 25 and 75% of vital capacity (FEF25-75), ME, RV/TLC, and maximal expiratory flow rates at 25 and 50% of vital capacity (Vmax25 and 50, respectively; r = -0.66, -0.61, 0.72, -0.71, -0.74). ME also correlated with the above measures. In asthma, TG did not correlate with the FEF25-75, ME, RV/TLC, Vmax25, or Vmax50. Furthermore, TG was frequently found in patients with asthma with moderate AL while it was often absent in patients with severe AL. For both CF and asthma, neither the severity of AL nor the magnitude of the TG could be predicted from the increase in Vmax50 with helium (delta V50).(ABSTRACT TRUNCATED AT 250 WORDS)     

Interrupter technique versus plethysmography for measurement of respiratory resistance in children with asthma or cystic fibrosis

The purpose of the present study was to compare measurements of respiratory system resistance by the interrupter method (Rrsint) with those of airway resistance by plethysmography (Raw) in nonobstructed children with asthma or cystic fibrosis (ratio of forced expiratory volume in 1 sec to vital capacity, FEV(1)/VC >/=80% with a forced expiratory flow rate between 25-75% of forced vital capacity, FEF(25-75) >/=75% of normal values) and in obstructed children with the same diseases (FEV(1)/VC <80% and/or FEF(25-75) <75% of normal values). Eighty-one children (47 asthmatics and 34 suffering from cystic fibrosis) aged 5-18 years (mean 11.2 +/- SD 3.4 years) were included in the study. For the overall group, we observed generally lower values for Raw (4.7 +/- 2. 8 cmH(2)O.L(-).s) than for Rrsint20 (extrapolation of the mouth pressure during occlusion to 40 ms after interruption) (5.6 +/- 1.7 cmH(2)O.L(-1).s) (P < 0.02), or for Rrsint40 (extrapolation of the mouth pressure during occlusion to 60 ms after interruption) (6.6 +/- 2.2 cmH(2)O.L(-1).s) (P < 0.001), but there was no difference between Rrsint20 and Raw in the obstructed subgroup. Moreover, we observed a correlation between the difference (Rrsint20 - Raw) expressed in percentage of predicted values and the degree of obstruction estimated by FEV(1)/VC (r = 0.56, P < 0.001). The differences between the specific resistances (sRrsint20 - sRaw, sRrsint40 - sRaw) were also correlated with the severity of the obstruction (r = 0.65, P < 0.001 and r = 0.57, P < 0.001, respectively). We observed also that the tendency to underestimate resistance by Rrsint in obstructed children was not the same in children with asthma and cystic fibrosis. We conclude that the tendency of Rrsint, as measured with our method, to underestimate airway obstruction appears to increase in proportion to the severity of the airway obstruction.     

Pulmonary function tests in preschool children with cystic fibrosis

Pulmonary function tests have rarely been assessed in preschool children with cystic fibrosis (CF). The objective of this multicenter study was to compare pulmonary function in 39 preschool children with CF (height, 90-130 cm; 16 homozygous Delta F508) and in 79 healthy control children. Functional residual capacity (helium dilution technique) and expiratory interrupter resistance (Rint(exp)) (interrupter technique) were measured. As compared with control children, children with CF had significantly higher Rint(exp), expressed as absolute values and as Z-scores (1.05 +/- 0.36 versus 0.80 +/- 0.20 kPa.L(-1). second, p < 0.0001; and 1.31 +/- 1.72 versus 0.19 +/- 0.97, p < 0.0001), and significantly lower specific expiratory interrupter conductance (1.29 +/- 0.34 versus 1.63 +/- 0.43 kPa(-1). second, p < 0.0001). The effect of the bronchodilator salbutamol on Rint(exp) was not significantly different between children with CF and control children. Rint(exp) Z-scores were significantly higher in children with CF who were exposed to passive smoke (n = 8) (p < 0.03). Children with CF and with a history of respiratory symptoms (n = 31) had significantly higher functional residual capacity Z-scores (p < 0.02) and lower specific expiratory interrupter conductance Z-scores (p < 0.04). Genotype did not influence the data. We conclude that Rint(exp) and functional residual capacity measurements may help to follow young children with CF who are unable to perform reproducible forced expiratory maneuvers.