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At least 379 records · Page 21Linked to original sources
PubMed1997

Inhaled nitric oxide and hypoxic respiratory failure in infants with congenital diaphragmatic hernia. The Neonatal Inhaled Nitric Oxide Study Group (NINOS).

OBJECTIVE: We designed and conducted a randomized, double-masked, controlled multicenter study to determine whether inhaled nitric oxide (INO) in term and near-term infants with congenital diaphragmatic hernia (CDH) would reduce the occurrence of death and/or the initiation of extracorporeal membrane oxygenation (ECMO). PATIENTS AND METHODS: Infants of 34 weeks gestation or more, <14 days of age with CDH, without known structural heart disease, requiring assisted ventilation for hypoxemic respiratory failure with two oxygenation indices (OIs) of 25 or more at least 15 minutes apart, were eligible for this trial. Infants were centrally randomized and then received masked treatment with 20 ppm NO or 100% oxygen as control. Infants with less than a full response to 20 ppm NO (increase in PaO2 > 20 Torr) after 30 minutes were evaluated at 80 ppm NO/control study gas. RESULTS: The 28 control and 25 treated infants enrolled by the 13 participating centers were not significantly different at randomization for any of the measured variables including prerandomization therapies and initial OIs (45.8 +/- 16.3 for controls, 44.5 +/- 14.5 for INO). Death at <120 days of age or the need for ECMO occurred in 82% of control infants compared with 96% of INO infants (ns). Death occurred in 43% of controls and 48% of the INO group (ns), and ECMO treatment was used for 54% of control and 80% of INO-treated infants. There was no significant improvement in PaO2 (delta PaO2 7.8 +/- 19.8 vs 1.1 +/- 7.6 Torr, ns) nor significant reduction in OI (-2.7 +/- 23.4 vs 4.0 +/- 14.8, ns) associated with INO treatment. Mean peak nitrogen dioxide (NO2) concentration was 1.9 +/- 1.3 ppm and the mean peak methemoglobin was 1.6 +/- 0.8 mg/dL. No infant had study gas discontinued for toxicity. There were no differences between the control and INO groups for the occurrence of intracranial hemorrhage, specific grades of intracranial hemorrhage, periventricular leukomalacia, brain infarction, and pulmonary or gastrointestinal hemorrhages. CONCLUSIONS: Although the immediate short-term improvements in oxygenation seen in some treated infants may be of benefit in stabilizing responding infants for transport and initiation of ECMO, we conclude that for term and near-term infants with CDH and hypoxemic respiratory failure unresponsive to conventional therapy, inhaled NO therapy as used in this trial did not reduce the need for ECMO or death.

Administration, Inhalation↗
PubMed2004

Formoterol dry-powder inhalation--Novartis/SkyePharma: Foradil MDDPI, Foradil MDPI, Foradil SkyeHaler, formoterol fumarate dry-powder inhalation.

In November 1998, Novartis Pharma of Switzerland and SkyePharma PLC of the UK signed an agreement to jointly develop a new formulation of the beta(2)-adrenoceptor agonist formoterol (Foradil). The new product, Foradil Certihaler, utilises a multidose dry-powder inhaler (MDPI or MDDPI) device, SkyeHaler, developed by SkyePharma. It also utilises SkyePharma's SkyeProtect powder formulation technology, which protects the drug from moisture. The product is waiting for approval for the treatment of asthma. Foradil MDPI may also have potential for the treatment of chronic obstructive pulmonary disease (COPD). Novartis has stated that Foradil Certihaler offers certainty of dosing and dose confirmation, and will also contain a dose counter that indicates the number of doses left. SkyePharma is responsible for development of the product in its finished form; this includes the supply of both the powder and the inhalation device as a product to Novartis. The product is manufactured at SkyePharma's Lyon facility in France. SkyePharma is receiving fees, development costs and milestone payments from Novartis. SkyePharma will also receive royalty income on worldwide sales. SkyePharma has granted Novartis an exclusive worldwide licence to market Foradil MDPI.Foradil Certihaler was approved in Switzerland in March 2004. This is the first approval in Europe, and will trigger an undisclosed milestone payment by Novartis to SkyePharma. Submissions for regulatory approval in the asthma indication were filed in the EU (on a country-by-country basis) and the US in December 2002. On 22 October 2003, SkyePharma announced that the US FDA had issued an 'approvable' letter for Foradil Certihaler. Launch of the product is anticipated for 2004. Clinical trials of Foradil MDPI for the treatment of asthma began in October 1999. In December 2000, phase III trials commenced in Europe. SkyePharma stated in April 2001 that phase III trials had commenced recently in the US. SkyePharma estimated in April 2001 that the worldwide sales potential of Foradil MDPI could be as much as 600 million US dollars. SkyePharma anticipates receiving royalties and manufacturing revenues of more than 10%.

Administration, Inhalation↗
PubMedDate not supplied

Concurrent use of salmeterol with inhaled corticosteroids is more effective than inhaled corticosteroid dose increases.

This randomized, double-blind, parallel, multi-center study was designed to determine whether the addition of salmeterol to existing inhaled corticosteroid therapy provides greater therapeutic benefit than doubling the dose of inhaled corticosteroids in symptomatic patients with asthma. A total of 514 adults were randomized to either beclomethasone 168 micrograms plus salmeterol 42 micrograms twice daily or beclomethasone 336 micrograms twice daily for 24 weeks. Both treatments resulted in significantly improved symptom control and increased pulmonary function. However, beclomethasone plus salmeterol provided greater improvements than doubling the dose of beclomethasone (p < or = 0.05) in FEV1 and in daily-recorded measurements of morning (38 L/minute versus 20 L/minute after treatment with higher dose beclomethasone) and evening peak expiratory flow, asthma symptom scores, symptom-free days, supplemental albuterol use, and days and nights not requiring albuterol. There were no significant differences between treatment groups in the number of patients with abnormal response to corticotropin stimulation at Treatment Week 24. No treatment differences in asthma exacerbation and adverse event frequency rates were seen. Beclomethasone 168 micrograms plus salmeterol 42 micrograms administered twice daily was superior to beclomethasone 336 micrograms taken twice daily in patients symptomatic on beclomethasone 168 micrograms, with no added safety risks.

Administration, Inhalation↗
PubMed2000

[The administration of 20 ppm of inhaled nitric oxide produces a faster response than the inhalation of 5 ppm in adult respiratory distress syndrome].

OBJECTIVES: To compare the effects of 5 and 20 ppm of nitric oxide, evaluating time until response for each dose, in patients with adult respiratory distress syndrome (ARDS). PATIENTS AND METHODS: The study was prospective, controlled and random. Fifteen patients assigned to two groups received either 5 ppm (8 patients) or 20 ppm (7 patients) from November 96 to July 97. The main variables analyzed were PaO2/FiO2 and pulmonary vascular resistance index. We also studied etiology, severity of pulmonary damage as reflected by the Lung Injury Score, age, sex, Apache II prognostic score and exitus. Outcome was considered good if PaO2/FiO2 increased and/or pulmonary vascular resistance index decreased by more than 30% from the initial level (before inhalation of nitric oxide). RESULTS: The mean lung injury score was 2.9 +/- 0.4 and the two groups were homogeneous. Time until response to nitric oxide was significantly less in the 20 ppm group. Both PaO2/FiO2 and pulmonary vascular resistance index improved significantly in both groups whereas Qs/Qt improved only in the 20 ppm group. We also found that cardiac index and oxygen transport increased, the latter significantly only in the 20 ppm group. NO2 formation was less than 2 ppm and methemoglobin levels did not rise above 2%. CONCLUSIONS: Inhaled nitric oxide significantly improves oxygenation and decreases pulmonary vascular resistance without altering systemic vascular resistance during treatment of ARDS. The final outcomes were similar for both doses, but the 20 ppm dose produced a significantly faster response as well as a significant decrease in Qs/Qt.

Administration, Inhalation↗
PubMed1989

Inhaled beta adrenergic agonists and inhaled steroids in the treatment of asthma.

In summary, inhaled steroids are the treatment to be preferred for patients requiring maintenance therapy with steroids, since they cause a dramatic fall in sensitivity and reactivity of bronchial response, improve lung function to normal, reduce the diurnal variation in peak expiratory flow rates, and markedly reduce symptoms. Nevertheless they must be given at adequate dosage for a long time, associated with inhaled beta-agonists, and in more severe asthma with short courses of oral steroids.

Administration, Inhalation↗
PubMed1988

A placebo-controlled comparison between the bronchodilatory effects of ipratropium bromide inhaled as a dry powder and by metered dose inhaler in chronic obstructive pulmonary disease.

A placebo-controlled study was performed to compare the effect of the inhalation of ipratropium bromide as a powder (capsule = 40 micrograms) and by pressurized aerosol (two puffs of 20 micrograms; ie, 40 micrograms). Fifteen patients (nine males and six females) with chronic obstructive pulmonary disease were studied in a double-blind crossover comparison of the two different modes of administration. The VC, FEV1 and viscous work of breathing time-response curves were almost identical, indicating bronchodilation. We conclude that in patients with chronic obstructive pulmonary disease, the powder inhalation was not more effective than the pressurized aerosol. It could, however, be offered as an alternative to patients with poor hand-lung coordination. The patients tolerated the two modes of administration without difficulties: no local irritation or coughing was observed.

Administration, Inhalation↗
PubMed1994

[Usefulness of inhaled steroids in steroid-dependent intractable asthma--equivalent dose of oral steroid to inhaled steroid].

Twenty-four steroid-dependent intractable asthmatics were treated with oral prednisolone (PSL) (basic dose) + additional PSL and oral PSL (basic dose) + inhaled beclomethasone (BDP) alternately, to assess the clinical symptoms in each administration period. Equivalent doses of PSL to BDP were calculated. 1. Peak expiratory flow rate (PEF) during additional administration of BDP was markedly higher both in the morning and at night compared with that during additional administration of BDP was markedly higher both in the morning and at night compared with that during additional administration of PSL (p < 0.01 and p < 0.05 respectively). 2. The relation between additional doses of either PSL or BDP and attack scores was analysed in regression to obtain a dose equivalence line. 3. BDP 400 micrograms was equivalent to PSL 7.04 mg on average. 4. The equivalent dose of PSL to BDP tended to be lower in cases where the period of dependency on oral steroids was longer, the basic dose was larger, or the asthma was more severe. These data indicate that the application of inhaled steroids may be useful in the therapeutic management of steroid-dependent intractable asthmatics.

Administration, Inhalation↗
PubMed1997

Pulmonary response to inhaled antigen: neuroimmune interactions promote the recruitment of dendritic cells to the lung and the cellular immune response to inhaled antigen.

Dendritic cells (DCs) play a critical role in capturing and presenting inhaled antigens to T lymphocytes. We report that pulmonary DCs in the Lewis rat are normally located in the lung in immediate proximity to nerve fibers that contain immunoreactive substance P (SP). Functionally, pulmonary DCs bound 125I-SP and displayed increased motility in vitro in response to graded concentrations of SP. However, SP had no effect on the accessory cell activities of DCs. To examine the role of neural influences on the pulmonary immune response to inhaled antigen, Lewis rats were pretreated with capsaicin (CAP), which damages small nerves and depletes neuropeptide stores, and then challenged intratracheally (i.t.) with hen egg lysozyme (HEL). The number and antigen-presenting cell activities of pulmonary DCs in the CAP-treated rats were comparable to those of controls up to day 14. T lymphocytes harvested from the regional lymph nodes draining the lung were effectively sensitized to HEL in both groups. However, when CAP-treated rats sensitized to HEL i.t. at day 0 were rechallenged with HEL i.t. at day 14, the lungs showed decreased numbers of OX-6+ DCs and diminished pulmonary lymphoid infiltrates compared with controls. We suggest that CAP interferes with a neural-mediated response that contributes to the accumulation of inflammatory cells during the efferent limb of the pulmonary-cell-mediated immune response in vivo.

Administration, Inhalation↗
PubMed2004

Evaluation of the Malvern Spraytec with inhalation cell for the measurement of particle size distribution from metered dose inhalers.

The purpose of this study was to evaluate the Malvern Spraytec with inhalation cell attachment as a means of analyzing the particle size distribution of aerosols from pressurized metered dose inhalers (pMDIs). The aerosol particle size distribution of various commercially available, placebo, and experimental pMDI formulations was determined using Spraytec under various experimental conditions and the relevant data were compared with the Andersen cascade impactor data. The Spraytec volume median diameter (Dv 50) values for commercial chlorofluorocarbon- and hydrofluoroalkane (HFA)-based pMDIs were respectively smaller and higher compared with their reported mass median aerodynamic diameter values. It was possible to obtain a close agreement between Spraytec Dv 50 and the reported mass median aerodynamic diameter values for a solution-type pMDI formulation, Qvar 50, by equilibrating the pMDI to 55 degrees C before the measurement and using a 20-cm throat extension. Incorporation of a nonvolatile solvent propylene glycol (PG) in placebo pMDIs (15% w/w ethanol, 0.5-20.0% w/w PG in HFA 134a) showed an increase in Dv 50 with increasing concentration of PG. Furthermore, it was possible to obtain a correlation (R(2) = 0.8037) between Spraytec and Andersen cascade impactor data for the experimental nimesulide-pMDI formulations containing 0.1% w/w drug, 0.25-10% w/w PG, and 15% ethanol in HFA 134a.

Aerosols↗
PubMed1976

A study of the inhalation of pentachlorophenol by rats. Part II. A new inhalation exposure system for high doses in short exposure time.

An exposure system has been designed which is applicable for short time, acute exposures of rats to the aerosol of pesticides. The aerosol is generated by compressed air aspiration. Larger droplets are removed by a cyclone separation. The exposure chamber has 12 inhalation sites separated from the animal containers by rubber seals which insure inhalation as the only route of exposure.

Aerosols↗
PubMed1986

Inhalation pharmacokinetics of carbon tetrachloride in rats based on arterial blood:inhaled air concentration ratios.

To estimate the rate of CCl4 metabolism in vivo by using an inhalation pharmacokinetic approach based on arterial blood:air concentration ratios, the blood CCl4 concentrations (Cart) at the end of 5-hr exposure to varying concentrations of CCl4 in inhaled air (Cinh) were determined in male, naive rats and in rats pretreated with po administration of 100 or 200 microliters CCl4/100 g body weight 24 hr before exposure. Hepatic cytochrome P-450 content during and at the end of exposure was also determined. The biphasic nature of the Cart-Cinh curve for naive rats, with a transition at Cinh of about 100 ppm, indicated that CCl4 metabolism is perfusion-limited below 100 ppm and is saturated above 100 ppm. In 100 microliters CCl4-pretreated rats, Cinh at the transition point decreased from 100 to 50 ppm; this percentage decrease was consistent with the decreased cytochrome P-450 content induced by administration of 100 microliters CCl4. In 200 microliters CCl4-pretreated rats, where CCl4 metabolizing enzyme activity was completely inhibited, the Cart-Cinh curve gave a single line with a shallower slope than that of the steeper part of the curve for naive rats, reflecting a loss of cytochrome P-450 content during exposure. The curves of calculated uptake rate showed continued uptake in completely inhibited rats, representing the contribution of fat loading only. The rate of metabolism was approximated by the uptake rate for naive rats minus that for 200 microliters CCl4-pretreated rats, and decreased gradually with increasing Cinh over the range of saturable metabolism. From this rate curve, Vmax and Km for naive rats were 2.7 mg/kg/hr and of the order of 0.3 mg/liter, respectively. The gradual decrease in the rate of metabolism could be interpreted in terms of the rapid loss of cytochrome P-450 content. The Vmax for 100 microliters CCl4-pretreated rats decreased by about 57%, which was in good agreement with the decrease of cytochrome P-450 content. These experiments suggest the usefulness and validity of this approach for studying metabolism of a volatile compound.

Air↗
PubMed1999

Inhalation therapy in asthma: nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children.

OBJECTIVE: To compare lung deposition from a nebulizer and a pressurized metered-dose inhaler (pMDI)/holding chamber to determine their efficiency in aerosol delivery to children. STUDY DESIGN: Children with stable asthma (n = 17) aged 2 to 9 years inhaled in random order radiolabeled salbutamol from a nebulizer and a pMDI through a nonstatic holding chamber. Body and lung deposition of radiolabeled salbutamol was assessed with a gamma camera. RESULTS: Mean (absolute dose) total lung deposition expressed as a percentage of the nebulized dose was 5.4% (108 microg) in younger children (<4 years) and 11.1% (222 microg) in older children (>4 years). Mean (absolute dose) total lung deposition expressed as a percentage of the metered dose was 5.4% (21.6 microg) in younger and 9.6% (38.4 microg) in older children. CONCLUSIONS: For the same age groups we have shown equivalent percentages of total lung deposition of radiolabeled salbutamol aerosolized by either a nebulizer or a pMDI/holding chamber. However, the delivery rate per minute and the total dose of salbutamol deposited were significantly higher for the nebulizer.

Albuterol↗
PubMed2000

Equivalence testing and equivalence limits of metered-dose inhalers and dry powder inhalers measured by in vitro impaction.

In this study, criteria for the acceptability of comparative in vitro equivalence testing are proposed. Furthermore, the following equivalence limits for in vitro impaction methods are postulated: the 90% confidence interval (CI) of the in vitro deposition ratio of the test product and the reference product should lie within 0.80-1.20. The aim of this study was to challenge these limits by applying them to in vitro impaction results of several groups of pressurized metered-dose inhalers and dry powder inhalers containing salbutamol and beclomethasone dipropionate. The deposition results were obtained with the Twin Impinger. All products had a marketing authorization in The Netherlands and were considered therapeutically equivalent within each group. The postulated equivalence limits/group were challenged by fictitiously assigning a preparation as a test product or reference product and calculating the 90% CI of the deposition ratio of the test and reference products. All possible combinations of products within a group were tested. The products were considered equivalent if the 90% CI of the quotient lay within 0.80-1.20. In most cases, the quotient of the test product and reference product remains within 0.80-1.20, but due to a high variability in the deposition results of several products, the 90% CI of the quotient sometimes falls outside the proposed equivalence limits. It is concluded that the equivalence limits postulated are rather conservative, with respect to accepting equivalence. The limits can therefore serve as a prudent predictor of equivalence within the acceptability criteria proposed, but have to be further validated.

Albuterol↗
PubMed2005

Utility and efficacy of fluticasone propionate and salmeterol inhaled from a single inhaler for persistent asthma.

The utility of a new therapy, in this instance fluticasone and salmeterol combination (FSC), is determined by multiple uncontrollable factors in individual patients and can be measured by continued use and efficacy over time. Over one year from April 2001, 186 patients with persistent asthma were switched from controller pharmacotherapy to FSC at equidose to prior inhaled corticosteroid. Follow-up data on 171 (92%) indicated 129 (75%) had continued FSC for one year. Compared to the 42 who discontinued FSC, those who continued had significant reduction of asthmatic exacerbations, improved spirometry, and reduced usage of inhaled reliever and systemic corticosteroid.

Adolescent↗
PubMed2001

Selecting an accessory device with a metered-dose inhaler: variable influence of accessory devices on fine particle dose, throat deposition, and drug delivery with asynchronous actuation from a metered-dose inhaler.

Accessory devices reduce common problems with metered-dose inhalers (MDIs), namely high oropharyngeal deposition of aerosol and incoordination between actuation and inhalation by the patient. The objective of this study was to systematically compare the performance of various accessory devices in vitro. MDIs were tested alone or in combination with four spacers (Toilet paper roll, Ellipse, Optihaler, Myst Assist) and five holding chambers (Aerochamber, Optichamber, Aerosol Cloud Enhancer, Medispacer, and Inspirease). An Anderson cascade impactor was used to measure aerosol mass median aerodynamic diameter (MMAD) and fine particle dose (MMAD < 4.7 microm). In separate experiments, the influence of asynchronous MDI actuation on drug delivery was determined with a simulated spontaneous breathing model. Compared with the MDI alone, all of the accessory devices reduced aerosol MMAD and increased lung-throat ratio (fine particle dose/throat impaction; p < 0.05 for both parameters). The fine particle dose of albuterol was 40% higher with the Ellipse (p < 0.01), was equivalent with the Toilet Paper Roll, Aerochamber, Optichamber, and Medispacer, and was 33-56% lower with the Optihaler, Myst Assist, Aerosol Cloud Enhancer, and Inspirease (p < 0.03). MDI actuation in synchrony with inspiration produced highest drug delivery; when MDI actuation occurred 1-sec before inspiration or during exhalation, decrease in drug delivery with holding chambers (10-40% reduction) was less than that with spacers (40-90% reduction). Accessory device selection is complicated by variability in performance between devices, and in the performance of each device in different clinical settings. In vitro characterization of a MDI and accessory device could guide appropriate device selection in various clinical settings.

Albuterol↗
PubMed1995

Aerosol particle generation from dry powder inhalers: can they equal pressurized metered dose inhalers?

In comparison with pressurized metered dose inhalers (pMDIs), dry powder inhalers (DPIs) emit a semi-stable aerosol cloud and are inspiratory flow actuated and inspiratory flow driven. In vitro studies show that different DPIs vary in their efficiency as delivery systems of fine drug particles (aerodynamic diameter < 5 microns). The efficiency of DPIs may vary according to the inspiratory force used to generate the aerosol. In comparison with other DPIs, Turbuhaler has been shown to be an efficient fine particle generator at weak, moderate and strong inspiratory forces. Deposition studies using human throat casts have shown that the throat has a minor influence on the deposition of drugs delivered from DPIs, whereas the throat has a major influence on the deposition of drug delivered from pMDIs. The fine particle dose able to penetrate the human throat casts was considerably higher for budesonide Turbuhaler than for budesonide pMDI, whereas for fluticasone propionate the fine particle dose was considerably higher from the pMDI than from Diskhaler. Thus, whether the fine particle dose and the deposition pattern of a drug generated from DPIs can equal that generated from pMDIs depends on the drug, the formulation and the patient.

Adult↗
PubMed1999

Aerosol characterization of three corticosteroid metered dose inhalers with volumatic holding chambers and metered dose inhalers alone at two inspiratory flow rates.

Inhaled corticosteroids are first-choice drugs in the treatment of chronic asthma. A metered dose inhaler (MDI) equipped with a spacer device is easier to use for patients with a poor inhalatory technique; it favors a reduction in the size of the particles delivered to the patient and thus a reduction in the incidence of local and systemic side effects of these drugs. The aim of this study was to determine the particle characteristics of fluticasone propionate (FP), flunisolide (FLUN), and beclomethasone dipropionate (BDP), each administered at a rate of 250 micrograms per puff and at inspiratory flow rates of 30 and 60 L/min in vitro, to estimate the particle characteristics of these drugs aspirated via an MDI alone and via a large-volume holding chamber (Volumatic). Compared with the MDI alone, at 30 L/min, the Volumatic (Glaxo Wellcome, Ware, UK) significantly reduced the mass median aerodynamic diameter (MMAD) and increased the fine particles (< 5 microns and < 2 microns) generated by all three drugs. At 60 L/min, the MMAD increased and the generation of fine particles decreased with both devices. These data suggest that the inspiratory flow applied by means of the devices may be a determinant for the deposition of the drug in the lower airways in that by increasing the inspiratory flow, the MMAD increases and the percentage of fine particles decreases, probably because of the reaggregation favored by the higher flows.

Aerosols↗
PubMed2005

Formoterol delivered via a new multi-dose dry powder inhaler (Certihaler) is as effective and well tolerated as the formoterol dry powder inhaler (Aerolizer) in children with persistent asthma.

The Certihaler is a new multi-dose dry powder inhaler for the delivery of formoterol (Foradil), a long-acting beta(2)-agonist. This dose-ranging study compared the efficacy and safety of formoterol 5, 10, 15 and 30 microg and placebo administered via the Certihaler or formoterol 12 microg via a single-dose dry powder inhaler (Aerolizer) in children with persistent asthma. This was a randomized, placebo-controlled, double-blind, double-dummy, incomplete block crossover, dose-finding and pharmacokinetic study. Children (5-12 years, n = 77) received four of the active treatments twice weekly (BID) for 1 week separated by 1-week single-blind washouts. The primary efficacy variable was 12-h AUC of FEV(1) after 1 week's treatment. Secondary variables included serial 12-h FEV(1). A subset of patients (n = 37) participated in a pharmacokinetic analysis. All formoterol doses resulted in significant increases in 12-h AUC of FEV(1) compared with placebo, and there was no difference between active treatments. The onset of action of formoterol was <3 min for all active treatments. Doses of formoterol > or =10 microg via the Certihaler increased FEV(1) significantly for up to 12 h compared with placebo. The 5 microcg dose via the Certihaler and 12 microg dose via the Aerolizer had a significant effect up to 8 and 7 h post-dose, respectively. Urinary excretion of formoterol via the Certihaler increased in a dose-proportional manner. All formoterol doses were well tolerated, but some patients experienced tremor at the 15 and 30 microg doses. Despite the lack of significant differences between the active doses in the overall bronchodilation, formoterol 10 microg BID via the Certihaler was the dose that provided the best balance between efficacy and tolerability: its duration of action was sustained over 12 h, contrary to that the lower dose (5 microg BID), whereas its tolerability, especially with regard to tremor, was better than the higher doses (15 and 30 microg BID). Overall, Certihaler 10 microg BID was not significantly different from formoterol 12 microg BID via Aerolizer.

Adrenergic beta-Agonists↗