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At least 811 records · Page 45Linked to original sources
PubMed2003

Withdrawal of inhaled corticosteroid therapy in long-term, stable, mild to moderate, persistent asthmatic patients.

We aimed to evaluate the effect of withdrawal of inhaled corticosteroid (ICS) therapy on the course of mild to moderate asthma. Nineteen cases with stable, mild to moderate asthma were included in this study. Patients had used ICSs regularly during the past year and had no symptoms and signs for the last 3 months prior to the study. The patients were randomized into two groups. Group 1 included 11 patients who were followed after withdrawal of ICS therapy (mean age 48.8 +/- 13.1 years; M/F: 2/9), while Group 2 included 8 patients still taking ICS therapy (mean age 47.2 +/- 14.8 years; M/F: 4/4). All subjects were seen at the end of the 1st (V2), 2nd (V3), 3rd (V4), 6th (V5), and 12th (V6) months. Symptom scores and FEV1 measurements were evaluated during these visits. Patients with relapses were excluded from the study. Bronchial challenge test was applied in all cases at V0, V4, V5, and V6. In 10 of 11 cases (90.9%) in which ICS therapy was discontinued, relapse was observed in 1.55 +/- 0.86 months, while in 2 of 8 subjects (25%) still taking ICSs, relapse occurred after 3.76 +/- 1.99 months. In Group 1, "mean symptom score" and "mean PC20FEV1" values measured during the whole follow-up period were found to be lower than in Group 2. We concluded that withdrawal of ICS therapy could increase the possibility of relapse in mild to moderate asthma even in asymptomatic and stable cases.

Administration, Inhalation↗
PubMed2002

[Ambulance transport of patients with respiratory problems: a prospective observational study].

The aim of this study was to prospectively compile and analyze all emergency transports of patients with respiratory problems. The main target variables were frequency of the different reasons for transport and treatments administered during the emergency event. Special emphasis was placed on the use of inhalation therapy. The data of all patients who, in 2000, were transported by the "Realü" emergency medical service of the Chur Rhine Valley (a community with a population of approximately 100,000) due to respiratory problems were prospectively compiled according to predefined criteria. The emergency records and the medical release reports were evaluated. A total of 137 patients were prospectively included for the year 2000, corresponding to 8% of all patients transported by "Realü" (out of a total of 1675 patients). The average age was 66 years (2-98 years). Around one-fifth of the transports involved patients with exacerbations of chronic obstructive pulmonary disease (COPD), pulmonary embolisms, pulmonary infections or cardiac dyspnea. Six patients (5%) were transported by ambulance because of bronchial asthma. Inhalation therapy was administered in only 41% of the cases with obstructive pulmonary disease in which it would have been indicated. In conclusion, our evidence shows that bronchial asthma is the primary diagnosis in only 6% of the patients requiring emergency transport due to respiratory symptoms. In these emergency situations, antiobstructive inhalation therapy was given to a mere 41% of the patients suffering exacerbations of COPD or bronchial asthma. More frequent use of such a simple and effective treatment should be encouraged.

Adolescent↗
PubMed2000

Combination therapy with inhaled nitric oxide and intravenous dobutamine during pulmonary hypertension in the rabbit.

Combination therapy with an intravenous inovasodilator and inhaled nitric oxide (NO) may be appropriate in patients with pulmonary hypertension and associated right ventricular failure. We examined whether dobutamine and inhaled NO would have additive pulmonary vasodilator effects in experimental pulmonary hypertension. Pulmonary hypertension was produced in anesthetized, mechanically ventilated rabbits by infusion of U46619, a thromboxane analogue. Dobutamine was administered in increasing doses (2.5-20 microg/kg/min) with and without inhaled NO (40 ppm). Dobutamine produced dose-dependent decreases in pulmonary vascular resistance (PVR) and mean arterial pressure (MAP) and increases in cardiac output (CO). Inhaled NO alone decreased pulmonary artery pressure (PAP) and PVR with no effect on MAP or CO. The effects of dobutamine and inhaled NO were additive, so that at each dose of dobutamine, inhaled NO decreased PAP and PVR with no effect on systemic hemodynamics. This study suggests that the combination of dobutamine and inhaled NO should produce additive pulmonary vasodilation in patients with pulmonary hypertension and associated right ventricular dysfunction.

Administration, Inhalation↗
PubMed2004

Combination therapy of inhaled corticosteroids and long-acting beta2-adrenergics in management of patients with chronic obstructive pulmonary disease.

Chronic obstructive pulmonary disease (COPD) affects over 5% of the adult population and is the only major cause of death in the United States where morbidity and mortality are increasing. Clinically, COPD is characterized by irreversible airflow obstruction and airway inflammation that eventually lead to dyspnea, cough and sputum production. Long-acting beta(2)-agonists (LABAs) are effective in reducing patient symptoms through their bronchodilatory action on airway smooth muscle. More importantly, when LABAs are given in conjunction with inhaled corticosteroids, they appear to provide added benefits for patients. While the mechanisms for this observation are not entirely clear, there is emerging evidence to indicate that LABAs and corticosteroids attenuate different but complementary components of the inflammatory cascade related to COPD. Moreover, LABAs and corticosteroids may beneficially interact to prevent downregulation of beta(2)-receptors in airway cells (and thereby preventing tachyphylaxis) and to facilitate translocation of glucocorticoid receptors into the nucleus of inflammatory cells (thereby, amplifying the anti-inflammatory activity of the corticosteroid). Regardless of the mechanism, several large, high-quality randomized controlled clinical trials indicate that combination therapy of LABA with inhaled corticosteroids improves patient symptoms, and reduces exacerbations by a third (compared to placebo). More importantly, combination therapy produces superior health outcomes than mono-therapy with inhaled corticosteroids or LABA, suggesting added clinical benefits of these two compounds in COPD. This article will present a comprehensive overview of the currently available clinical evidence for the use of combination therapy as well as the potential mechanisms of their actions in COPD.

Administration, Inhalation↗
PubMed2005

Glucocorticoid receptor nuclear translocation in airway cells after inhaled combination therapy.

Clinical evidence is accumulating for the efficacy of adding inhaled long-acting beta(2)-agonists (LABAs) to corticosteroids in asthma. Corticosteroids bind to cytoplasmic glucocorticoid receptors (GRs), which then translocate to the nucleus where they regulate gene expression. This article reports the first evidence in vivo of an interaction between inhaled LABA and corticosteroid on GR nuclear translocation in human airway cells using immunocytochemistry. We initially demonstrated significant GR activation 60 minutes after inhalation of 800 microg beclomethasone dipropionate in six healthy subjects. Subsequently, we determined the effects of salmeterol and fluticasone propionate (FP) in seven steroid-naive patients with asthma. We observed dose-dependent GR activation with 100- and 500-microg doses of FP, and to a lesser extent with 50 microg salmeterol alone. However, combination therapy with 100 microg FP and salmeterol augmented the action of FP on GR nuclear localization. In vitro, salmeterol enhanced FP effects on GR nuclear translocation in epithelial and macrophage-like airway cell lines. In addition, salmeterol in combination with FP enhanced glucocorticoid response element (GRE)-luciferase reporter gene activity and mitogen-activated protein kinase phosphatase 1 (MKP-1) and secretory leuko-proteinase inhibitor (SLPI) gene induction. Together, our data confirm that GR nuclear translocation may underlie the complementary interactions between LABAs and corticosteroids, although the precise signal transduction mechanisms remain to be determined.

Adrenal Cortex Hormones↗
PubMed2006

Potential mechanisms of improvement of airway hyperresponsiveness by inhaled corticosteroid therapy in asthmatic patients.

OBJECTIVE: Recent clinical trials with administration of IL-5 antibodies to asthmatic patients have revealed reduction of eosinophilia but unaltered airway hyperresponsiveness (AHR). In contrast, inhaled corticosteroid (ICS) therapy eliminates both eosinophilia and AHR. This study was designed to examine the mechanisms by which ICS improves airway hyperresponsiveness in asthmatic patients. METHODS: Clinical variables of asthma involving vascular permeability and IL-5 levels were examined in 23 asthmatic patients and 11 normal control subjects. After the first sputum induction, inhaled beclomethasone dipropionate (BDP 800 microg/day) was administered to asthmatic patients for 8 weeks, and sputum induction was repeated. RESULTS: IL-5 levels in induced sputum and airway vascular permeability index were significantly higher in asthmatic patients. IL-5 was positively correlated with percentage of eosinophils in induced sputum, and negatively correlated with FEV1, but not correlated with PC20 methacholine. After BDP therapy, eosinophils, ECP, and IL-5 levels were significantly decreased to the same levels as in normal subjects. Conversely, PC20 methacholine and airway vascular permeability did not improve to the same levels as in normal subjects. Increase in PC20 methacholine from before to after BDP therapy was significantly correlated with decrease in airway permeability index, but not with decrease in IL-5 level. CONCLUSION: Our results suggest a clear dissociation between IL-5 and AHR. ICS therapy improves AHR at least in part through decrease in airway vascular permeability.

Administration, Inhalation↗
PubMed2003

Optical feedback training of inhalation with Autohaler and Turbuhaler in COPD patients.

The success of inhalation therapy depends on patients inhalation technique and correct handling of the inhalation device. In this study the effort to train correct handling and optimal inhalation technique of patients using Autohaler and Turbuhaler was assessed. The Bad-Reichenhall-Aerosol-Therapy-Trial (BREATH) was a prospective, randomized, cross-over trial in 200 patients who were not familiar with either of the test systems. The correct handling of Autohaler and Turbuhaler was assessed by means of a checklist (observation score). An optimal inhalation maneuver was used evaluated with the computer-based Inhalation Manager (optical feedback, computer score). The Autohaler reached 6.58 +/- 3.64 (mean +/- SD) out of nine points in the observation score and 66.85 +/- 29.84% in the computer score before training. After training the scores increased significantly to 8.33 +/- 2.08 points and 86 +/- 23.40% respectively. The use of the Turbuhaler also significantly improved from 4.28 +/- 4.24 points and 56.67 +/- 42.97% to 7.78 +/- 2.74 points and 85.80 +/- 27.63%, respectively. The significant improvement of patients inhalation technique after training emphasizes the importance of training in inhalation therapy. In addition, it could be demonstrated that the optical feedback given by the Inhalation Manager was a useful tool for improving the inhalation technique of patients using Autohaler and Turbuhaler.

Administration, Inhalation↗
PubMed1997

Effect of beclomethasone dipropionate inhalation on eosinophilic bronchitis in patients with silicosis.

The efficacy of beclomethasone dipropionate (CAS 5534-09-8, BDP, beclomethasone) inhalation therapy over the course of 12 months were evaluated in 42 patients with established chronic silicosis. Their pulmonary functions were monitored every 3 months and volume of sputum production was established daily. Subjects were divided randomly into two groups; 21 patients (BDP group) were treated with BDP (400 micrograms/day) by way of a metered-dose inhaler, while the 21 controls did not receive the BDP inhalation therapy. Although FVC (forced vital capacity), FEV1 (forced expiratory volume in 1 s), MMEF (maximal mean expiratory flow) and arterial blood oxygen tension did not improve significantly, sputum production significantly decreased in the BDP group. The patients who responded most dramatically to the treatment presented with sputum eosinophilia and elevated serum IgE levels prior to therapy. Pulmonary tuberculosis or exacerbation of chronic airway infection was not observed in any of the patients. These results suggest that corticosteroid inhalation therapy is helpful in the management of chronic silicosis, especially in patients with sputum eosinophilia. Positive atopic factors may be related to the pathogenesis of eosinophilic bronchitis, a complication of chronic silicosis.

Aged↗
PubMed1999

Comparison between fenoterol and fenoterol plus oxitropium bromide delivered by metered-dose inhaler with InspirEase to relieve acute asthma attack.

Although the inhalation of beta2-agonists has frequently been used to relieve acute asthma attacks, the efficacy of anticholinergic agents for acute asthma attacks still remains unclear. This study was designed to compare the inhalation of fenoterol and the inhalation of fenoterol plus oxitropium bromide delivered by a metered-dose inhaler with holding chamber (InspirEase) to relieve acute asthma attacks. To accomplish this, 69 patients who had presented with an acute asthma attack were randomized to receive either fenoterol (1 puff [200 microg/puff] every 1 min for 5 min; total 1000 microg) or fenoterol plus oxitropium bromide (2 puffs [100 microg/puff] every 1 min for 5 min; total 1000 microg). The peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV1) values were measured before treatment, and 1, 15, 30, and 60 min after the inhalation therapy. The ratios of improvement, PEF (or FEV1) after treatment divided by PEF (or FEV1) before treatment, were also calculated. Thirty-three patients were evaluated in the combination group and 31 patients were evaluated in the fenoterol group. The PEF value at 60 min after inhalation therapy of the fenoterol plus oxitropium bromide group (261 +/- 18 L/min, mean +/- standard error) was significantly higher compared to that of the fenoterol group (210 +/- 17 L/min). In addition, the ratios of improvement of PEF at 1, 15, 30, and 60 min after inhalation therapy were significantly higher in the fenoterol plus oxitropium bromide group compared with the fenoterol group.

Acute Disease↗
PubMed1980

[Experiences with oral N-acetyl-cysteine treatment in children suffering from cystic fibrosis (author's transl)].

A clinical test with the oral use of Fluimucil was performed by ourselves: Forty-two children, who had been in stable condition for 8--10 years under inhalation therapy with Mucosolvin, were treated for a period of 6 months with Fluimucil used orally. We compared the clinical, bronchoscopic and lung function finding s before and after the 6-month period. In the case of 7 children the oral treatment had to be discontinued and replaced by a resumption of inhalation therapy after 6 to 12 weeks on an account of an exacerbation of the lungstate. The bronchoscopic studies showed results worse in 44% of the cases, unchanged in 22%, and improved in 34%. For lung-function the figures were 31%, 51% and 18% respectively. We can conclude from our results that it is not possible to replace inhalation therapy by an oral treatment for all children with cystic fibrosis. We can, however, surmise that such a treatment will be possible for 50--60% of the children and this must be considered as a significant step forward in the care of these children.

Acetylcysteine↗
PubMed1992

Interleukin-2 by inhalation: local therapy for metastatic renal cell carcinoma.

We report the use of inhaled natural interleukin-2 in patients with metastatic disease. Six patients with metastatic renal cell carcinoma received 100,000 units natural interleukin-2, 5 times per day by inhalation in addition to a 4-day cycle of intravenous natural interleukin-2 every 2 weeks and subcutaneous interferon 5 days per week. Response was clearly correlated with metastatic site. Distinct tumor burden and the poor condition of the patient did not impair success. Pulmonary metastases responded in 5 of 5 patients. Metastases in the mediastinum, liver, abdomen and pelvis were stabilized in 4 patients. No response was noted in 3 solitary bone metastases, which were successfully removed surgically after several months of therapy, and a pleural metastasis progressed despite a clear response of the pulmonary disease in the same patient. New metastases did not develop in any of the patients during treatment (median followup 183 days of treatment, range 97 to 296 days). The over-all importance of the low toxicity of this novel route of administration (World Health Organization classification not exceeding grade 1) making long-term outpatient treatment possible must be emphasized because limitations of systemic interleukin-2 application are mainly caused by pulmonary side effects, for example pulmonary capillary leakage syndrome and edema. However, this new type of topical natural interleukin-2 application and combination with low dose intravenous interleukin-2 achieved considerable antitumor responses.

Administration, Inhalation↗
PubMed2001

Patients' opinions of CFC-free inhaler changeover in primary care.

OBJECTIVE: To determine patient's opinions regarding the changeover from CFC containing to CFC-free salbutamol. DESIGN: Patients receiving metered dose salbutamol inhaler therapy were identified and verbal consent was obtained before a semi-structured interview was performed. Setting An outpatient respiratory clinic within a busy teaching hospita. MAIN OUTCOME MEASURES: Knowledge of CFC-free inhaler therapy and acceptance of change. RESULTS: A total of 28 patients were identified of whom only eight (29%) had been changed to a CFC-free product. Six of these (75%) had received counselling from their GP or pharmacist regarding the change. Differences were reported by all of the patients who had been changed to a CFC-free inhaler with comments including difference in taste (6 patients), difference in feel (6), less effective (1) and more effective (1). Three patients preferred the CFC-free inhaler to their previous therapy. Although 13 out of the 20 patients who had not received a CFC-free inhaler stated they were happy with the potential changeover, 10 (80%) has concerns relating to effectiveness. CONCLUSION: The majority of patients still receiving CFC inhalers were aware that the production of CFC-containing products had been restricted although they were unaware of the imminent changes that would take place regarding their inhaler therapy. However, the small sample size recruited in this study may mean that the results are unrepresentative of the CFC-free implementation process in the Grampian Health Board area as a whole. Nonetheless, in view of the differences experienced by patients who received CFC-free inhalers and the concerns stated about potential lack of efficacy by patients about to be changed over, it is essential that healthcare professionals provide advice on CFC-free inhalers to all patients.

Air Pollutants↗
PubMed2000

Clinical aspects of inhaled anticholinergic therapy.

Anticholinergic therapy is directed toward muscarinic receptors within the lung. Inhaled quaternary muscarinic antagonists are used because they cause less systemic adverse effects than other types of antimuscarinic drugs. Of the 5 possible muscarinic receptors, the lung contains three: M1, M2, and M3. Antagonism of the M1 and M3 receptors results in bronchodilation, primarily in the larger airways. The efficacy of the antimuscarinic bronchodilators cannot be entirely explained by this mechanism, and there is probably peripheral activity as well. The use of inhaled antimuscarinic drugs is well tolerated, and the efficacy is maintained with chronic use. Although ipratropium is the first-line therapy for symptomatic COPD, it and other similar drugs can also be used to treat other obstructive diseases. Ipratropium is available in an MDI, in solution for small-volume nebulizer, and in combination with albuterol in an MDI. Newer antimuscarinic agents are being developed that are more selective for the M1 and M3 sites and last longer. Research is continuing to better understand the sites of action of these agents as well as to develop even more effective drugs.

Administration, Inhalation↗
PubMed2004

Comparison of improvement in quality of life score with objective parameters of pulmonary function in Indian asthmatic children receiving inhaled corticosteroid therapy.

This prospective, hospital based, descriptive study was designed to compare improvement in quality of life (QOL) score with objective measures of pulmonary function in children with persistent bronchial asthma receiving inhaled corticosteroid (ICS) therapy. QOL score (measured by an indigenous tool), forced expiratory volume in first second (FEV1), forced vital capacity (FVC), peak expiratory flow rate (PEFR) and asthma symptom score were measured in 20 newly diagnosed children with persistent asthma- before, during and eight weeks after ICS therapy. There was a significant improvement in all parameters compared at each follow up visit and at termination of the study (p less than 0.05). The magnitude of improvement in QOL was similar to improvement in objective measures of pulmonary function; although these changes were not similar to changes in asthma symptom score. Improvement in QOL score is likely to be a sensitive measurement of functional improvement in asthmatic children on treatment; however subjective sensation of improvement lags behind objective measures.

Administration, Inhalation↗
PubMed1996

Effects of immunotherapy on symptoms, PEFR, spirometry, and airway responsiveness in patients with allergic asthma to house-dust mites (D. pteronyssinus) on inhaled steroid therapy.

The present study was designed to investigate the effects of immunotherapy (IT) with an extract of Dermatophagoides pteronyssinus (Alergo-Merck Depot) during a 27-month period in patients with allergic asthma to house-dust mites. We included 11 patients (mean age 18 years) treated with a combination of IT and inhaled beclomethasone dipropionate (BDP) in comparison to another 11 (mean age 22 years) treated with BDP alone. We evaluated symptom scores, salbutamol use, peak expiratory flow rates (PEFR), spirometry, and bronchial hyperresponsiveness (BHR) during 18 months of therapy with BDP and in the 9 months after BDP interruption. The two kinds of treatment were efficient and comparable in relation to symptom score, salbutamol use, morning PEFR, FVC, and FEV1, but patients treated with IT and BDP had a faster improvement of BHR and PEFR variability. The interruption of BDP after 18 months of therapy was linked to an impairment of all end points, which were more pronounced in patients previously treated only with BDP. These findings suggest that in selected asthmatic patients allergic to house-dust mites, the association of IT and BDP is more effective than therapy with this inhaled steroid alone due to a faster and more striking improvement during the first months of treatment and to a lower rate of relapse after the interruption of therapy with BDP.

Administration, Inhalation↗