ObjectiveDeterioration in ventricular function is often observed in patients treated with anthracyclines for cancer. There is a paucity of evidence on interventions that might provide cardio-protection. We investigated whether prophylactic use of carvedilol can prevent doxorubicin-induced cardiotoxicity and whether any observed effect is dose related.MethodsA prospective, randomized, double-blind study in patients treated with doxorubicin, comparing placebo (n = 38) with different doses of carvedilol [6.25 mg/day (n = 41), 12.5 mg/day (n = 38) or 25 mg/day (n = 37)]. The primary endpoint was the measured change in left ventricular ejection fraction (LVEF) from baseline to 6 months.ResultsLVEF decreased from 62 ± 5% at baseline to 58 ± 7% at 6-months (p = 0.002) in patients assigned to placebo but no statistically significant changes were observed in any of the 3 carvedilol groups. At 6 months, only one of 116 patients (1%) assigned to carvedilol had an LVEF < 50% compared to four of the 38 assigned to placebo (11%), (p = 0.013). No significant differences were noted between carvedilol and placebo in terms of the development of diastolic dysfunction, clinically overt heart failure or death.ConclusionsCarvedilol might prevent deterioration in LVEF in cancer patients treated with doxorubicin. This effect may not be dose related within the studied range.

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deterioration in lung function, which has been described after nebulised asthma treatment in infancy, did not occur."4 Ipratropium bromide acts on the nose by decreasing secretions but has not been shown to alter resistance in the nasal airway. As two infants with complete nasal blockage showed a 20% improvement in specific conductance we assume that the improvement seen after ipratropium bromide was due to bronchodilatation.A Nebuhaler has been shown to be effective in giving inhaled budesonide to young children.' We used this delivery system to give budesonide and fP2 agonists to asthmatic children aged under 2 and obtained dramatic improvement in many cases (unpublished results).Though this method of delivery does not replace nebulisers in severe attacks of asthma in young children, it may enable many children without access to a nebuliser to be treated successfully at home. Handicapped patients who cannot use other inhalation devices may also benefit.