A long-term prospective assessment of home nebulizer treatment

O’Driscoll, B R; Kay, E. A.; Taylor, R.J.; Weatherby, H.; Chetty, Mahendran; Bernstein, A

doi:10.1016/s0954-6111(06)80031-4

Cited by 44 publications

(16 citation statements)

References 23 publications

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“…27 We therefore confined ourselves to a single measure of subjective benefit similar to that used in other studies assessing nebuliser therapy. 28 Although ipratropium bromide is generally well tolerated and safe, adverse (anticholinergic) effects do occur. The addition of ipratropium bromide to a 02 agonist in the treatment of acute COPD will therefore increase the possibility of side effects as well as the cost of therapy.…”

Section: Resultsmentioning

confidence: 99%

Comparison of nebulised salbutamol and ipratropium bromide with salbutamol alone in the treatment of chronic obstructive pulmonary disease.

Martin

Congleton

Page

et al. 1995

Thorax

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Background -Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) are often prescribed ipratropium bromide in combination with a P2 agonist such as salbutamol. Studies have not shown any benefit in adding ipratropium bromide to salbutamol in acute exacerbations of COPD, but these studies have only assessed patients for 60-90 minutes and short term studies may not predict long term clinical response. Combination therapy with the two drugs was compared with salbutamol alone in the treatment of acute exacerbations of COPD during a hospital admission. Methods -Seventy patients admitted to hospital with an acute exacerbation of COPD were randomly allocated to receive either nebulised salbutamol 5 mg and ipratropium bromide 500 tg, or nebulised salbutamol 5 mg alone (all four times a day) on admission. All other treatment was prescribed at the discretion of the attending physician. Length ofstay in hospital and spirometeric values on days 1, 3, 7, 14, and discharge were assessed. Patients completed a subjective symptom score each day. Results -There was no difference between the two groups in the mean (SD) length of stay (salbutamol 10-5 (4.7) days, salbutamol + ipratropium bromide 11*8 (4.4) days; 95% CI -1-02 to 3.62). There was no difference in spirometric values on days 1, 3, 7, 14, or discharge between the two groups. The subjective improvement was similar with both treatments. Conclusions -The routine addition of nebulised ipratropium bromide to salbutamol appears to be of no benefit in the treatment of acute exacerbations of COPD. (Thorax 1995;50:834-837) Keywords: chronic obstructive pulmonary disease, P2 agonist, ipratropium bromide.Patients admitted to hospital with an acute exacerbation of chronic obstructive pulmonary disease (COPD) are usually treated with a high dose P2 agonist as part of their therapy. It is now commonplace for patients to receive, in addition, nebulised ipratropium bromide with obvious additional cost. This is logical pharmacologically as ipratropium has a different mode of action, inhibiting vagally-mediated bronchomotor tone.' There is evidence that adding ipratropium bromide to a nebulised 12 agonist is valuable in the long term management of COPD2A and in acute severe asthma.5 There have been no studies, however, on the place of ipratropium bromide in the management of acute exacerbations of COPD. Additionally, it has been known for some years that atropine-like drugs may be more effective in remissions of airways obstruction than in relapse.67 We have therefore compared nebulised salbutamol with nebulised salbutamol plus ipratropium bromide (combination therapy) in the treatment of acute exacerbations of COPD in a randomised trial. MethodsPatients admitted as emergencies to acute medical units with a diagnosis of an acute exacerbation of COPD who were not taking regular nebulised bronchodilators at home were eligible for the study. All were aged over 45 years and had a smoking history of more than 10 pack years. All had a forced expir...

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Section: Resultsmentioning

confidence: 99%

Comparison of nebulised salbutamol and ipratropium bromide with salbutamol alone in the treatment of chronic obstructive pulmonary disease.

Martin

Congleton

Page

et al. 1995

Thorax

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“…Our patients were typical of the population likely to be con sidered for such therapy. They would be conventionally considered non-responders to salbutamol in terms of lung function, but nebulised therapy is frequently prescribed for patients who derive significant symptomatic benefit even in the absence of objective change in a formal trial of nebulised therapy [4]. The period of study was how ever too short to categorise the patients' overall response to therapy [3].…”

Section: Discussionmentioning

confidence: 99%

“…High-dose (3-agonists, usually given by a nebuliser. are nevertheless now commonly prescribed for patients with airflow obstruction both in hospital and at home [3,4], though caution has been urged over the safety of such nebulised therapy [5][6][7][8][9], Studies of the arrhythmogenicity of (3-agonists in CAO [7, I0-14| have broadly suggested minor increases in car diac events of uncertain significance. However, the un controlled nature of most of these studies together with variations in the ECG monitoring techniques used render such studies inconclusive.…”

Section: Introductionmentioning

confidence: 99%

Effect of High-Dose Salbutamol on Cardiac Rhythm in Severe Chronic Airflow Obstruction: A Controlled Study

Hall

Woodhead²,

Johnston³

1994

Respiration

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Despite concern over possible adverse cardiac effects of high-dose β-agonists there have been no controlled studies of the effects of such a therapy in patients with severe chronic airflow obstruction (CAO). We therefore studied 22 CAO patients (FEV < 1 litre) with continuous ambulatory cardiac monitoring. Patients received either nebulised salbutamol (5 mg) or saline each given 4 times daily for 24 h on 2 consecutive days, single blind, in random order. Supraventricular arrhythmias were common on both saline and salbutamol days (8 vs. 9 patients, p = NS), but none were clinically apparent. There were no episodes of ventricular tachycardia. Ventricular ectopic activity was highly variable but did not significantly differ between the two study days overall or between specific periods after nebulised salbutamol or saline. Serum potassium (mean) fell by 0.23 (SD 0.06) mmol/l in 10 patients after salbutamol. Baseline FEV₁, PaO₂ PCO₂ were not predictive of arrhythmias or ectopic activity. While occasional adverse effects cannot be excluded, we conclude that high-dose salbutamol does not lead to any general increase in ar-rhythmogenic potential in severe CAO.

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“…[11][12][13][14] Inhaled bronchodilator medications are safe with few untoward effects. First aid providers may assist the victim in using prescribed bronchodilator medication (Class IIb; LOE 4 studies [11][12][13][14] extrapolated to first aid ϭ LOE 7). They are not expected to make a diagnosis, but they can assist the victim under the following conditions:…”

Section: Medical Emergencies Breathing Difficultiesmentioning

confidence: 99%