Aerosol salbutamol administration by IPPB: lowest effective dose.

Ruffin, R.; Obminski, George; Newhouse, Michael T.

doi:10.1136/thx.33.6.689

Cited by 38 publications

(9 citation statements)

References 13 publications

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“…The maximum dose deposited in the of 900 fig (20 fig/min for 45 min) (65), and had lungs is about 10% of that initially present in no side effects. The divergent findings may be the nebulizer (114). due to the much longer inhalation time (45 IPPB has been claimed to carry a definite risk min) used in the latter study.…”

mentioning

confidence: 77%

The Treatment of Status Asthmaticus

Georg

1981

Allergy

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Asthma has proved difficult to define (42, 103, in asthma often comes suddenly and unexpect-116) and physicians do not always agree about edly, and even experienced physicians may when a patient should be called asthmatic, have difficulty in judging the severity of an Status asthmaticus cannot be easier to define, attack. The patient may be a better judge in but it seems much more seldom that physicians this respect (122), but many asthmatics are not disagree about a diagnosis of status asthma-very sensitive to changes in airway obstruction, ticus. The term will be used here to denote a Rubinfeld & Pain (111) found that 15% were sustained attack of severe asthma that has not unable to sense a reduction in FEVj below 50% responded to the treatment administered by of predicted value. An objective assessment the patient and his doctor. It is a serious and ought usually to be the first step taken when potentially lethal phase of the disease and if dealing with a patient in status asthmaticus. It hospital admission is possible it will usually be can be carried out in a few minutes, and it required.provides both a baseline from which the proStatus asthmaticus is an acute aggravation gress of the patient can be assessed and a gradwhich may afflict the allergic as well as the ing of the severity of the attack, non-allergic asthmatic. It may occur at any age.The physical signs of wheezing, the use of but the risk seems to be greatest in the middle-accessory respiratory muscles and the presence aged patient with asthma of late onset. It also of pulsus paradoxus have not been found to be seems to afflict women more often than men. reliable indicators of the severity of asthma (71, In seven recent papers (7,25,58,61,70,118,121). 119) out of a total of 1,540 patients, 1,136 were Counting the heart rate is the simplest of females and 404 males, i.e. a ratio of about 3:1.objective measurements and will provide some We have now fairly good knowledge of the indication of the severity of the attack. An elecliberation of mediator substances from the trocardiogram and a chest radiograph should mast cell in the reaction with specific allergens also be available. Tachycardia is always a feature and about their possible significance in acute, of severe asthma and is related to the degree of asthmatic attacks. Yet we do not understand hypoxaemia (107). The average heart rate is what happens when the patient lapses into about [120][121][122][123][124][125][126][127][128][129][130] found an average status asthmaticus despite the use of the medi-rate of 126; Westerman (137) 139 with a range cation which in other situations has successfully from 110 to 180; Rees (107) 118, range 96-160. brought him relief Cooke et al. (25) found a heart rate above 90 in 87% of their patients and that 75% of the complications occurred in patients with a heart Objective assessment ^ , ,0•^ rate above 130. The treatment of severe asthma must reasonTwo important objective measurements that ably begin with an assessment of severity. Death any emergency ward s...

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confidence: 77%

The Treatment of Status Asthmaticus

Georg

1981

Allergy

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“…Given the limited patient numbers, clinical judgment is paramount. Increasing from 2.5 to 5 mg salbutamol produces only limited incremental bronchodilation (96,97).…”

Section: Nebulized Beta-agonists In Hfmentioning

confidence: 99%

Heart Failure and Chronic Obstructive Pulmonary Disease

Hawkins¹,

Petrie²,

MacDonald³

et al. 2011

Journal of the American College of Cardiology

130

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The combination of heart failure and chronic obstructive pulmonary disease presents many therapeutic challenges. The cornerstones of therapy are beta-blockers and beta-agonists, respectively. Their pharmacological effects are diametrically opposed, and each is purported to adversely affect the alternative condition. The tolerability of beta-blockade in patients with mild and fixed airflow obstruction likely extends to those with more severe disease. However, the evidence is rudimentary. The long-term influence of beta-blockade on pulmonary function, symptoms, and quality of life is unclear. Low-dose initiation and gradual up-titration of cardioselective beta-blockers is currently recommended. Robust clinical trials are needed to provide the answers that may finally allay physicians' mistrust of beta-blockers in patients with chronic obstructive pulmonary disease. Beta-agonists are associated with incident heart failure in patients with pulmonary disease and with increased mortality and hospitalization in those with existing heart failure. These purported adverse effects require further investigation. In the meantime, clinicians should consider carefully the etiology of dyspnea and obtain objective evidence of airflow obstruction before prescribing beta-agonists to patients with heart failure.

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“…For patients similar to those in the present study, daily treatment by IPPB and somewhat lower doses (2.5-5 mg) of salbutamol have been recommended [Ben nis and Svedmyr, 1977;Shenjield et al, 1973;Spilzer et al, 1972]. Ruffin et al [1978b] found no significant differences between the peak bronchodilator effects of 1 and 5 mg of salbutamol in solution.…”

Section: Discussionmentioning

confidence: 41%

“…A report on a radiotracer technique [Ruffin et al, 1978a] indicates that a dose of about 30 pg of fenoterol in the airways produces maxi mal bronchodilation. Since it has been es timated that about 10% of a dose inhaled using IPPB reaches the lungs [ Ruffin et al, 1978b;Shenfield et al, 1973], it can be pre dicted that about 0.3 mg of fenoterol will cause maximal bronchodilation when ad ministered in this way. The dose used in the present study was of a similar order of magnitude.…”

Section: Discussionmentioning

confidence: 99%