Bronchodilator treatment in moderate asthma or chronic bronchitis: continuous or on demand? A randomised controlled study.

Schayck, C.P. van; Dompeling, E.C.; Herwaarden, C.L.A. van; Folgering, H.T.M.; Verbeek, A.L.M.; Hoogen, H.; Weel, Chris van

doi:10.1136/bmj.303.6815.1426

Cited by 252 publications

(74 citation statements)

References 24 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The beta-agonists available at the time were isoproterenol and salbutamol, the latter introduced in France early in 1971. Whilst the cardiac toxicity of isoproterenol is greater than the newer beta 2 -selective bronchodilators, their relationship to FEV1 decline is more likely to be related to chronic bronchodilation than to any specific effect of different bronchodilators [7]. This interpretation is further supported by analyses not detailed in the present report which demonstrate similar associations when examining theophylline type bronchodilators.…”

Section: Discussionsupporting

confidence: 76%

“…Current guidelines for the treatment of asthma insist on the early use of anti-inflammatory therapy with less reliance on bronchodilator therapy [5,6]. Potential hazards of regular use of bronchodilators in COPD have been less commonly reported, but such reports do exist [7]. Corticosteroids, both oral and inhaled, are commonly used in the regular treatment of COPD despite only moderate efficacy.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Long-term effects of therapy on respiratory health

Fuhrman

Ernst²,

Kauffmann³

1996

Eur Respir J

View full text Add to dashboard Cite

Only scant information is available on the long-term consequences to respiratory health of treatment with bronchodilators and oral corticosteroids.In the present study, we aimed to gain more information about these consequences. We examined 712 men working in the Paris area, by means of a subjective assessment of whether their respiratory health worsened or improved from 1960 to 1972, the decline in forced expiratory volume in one second (FEV1) over this time-period, and mortality from 1972 to 1992, in relation to respiratory therapy dispensed during a 2 year period in 1970-1971, as recorded in social security reimbursement records.As expected, subjects with respiratory symptoms or airflow limitation were more likely to have been prescribed respiratory therapy. After accounting for the effect of lung function level and smoking, subjects dispensed inhaled β-agonists were likely to feel their condition had worsened and had a greater decline in FEV1 from 1960 to 1972.Among subjects with airflow limitation who reported asthma or persistent wheeze, having been dispensed oral corticosteroids on an intermittent basis was associated with improved survival (relative risk (RR) 0.32; 95% confidence interval (95% CI): 0.10-0.91) after adjusting for FEV1 level and smoking category.Our results add to the evidence that regular use of β-agonist bronchodilators may be associated with adverse effects on respiratory health, whilst intermittent use of corticosteroids may be of long-term benefit.

show abstract

Section: Discussionsupporting

confidence: 76%

mentioning

confidence: 99%

Long-term effects of therapy on respiratory health

Fuhrman

Ernst²,

Kauffmann³

1996

Eur Respir J

View full text Add to dashboard Cite

show abstract

“…Since the present study was designed the safety of regular short-acting beta-agonists has been questioned [18], and their regular prescription is no longer recommended as part of the standard treatment for asthma [19]. However, it is still common for them to be used regularly in the morning and evening, the former because of morning wheeze and the latter to try to reduce nocturnal waking.…”

Section: Discussionmentioning

confidence: 99%

Patient compliance with inhaled medication: does combining beta-agonists with corticosteroids improve compliance?

Bosley

Parry²,

Cochrane³

1994

Eur Respir J

109

View full text Add to dashboard Cite

P Pa at ti ie en nt t c co om mp pl li ia an nc ce e w wi it th h i in nh ha al le ed d m me ed di ic ca at ti io on n: : D Do oe es s c co om mb bi in ni in ng g b be et ta a--a ag go on ni is st ts s w wi it th h c co or rt ti ic co os st te er ro oi id ds s i im mp pr ro ov ve e c co om mp pl li ia an nc ce e? ? In an open, multicentre, parallel group study 102 asthmatic patients were randomly divided into two groups, either receiving the two drugs in separate Turbuhalers or combined into one Turbuhaler. A twice daily regimen was prescribed and a preweighed metered-dose inhaler (MDI) of salbutamol was provided for rescue use. Compliance was measured using the Turbuhaler Inhalation Computer (TIC), which recorded the time and date of each inhalation over a 12 week period. Forced expiratory volume in one second (FEV 1 ) and forced vital capacity (FVC) measurements were carried out at week 0, 6 and 12.Results from 72 patients were analysed. The average compliance was 60-70%. Treatment was taken as prescribed on 30-40% of the study days, and over-usage occurred on less than 10% of days. Only 15% of patients took the drugs as prescribed for more than 80% of the days.Compliance was no greater in patients using the combined inhalers. Other ways of improving patient self-management need further investigation.

show abstract

“…17 The effect of primary-care research on chronic disease is perhaps more difficult to tease out because applied clinical research also takes place in a hospital setting. However, a substantial number of important and clinically relevant trials and cohort studies have been published by primary-care based researchers in relation to all the common chronic conditions managed in primary care, including back pain, 18 asthma, 19 cancer, 20 heart failure, 21 diabetes, 22 and depression. 23 Primary care has taken a lead in developing the methodology of applied clinical research to assess the effectiveness of complex health service interventions.…”

Section: Primary-care Research Can Affect Clinical Practicementioning

confidence: 99%