Concomitant bitolterol mesylate aerosol and theophylline for asthma therapy, with 24 hr electrocardiographic monitoring

Kemp, James P.; Chervinsky, Paul; Orgel, H.Alice; Meltzer, Eli O.; Noyes, J H; Mingo, Thomas S.

doi:10.1016/0091-6749(84)90481-0

Cited by 43 publications

(3 citation statements)

References 25 publications

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“…Our data do not support such a conclusion; the addition of theophylline to a salbutamol regimen did not increase the frequency or alter the severity of these ventricular or supraventricular arrhythmias. This finding is in agreement with those of several other recent studies [6, 7, 8, 16, 18]. Although these studies have not been especially designed to assess the effects of combined theophylline and salbutamol use in patients with obstructive pulmonary disease with concurrent heart disease, some patients in the studies of Dutt et al [18] and Eidelman et al [8] also had coronary artery disease or heart failure.…”

Section: Discussionsupporting

confidence: 90%

“…Even deaths of asthma patients have been attributed to the combined use of inhaled beta‐agonists and oral theophylline [5]. An increased frequency of arrhythmia has been observed during the use of these drugs, although this has been considered to be clinically insignificant [6–8]. Most studies, however, have been conducted in young, otherwise healthy subjects.…”

Section: Introductionmentioning

confidence: 99%

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Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias

Poukkula

Korhonen

Huikuri

et al. 1989

Journal of Internal Medicine

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 99%

Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias

Poukkula

Korhonen

Huikuri

et al. 1989

Journal of Internal Medicine

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“…the new Pz compounds in therapeutic amounts even when arrhythmias are specifically sought with Holter monitoring (Kelly et rrl. 1985;Kemp et al 1984;Pearlman et ul. 1992;D'Alonzo et d. 1994).…”

Section: Minireviewmentioning

confidence: 99%

The Use of β₂‐Adrenoceptor Agonists in the Treatment of Bronchial Asthma

Svedmyr¹

1996

Pharmacology & Toxicology

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All guidelines recommend short-acting inhaled beta 2-adrenoceptor agonists as the first-line drugs in acute asthma attacks and inhaled corticosteroids as the drugs of choice when regular daily treatment is needed. Short-acting inhaled beta 2-adrenoceptor agonists are not effective in reducing nocturnal awakenings because of their short duration of action. In addition there has been an intense debate about the regular use of these drugs. This debate is reviewed. They should only be used on "as needed basis". The Swedish guidelines for the treatment of asthma were the first to recommend the new long-acting inhaled beta 2-adrenoceptor agonists at relatively early stage of the illness (800 micrograms daily of inhaled corticosteroids). Two recently completed large multicentre studies with salmeterol in asthmatics support this opinion. Both studies showed a better asthma control with a combination of a low inhaled steroid dose and salmeterol compared to a doubling of the steroid dose. In most asthmatic patients, still symptomatic on inhaled steroids doses 400 to 800 micrograms daily, a test of the addition of inhaled salmeterol is recommended. The steroid dose can be kept low and safe. However, asthmatic patients with either frequent or severe exacerbations should primarily have their steroid dose increased.

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Addition of long-acting beta2-agonists to inhaled steroids as first line therapy for persistent asthma in steroid-naive adults and children

Chróinín

Greenstone

Lasserson

et al. 2009

Cochrane Database of Systematic Reviews

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Background Consensus statements recommend the addition of long-acting inhaled ß2-agonists (LABA) only in asthmatic patients who are inadequately controlled on inhaled corticosteroids (ICS). It is not uncommon for some patients to be commenced on ICS and LABA together as initial therapy. Objectives To compare the efficacy of combining inhaled corticosteroids with long-acting ß2-agonists (ICS+LABA) with inhaled corticosteroids alone (ICS alone) in steroid-naive children and adults with persistent asthma. We assessed two protocols: (1) LABA + ICS versus a similar dose of ICS (comparison 1) and (2) LABA + ICS versus a higher dose of ICS (comparison 2). Search methods We identified randomised controlled trials through electronic database searches (May 2008). Selection criteria Randomised trials comparing ICS + LABA with ICS alone in children and adults with asthma who had no inhaled corticosteroids in the preceding 28 days prior to enrolment. Data collection and analysis Each author assessed studies independently for risk of bias and extracted data. We obtained confirmation from the trialists when possible. The primary endpoint was rate of patients with one or more asthma exacerbations requiring rescue systemic corticosteroids. Results are expressed as relative risks (RR) for dichotomous data and as mean differences (MD) or standardised mean differences (SMD) for continuous data. Main results Twenty-eight study comparisons drawn from 27 trials (22 adult; five paediatric) met the review entry criteria (8050 participants). Baseline data from the studies indicated that trial populations had moderate or mild airway obstruction (FEV1 65% predicted), and that they were symptomatic prior to randomisation. In comparison 1, the combination of ICS and LABA was not associated with a significantly lower risk of patients with exacerbations requiring oral corticosteroids (RR 1.04; 95% confidence interval (CI) 0.73 to 1.47) or requiring hospital admissions (RR 0.38; 95% CI 0.09 to 1.65) compared to a similar dose of ICS alone. The combination of LABA and ICS led to a significantly greater improvement from baseline in FEV1 (0.12 L/sec; 95% CI 0.07 to 0.17), in symptoms (SMD −0.26; 95% CI −0.37 to −0.14) and in rescue ß2-agonist use (−0.41 puffs/day; 95% CI −0.73 to −0.09) compared with a similar dose of ICS alone. There was no significant group difference in the risk of serious adverse events (RR 1.15; 95% CI 0.64 to 2.09), any adverse events (RR 1.02; 95% CI 0.96 to 1.09), study withdrawals (RR 0.95; 95% CI 0.82 to 1.11), or withdrawals due to poor asthma control (RR 0.94; 95% CI 0.63 to 1.41). In comparison 2, the combination of LABA and ICS was associated with a higher risk of patients requiring oral corticosteroids (RR 1.24; 95% CI 1 to 1.53) and study withdrawal (RR 1.31; 95% CI 1.07 to 1.59) than a higher dose of ICS alone. For every 100 patients treated over 43 weeks, nine patients using a higher dose ICS compared to 11 (95% CI 9 to 14) on LABA and ICS suffered one or more exacerbations requiring rescue oral cortico...

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Concomitant bitolterol mesylate aerosol and theophylline for asthma therapy, with 24 hr electrocardiographic monitoring

Cited by 43 publications

References 25 publications

Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias

Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias

The Use of β₂‐Adrenoceptor Agonists in the Treatment of Bronchial Asthma

Addition of long-acting beta2-agonists to inhaled steroids as first line therapy for persistent asthma in steroid-naive adults and children

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Concomitant bitolterol mesylate aerosol and theophylline for asthma therapy, with 24 hr electrocardiographic monitoring

Cited by 43 publications

References 25 publications

Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias

Theophylline and salbutamol in combination in patients with obstructive pulmonary disease and concurrent heart disease: effect on cardiac arrhythmias

The Use of β2‐Adrenoceptor Agonists in the Treatment of Bronchial Asthma

Addition of long-acting beta2-agonists to inhaled steroids as first line therapy for persistent asthma in steroid-naive adults and children

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The Use of β₂‐Adrenoceptor Agonists in the Treatment of Bronchial Asthma