Determination of the optimum dose of subcutaneous salbutamol in asthmatic patients.

Coady, T.; Stewart, C.J.; Davis, Heather

doi:10.1111/j.1365-2125.1976.tb00598.x

Brit J Clinical Pharma

1976

DOI: 10.1111/j.1365-2125.1976.tb00598.x

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Determination of the optimum dose of subcutaneous salbutamol in asthmatic patients.

T. Coady¹,

C.J. Stewart²,

Heather Davis³

Abstract: Saline and salbutamol (250 mug, 500 mug, 750 mug, and 1000 mug) injections were administered under double‐blind conditions to seven chronic stable asthmatic patients. The response on the respiratory system (FEV1, FVC) and cardiovascular system (pulse rate, blood pressure and ECG) was monitored for 3 hours. Increasing the dose of salbutamol increased the peak and weighted average effects of FEV1 and pulse rate. The optimum dose, a titration of desired increases in FEV1 and undesirable increases in pulse rate, i… Show more

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1979

1984

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Cited by 3 publications

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“…In the very severely ill patient, takes up to 30 min for peak activity to be intravenous administration is preferable, reached. A dose of 500 fig has been found to The employment of intermittent positive give optimum response, but doses of 750 and pressure breathing has never convincingly been 1000 fig can be given if necessary (20). demonstrated to be better than ordinary inhala-A comparison of intravenous and aerosol tion (26,66,98).…”

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confidence: 99%

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: 99%

The Treatment of Status Asthmaticus

Georg

1981

Allergy

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Albuterol and Isoproterenol in Bronchial Asthma

Light¹,

Taylor²,

George³

1979

Arch Intern Med

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Albuterol: An Adrenergic Agent for Use in the Treatment of Asthma Pharmacology, Pharmacokinetics and Clinical Use

Ahrens

Smith

1984

Pharmacotherapy

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Albuterol is a long-acting beta 2-adrenergic receptor-selective drug that relaxes airway smooth muscle. It is currently available in the United States in oral and metered-dose inhaler forms. Nebulizer solutions and parenteral preparations are likely to be marketed here in the future. The chemical modifications that make albuterol beta 2-selective also promote oral bioavailability and increased duration of action by decreasing sensitivity to degradative enzymes. Albuterol can also produce undesirable dose-related effects: metabolic effects including decreased levels of plasma potassium, phosphate, calcium and magnesium; increased levels of plasma glucose, insulin, renin, lactate and ketones; peripheral vasodilation and perhaps some direct cardiac stimulation resulting in decreased systemic and pulmonary vascular resistance, increased pulse pressure and tachycardia; and skeletal muscle tremor. These side effects are most common with parenteral administration and much less prominent with aerosol administration, which yields lower systemic concentrations. Limited pharmacokinetic data suggest a long distribution phase, a terminal half-life of 3-8 hours, and 10-20% oral bioavailability. Aerosolization of albuterol or a similar agent with a compressed-air nebulizer appears to be best first-line management of the patient with acute dyspneic asthma, but appropriate preparations for this kind of therapy are currently missing from the United States market. Intravenous albuterol has also been employed in acutely dyspneic patients, but produces more side effects than carefully administered intravenous theophylline, is impaired by lack of sufficient pharmacokinetic information to guide dosing, and is of uncertain efficacy in the asthmatic with respiratory failure. However, it appears to lack the potentially life-threatening side effects that can result when theophylline is used carelessly . In the ambulatory patient, aerosolized albuterol (or a similar agent) administered by metered-dose inhaler is an excellent agent for treatment as needed and/or for prevention of acute bronchospasm triggered by exercise or other predictable cause. Advantages include a high degree of efficacy, rapid onset and long duration of effect, and minimal side effects. Regularly scheduled administration of albuterol by metered-dose inhaler is a widely used and effective maintenance medication for patients requiring long-term prophylactic therapy. However comparisons of the ability of this regimen and the other common maintenance regimens (cromolyn and theophylline) to control chronic symptoms of asthma are needed.

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Determination of the optimum dose of subcutaneous salbutamol in asthmatic patients.

Cited by 3 publications

References 7 publications

The Treatment of Status Asthmaticus

The Treatment of Status Asthmaticus

Albuterol and Isoproterenol in Bronchial Asthma

Albuterol: An Adrenergic Agent for Use in the Treatment of Asthma Pharmacology, Pharmacokinetics and Clinical Use

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