Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial

Ashoor, Tarek M; Hasseb, Ahmad Mahmoud; Esmat, Ibrahim M.

doi:10.4097/kja.19418

Cited by 12 publications

(19 citation statements)

References 38 publications

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“…Coagulation dysfunction was rather common in AECOPD patients 13,17 . In this observation, PT and APTT were significantly prolonged and FIB was evidently elevated in the AECOPD patients (Table 3).…”

Section: Discussionmentioning

confidence: 51%

“…6 Coagulation dysfunction was rather common in AECOPD patients. 13,17 In this observation, PT and APTT were significantly prolonged and FIB was evidently elevated in the AECOPD patients (Table 3). The prolongation of the coagulation parameters (such as APTT and PT) might be caused by the consumption of clotting factors, 18,19 indicating that coagulation dysfunction in AECOPD patients is a complex process.…”

Section: Factors Influencing Coagulation Statusmentioning

confidence: 55%

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Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia

Liu

Jiang

et al. 2021

Clinical Laboratory Analysis

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Chronic obstructive pulmonary disease (COPD) is one of the common chronic airway obstructive diseases, characterized by persistent respiratory symptoms and airflow limitation. Chronic respiratory diseases was recognised as the third leading cause of death in 2017 and COPD was the most common cause of chronic respiratory disease-attributable deaths. 1 It is estimated that COPD will become the fourth largest cause of death in the world and potentially the direct cause of 4.4 million deaths. 2 This will place a significant burden on economic and healthcare systems throughout the world. Although the inflammation in the early stage of COPD only involves the trachea and lung, hypoxia and further acute inflammation are systemic. In acute exacerbation stage,

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Section: Discussionmentioning

confidence: 51%

Section: Factors Influencing Coagulation Statusmentioning

confidence: 55%

Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia

Liu

Jiang

et al. 2021

Clinical Laboratory Analysis

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“…Treatment with heparin or low MW heparin has been associated with reduced mortality in clinical studies of COVID-19 (Tang et al, 2020;Yin, Huang, Li, & Tang, 2020), and nebulised delivery of heparin is associated with a reduced requirement for ventilation in patients hospitalised by other respiratory diseases such as severe COPD (Ashoor, Hasseb, & Esmat, 2020;Dixon, Schultz, Hofstra, Campbell, & Santamaria, 2010;Shute, Puxeddu, & Calzetta, 2018).…”

Section: Platelet Responses Coagulopathy and Hyperinflammationmentioning

confidence: 99%

“…Treatment with heparin or low MW heparin has been associated with reduced mortality in clinical studies of COVID‐19 (Tang et al, 2020; Yin, Huang, Li, & Tang, 2020), and nebulised delivery of heparin is associated with a reduced requirement for ventilation in patients hospitalised by other respiratory diseases such as severe COPD (Ashoor, Hasseb, & Esmat, 2020; Dixon, Schultz, Hofstra, Campbell, & Santamaria, 2010; Shute, Puxeddu, & Calzetta, 2018). Although heparin is classically used as an anticoagulant, it has also been demonstrated to bind and reduce the activity of a range of cytokines implicated in the COVID‐19‐associated cytokine storm (Mulloy, Hogwood, Gray, Lever, & Page, 2015) and also interacts with the SARS‐CoV‐2 Spike protein in a manner which causes structural alteration of the ACE2‐binding domain which is likely to reduce viral entry (Mycroft‐West et al, 2020).…”

Section: Approaches To Improve Animal Models Of Pathological Mechanismentioning

confidence: 99%

Animal models of mechanisms of SARS‐CoV‐2 infection and COVID‐19 pathology

Cleary

Pitchford

Amison

et al. 2020

British J Pharmacology

177

187

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The coronavirus disease 2019 (COVID-19) pandemic caused by SARS-CoV-2 infections has led to a substantial unmet need for treatments, many of which will require testing in appropriate animal models of this disease. Vaccine trials are already underway, but there remains an urgent need to find other therapeutic approaches to either target SARS-CoV-2 or the complications arising from viral infection, particularly the dysregulated immune response and systemic complications which have been associated with progression to severe COVID-19. At the time of writing, in vivo studies of SARS-CoV-2 infection have been described using macaques, cats, ferrets, hamsters, and transgenic mice expressing human angiotensin I converting enzyme 2 (ACE2). These infection models have already been useful for studies of transmission and immunity, but to date only partly model the mechanisms involved in human severe COVID-19. There is therefore an urgent need for development of animal models for improved evaluation of efficacy of drugs identified as having potential in the treatment of severe COVID-19. These models need to reproduce the key mechanisms of COVID-19 severe acute respiratory distress syndrome and the immunopathology and systemic sequelae associated with this disease. Here, we review the current models of SARS-CoV-2 infection and COVID-19-related disease mechanisms and suggest ways in which animal models can be adapted to increase their usefulness in research into COVID-19 pathogenesis and for assessing potential treatments.

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“…Bronchodilators are commonly used in patients with COPD to reduce airway obstruction and ameliorate the symptoms of breathlessness. Previous studies have shown that the administration of salbutamol aerosol via metered-dose inhalers (200-400 μg; 2-4 puffs) significantly alleviated COPD-associated respiratory symptoms and improved lung volume parameters, such as forced expiratory volume in one second, forced vital capacity, and inspiratory capacity, in patients with stable or severe COPD [6][7][8][9], and greatly increased the vital capacity while reducing the residual volume in patients with pulmonary emphysema [10,11]. Moreover, in awake patients with COPD, inhaled salbutamol could decrease dynamic hyperinflation by attenuating the expiratory flow limitation, which indicated an improvement in the ventilation status [12].…”

Section: Introductionmentioning

confidence: 99%

Effects of salbutamol on the kinetics of sevoflurane and the occurrence of early postoperative pulmonary complications in patients with mild-to-moderate chronic obstructive pulmonary disease: A randomized controlled study

Jiang

Lian

et al. 2021

PLoS ONE

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Bronchodilators dilate the bronchi and increase lung volumes, thereby improving respiratory physiology in patients with chronic obstructive pulmonary disease (COPD). However, their effects on sevoflurane kinetics remain unknown. We aimed to determine whether inhaled salbutamol affected the wash-in and wash-out kinetics of sevoflurane and the occurrence of early postoperative pulmonary complications (PPCs) in patients with COPD undergoing elective surgery. This randomized, placebo-controlled study included 63 consecutive patients with COPD allocated to the salbutamol (n = 30) and control groups (n = 33). The salbutamol group received salbutamol aerosol (2 puffs of ~200 μg) 30 min before anesthesia induction and 30 min before surgery completion. The control group received a placebo. Sevoflurane kinetics were determined by collecting end-tidal samples from the first breaths at 1, 2, 3, 4, 5, 7, 10, and 15 min before the surgery (wash-in) and after closing the vaporizer (wash-out). PPCs were recorded for 7 days. The salbutamol group had higher end-tidal to inhaled sevoflurane ratios (p<0.05, p<0.01) than the control group, from 3 to 10 min during the wash-in period, but no significant differences were observed during the wash-out period. The arterial partial pressure of oxygen to the fraction of inhaled oxygen was significantly higher in the salbutamol group at 30 (320.3±17.6 vs. 291.5±29.6 mmHg; p = 0.033) and 60 min (327.8±32.3 vs. 309.2±30.5 mmHg; p = 0.003). The dead space to tidal volume ratios at 30 (20.5±6.4% vs. 26.3±6.0%, p = 0.042) and 60 min (19.6±5.1% vs. 24.8±5.5%, p = 0.007) and the incidence of bronchospasm (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.23–0.67, p = 0.023) and respiratory infiltration (OR 0.52, 95% CI, 0.40–0.65, p = 0.017) were lower in the salbutamol group. In patients with COPD, salbutamol accelerates the wash-in rate of sevoflurane and decreases the occurrence of postoperative bronchospasm and pulmonary infiltration within the first 7 days.

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Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial

Cited by 12 publications

References 38 publications

Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia

Coagulation dysfunction in patients with AECOPD and its relation to infection and hypercapnia

Animal models of mechanisms of SARS‐CoV‐2 infection and COVID‐19 pathology

Effects of salbutamol on the kinetics of sevoflurane and the occurrence of early postoperative pulmonary complications in patients with mild-to-moderate chronic obstructive pulmonary disease: A randomized controlled study

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