Relief of dyspnoea by β2-agonists after methacholine-induced bronchoconstriction

Abstract

Virtually all asthma patients use brorichodilators. Formoterol and salbutamol have a rapid onset of bronchodilating effect, whereas salmeterol acts slower. We studied the onset of improvement of dyspnoea sensation after inhalation with these bronchodilators and placebo to reverse a methacholine-induced bronchoconstriction as a model for an acute asthma attack. Seventeen patients with asthma completed this randomised, double-blind, crossover, double-dummy study. On 4 test days, forced expiratory volume in 1 s (FEV1) and Borg score were recorded and patients were challenged with methacholine until FEV1 fell with > or = 30% of baseline value. Thereafter, formoterol 12 microg via Turbuhaler, salbutamol 50 microg via Turbuhaler, salmeterol 50 microg via Diskhaler, or placebo was inhaled. FEV1 and Borg scores were assessed during the following 60 min. The first sensed improvement of Borg score was significantly (P<0.05) faster achieved with formoterol (geometric mean (Gmean) (range) 1.5 (1-40) min) and salbutamol 1.8 (1-10) min than with salmeterol 4.5 (1-30) min and placebo 3.4 (1-40) min. The Borg score returned significantly faster to the baseline value with formoterol, salbutamol, and salmeterol (Gmean time 13.8 (1-75), 13.4 (1-60), and 18.0 (1-75) min, respectively) than with placebo (33.6 (1-75 min). Formoterol and salbutamol act significantly faster than salmeterol in relieving dyspnoea induced by methacholine-induced bronchoconstriction, in patients with asthma.

Part 9: First Aid

“…Very-low-quality evidence (downgraded for risk of bias, imprecision, and indirectness) from 1 RCT 33 with 28 participants aged 3 months to 2 years showed benefit in reduction of respiratory rate (MD, 5.1; 95% CI, 0.45-9.75), wheezing score (MD, 0.8; 95% CI, 0.36-1.24), accessory muscle score (MD, 0.85; 95% CI, 0.45-1.23), and total clinical score (MD, 2.5; 95% CI, 1.06-3.94) when treatment (albuterol/salbutamol nebulization) was compared with placebo. Low-quality evidence (downgraded for imprecision and indirectness) from another RCT 34 with 17 participants aged 18 to 41 years showed benefit in reduction of time to subjective improvement in dyspnea in participants treated with fast-acting β 2 -adrenergic agonists (formoterol or salbutamol dry-powdered inhaler) compared with placebo dry-powdered inhaler or the slowacting β 2 -agonist (salmeterol dry-powdered inhaler). This study also demonstrated a reduction in time to return to baseline symptoms in the fast-acting β 2 -adrenergic agonist group compared with the placebo or slow-acting β 2 -agonist groups (MD indeterminable).…”

Kurzdarstellung

“…Durch die Gabe von Bronchodilatatoren beim Asthma wird die Rückbildungszeit der Symptome bei Kindern verkürzt und bei jungen Erwachsenen die Anschlagszeit für die Verbesserung der Luftnot verringert [822,823]. Helfen Sie Asthmatikern mit akuten Atemproblemen bei der Einnahme ihrer bronchienerweiternden Therapie.…”

Onset of relief of dyspnoea with budesonide/formoterol or salbutamol following methacholine-induced severe bronchoconstriction in adults with asthma: a double-blind, placebo-controlled study

“…Both salbutamol and formoterol are known to reverse this contraction of airway smooth muscle that represents at least part of the component of airway obstruction occurring in an acute asthma exacerbation [1,2,26,27]. Two previous studies have shown that high-dose budesonide/formoterol was as effective and well tolerated in the treatment of acute asthma in an emergency setting as high-dose salbutamol [19] or high-dose formoterol [20].…”