1
|
Dupont J, Roman Dura B, Salciccia A, Serteyn D, Sandersen C. Retrospective study of the changes in dynamic compliance and ventilation/perfusion mismatch following salbutamol inhalation in hypoxaemic mechanically ventilated anaesthetized horses. Vet Anaesth Analg 2024:S1467-2987(24)00119-3. [PMID: 39142981 DOI: 10.1016/j.vaa.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 05/28/2024] [Accepted: 06/13/2024] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To study the changes in dynamic compliance (Cdyn), ventilation/perfusion (V˙/ Q˙) mismatch and haemodynamic variables in hypoxaemic anaesthetized horses whose PaO2 increased following salbutamol inhalation. STUDY DESIGN Retrospective, clinical, cohort study. ANIMALS A group of 73 client-owned horses treated with salbutamol when PaO2 <100 mmHg (13.3 kPa) during anaesthesia. METHODS Horses were divided into two groups: responders (R), where PaO2 after salbutamol ≥1.2 PaO2 before treatment (i.e. ≥20% increase), and non-responders (NR), where PaO2 after salbutamol <1.2 PaO2 before treatment. Demographic data and intraoperative variables before treatment were compared between R and NR. Cdyn, arterial to end-tidal carbon dioxide difference [P(a-E´)CO2], estimated ratio of dead space to tidal volume (est.VD/VT), estimated shunt fraction (F-shunt), heart rate, systolic, mean and diastolic arterial pressure and dobutamine requirements were compared before and after treatment within R and NR. For each variable, the difference (Δ) between values pre- and posttreatment was calculated and compared between groups R and NR. Numerical data were compared using univariate or bivariate analysis and categorical data were compared using chi-square test; p < 0.05. RESULTS Of the 73 horses 50 were classified as R while 23 horses were classified as NR. There was no statistical difference between R and NR for demographic data or initial intraoperative variables except for body weight [R: 531 (170-715) kg, NR: 540 (420-914) kg]. While salbutamol did not alter Cdyn in either group, it significantly decreased P(a-E´)CO2, est.VD/VT and F-shunt in R only. ΔP(a-E´)CO2, Δest.VD/VT and ΔF-shunt were significantly greater in R (-17.8%, -19.0% and -24.1%, respectively) than in NR (11.5%, 6.6% and -0.3%, respectively). CONCLUSIONS AND CLINICAL RELEVANCE In hypoxaemic anaesthetized horses responding to inhaled salbutamol by a ≥1.2 increase in PaO2 no change in Cdyn was detected, but indicators of V˙/ Q˙ mismatch improved.
Collapse
Affiliation(s)
- Julien Dupont
- Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium.
| | - Bienvenida Roman Dura
- Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
| | - Alexandra Salciccia
- Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
| | - Didier Serteyn
- Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
| | - Charlotte Sandersen
- Department of Clinical Sciences, Anesthesiology and Equine Surgery, Faculty of Veterinary Medicine, University of Liege, Liège, Belgium
| |
Collapse
|
2
|
Akhtar A, Abbas SA, Zaidi SHM, Sohail A, Alam MI, Raza L. The Acute Effects of the Use of Salbutamol and Ipratropium on the Heart Rates of Patients With Obstructive Airway Disease. Cureus 2023; 15:e46409. [PMID: 37927692 PMCID: PMC10620622 DOI: 10.7759/cureus.46409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
Background The cornerstone of pharmaceutical therapy for obstructive airway illnesses involves inhalation of bronchodilators, such as ipratropium bromide (IP) and salbutamol (SB). The heart rate regulation may be changed by β-2 agonists and anticholinergic medications. Investigating the impact of inhaled SB and IP on the heart rate was the goal of this study. Methods A total of 304 patients were enrolled in this investigation. Baseline demographic characteristics, medical history, and adverse events were documented. Their heart rates were monitored before and after bronchodilator administration. SB and IP were selected based on historical usage. Blood pressure readings were also taken before and after each session. Results There was a significant increase in heart rates after SB from a mean of 106.69 to 117.20. Similarly, the heart rate of the patients in the IP group increased to a mean of 106.95 from 93.44, with a statistically significant p-value. Moreover, tremors were the most common adverse effect, accounting for 85.3% of the patients in the IP group and 75% in the SB group. In contrast, palpitation was more common in the SB group 25% vs. 14.7% with a significant p-value. Conclusion Frequently administered dosages of SB and IP caused a considerable increase in heart rates, as well as tremors and palpitation.
Collapse
Affiliation(s)
- Ayesha Akhtar
- Chest Medicine, Dr. Ziauddin University Hospital, Karachi, PAK
| | - Syed Ali Abbas
- Pulmonology and Critical Care, Dr. Ziauddin University Hospital, Karachi, PAK
| | | | - Adeel Sohail
- Critical Care Medicine, Dr. Ziauddin University Hospital, Karachi, PAK
| | - Muhammad I Alam
- Internal Medicine, Dr. Ziauddin University Hospital, Karachi, PAK
| | | |
Collapse
|
3
|
Faconti L, Farukh B, McNally RJ, Brett S, Chowienczyk PJ. Impaired β 2 -adrenergic endothelium-dependent vasodilation in patients previously hospitalized with coronavirus disease 2019. J Hypertens 2023; 41:951-957. [PMID: 37016904 DOI: 10.1097/hjh.0000000000003420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023]
Abstract
AIM The pulse wave response to salbutamol (PWRS) - change in augmentation index (AIx) - provides a means to assess endothelial vasodilator function in vivo . Endothelial dysfunction plays a relevant role in the pathogenesis of hypertension and cardiovascular disease and appears to underlie many of the complications of coronavirus disease 2019 (COVID-19). However, to what degree this persists after recovery is unknown. METHODS Individuals previously hospitalized with COVID-19, those recovered from mild symptoms and seronegative controls with well known risk factors for endothelial dysfunction were studied. To assess the involvement of nitric oxide-cyclic guanosine monophosphate pathway (NO-cGMP) on PWRS, sildenafil was also administrated in a subsample. RESULTS One hundred and one participants (60 men) aged 47.8 ± 14.1 (mean ± SD) years of whom 33 were previously hospitalized with COVID-19 were recruited. Salbutamol had minimal effect on haemodynamics including blood pressure and heart rate. It reduced AIx in controls ( n = 34) and those recovered from mild symptoms of COVID-19 ( n = 34) but produced an increase in AIx in those previously hospitalized: mean change [95% confidence interval] -2.85 [-5.52, -0.188] %, -2.32 [-5.17,0.54] %, and 3.03 [0.06, 6.00] % for controls, those recovered from mild symptoms and those previously hospitalized, respectively ( P = 0.001). In a sub-sample ( n = 22), sildenafil enhanced PWRS (change in AIx 0.05 [-2.15,2.24] vs. -3.96 [-7.01. -2.18], P = 0.006) with no significant difference between hospitalized ( n = 12) and nonhospitalized participants ( n = 10). CONCLUSIONS In patients previously hospitalized with COVID-19, there is long-lasting impairment of endothelial function as measured by the salbutamol-induced stimulation of the NO-cGMP pathway that may contribute to cardiovascular complications.
Collapse
Affiliation(s)
- Luca Faconti
- King's College London, Department of Clinical Pharmacology, St Thomas' Hospital, London, UK
| | | | | | | | | |
Collapse
|
4
|
Henry SL, Moore LE, Brotto AR, Rowland S, Fuhr D, Stickland MK. Systemic vascular health is compromised in both confirmed and unconfirmed asthma. Respir Med 2022; 200:106932. [PMID: 35870436 DOI: 10.1016/j.rmed.2022.106932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/21/2022] [Accepted: 07/11/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Asthma is associated with increased risk of cardiovascular diseases. Despite many presenting with symptoms of asthma, asthma cannot always be confirmed by physiological assessment. It is thus far unknown if the heightened cardiovascular risk applies to this group. The purpose of this study was to examine markers of cardiovascular risk, including endothelial function, arterial stiffness, and systemic inflammation, in individuals with confirmed asthma, unconfirmed asthma, and healthy controls. As short-acting beta agonist (SABA) use is associated with increased cardiovascular risk, a secondary analysis was conducted to investigate the impact of regular SABA use on vascular outcomes. METHODS Individuals with confirmed asthma (n = 26), unconfirmed asthma (n = 15), and healthy controls (n = 26) were recruited for this cross-sectional study. Asthma was confirmed by FEV1 reversibility, methacholine challenge, or exercise challenge. Endothelial function was assessed using flow-mediated dilation (FMD), arterial stiffness using pulse wave velocity (PWV), and systemic inflammation by C-reactive protein (CRP) levels. RESULTS FMD was significantly lower in both asthma groups compared to controls (confirmed: 7.7 ± 3.6%, unconfirmed: 7.3 ± 3.5%, controls: 10.4 ± 3.6%, p = 0.02). No difference was found in PWV nor CRP. Asthma participants who used SABA had increased arterial stiffness compared to those without SABA (9.2 ± 2.7 m/s, 7.7 ± 1.1 m/s respectively, p = 0.03). No difference was seen in FMD or CRP between SABA groups. CONCLUSION Individuals with a clinical history of asthma symptoms demonstrate vascular impairments regardless of physiological confirmation of disease. Regular SABA use increases arterial stiffness. Avoiding potentially inappropriate SABA use among people without physiologically confirmed asthma may thus be beneficial in curbing cardiovascular risk.
Collapse
Affiliation(s)
- Shelby L Henry
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada; Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Linn E Moore
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Andrew R Brotto
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Samira Rowland
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Desi Fuhr
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada
| | - Michael K Stickland
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Canada.
| |
Collapse
|
5
|
Clark-Price SC, Lascola KM, Auckburally A, Boone LH, Caldwell FJ, Weatherall KM, Hanson RR. The effect of inhaled albuterol on PaO2 in anesthetized horses receiving a FiO2 of 0.5 or > 0.95. J Equine Vet Sci 2022; 113:103944. [DOI: 10.1016/j.jevs.2022.103944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/04/2022] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
|
6
|
Use of a Wearable Biosensor to Study Heart Rate Variability in Chronic Obstructive Pulmonary Disease and Its Relationship to Disease Severity. SENSORS 2022; 22:s22062264. [PMID: 35336436 PMCID: PMC8952191 DOI: 10.3390/s22062264] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/05/2022] [Accepted: 03/10/2022] [Indexed: 12/19/2022]
Abstract
The purpose of this study was to explore the relationships between heart rate variability (HRV) and various phenotypic measures that relate to health and functional status in chronic obstructive pulmonary disease (COPD), and secondly, to demonstrate the feasibility of ascertaining HRV via a chest-worn wearable biosensor in COPD patients. HRV analysis was performed using SDNN (standard deviation of the mean of all normal R-R intervals), low frequency (LF), high frequency (HF), and LF/HF ratio. We evaluated the associations between HRV and COPD severity, class of bronchodilator therapy prescribed, and patient reported outcomes. Seventy-nine participants with COPD were enrolled. There were no differences in SDNN, HF, and LF/HF ratio according to COPD severity. The SDNN in participants treated with concurrent beta-agonists and muscarinic antagonists was lower than that in other participants after adjusting heart rate (beta coefficient −3.980, p = 0.019). The SDNN was positively correlated with Veterans Specific Activity Questionnaire (VSAQ) score (r = 0.308, p = 0.006) and handgrip strength (r = 0.285, p = 0.011), and negatively correlated with dyspnea by modified Medical Research Council (mMRC) questionnaire (r = −0.234, p = 0.039), health status by Saint George’s Respiratory Questionnaire (SGRQ) (r = −0.298, p = 0.008), symptoms by COPD Assessment Test (CAT) (r = −0.280, p = 0.012), and BODE index (r = −0.269, p = 0.020). When measured by a chest-worn wearable device, reduced HRV was observed in COPD participants receiving inhaled beta-sympathomimetic agonist and muscarinic antagonists. HRV was also correlated with various health status and performance measures.
Collapse
|
7
|
Pasqua E, Hamblin N, Edwards C, Baker-Glenn C, Hurley C. Developing inhaled drugs for respiratory diseases: A medicinal chemistry perspective. Drug Discov Today 2021; 27:134-150. [PMID: 34547449 DOI: 10.1016/j.drudis.2021.09.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Revised: 07/11/2021] [Accepted: 09/13/2021] [Indexed: 12/21/2022]
Abstract
Despite the devastating impact of many lung diseases on human health, there is still a significant unmet medical need in respiratory diseases, for which inhaled delivery represents a crucial strategy. More guidance on how to design and carry out multidisciplinary inhaled projects is needed. When designing inhaled drugs, the medicinal chemist must carefully balance the physicochemical properties of the molecule to achieve optimal target engagement in the lung. Although the medicinal chemistry strategy is unique for each project, and will change depending on multiple factors, such as the disease, target, systemic risk, delivery device, and formulation, general guidelines aiding inhaled drug design can be applied and are summarised in this review.
Collapse
Affiliation(s)
- Elisa Pasqua
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow CM19 5TR, UK.
| | - Nicole Hamblin
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow CM19 5TR, UK; Charles River Laboratories, Chesterford Research Park, Saffron Waldon CB10 1XL, UK
| | - Christine Edwards
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow CM19 5TR, UK
| | - Charles Baker-Glenn
- Charles River Laboratories, Chesterford Research Park, Saffron Waldon CB10 1XL, UK
| | - Chris Hurley
- Charles River Laboratories, 8-9 Spire Green Centre, Harlow CM19 5TR, UK
| |
Collapse
|
8
|
Safety of bronchodilator reversibility test in elderly subjects: a prospective study. Postepy Dermatol Alergol 2021; 38:256-261. [PMID: 34408593 PMCID: PMC8362750 DOI: 10.5114/ada.2020.92515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/17/2019] [Indexed: 11/17/2022] Open
Abstract
Introduction The reversibility test measures an increase in ventilation parameters after the administration of 400 mg of a short-acting β-agonist (SABA). It is worth noting that a typical dosage, applied as a rescue medicine for bronchospastic dyspnoea, is significantly less, i.e., 100–200 mg. Aim To assess the effects of inhaled 400 mg fenoterol (in the bronchodilator reversibility test) on the heart rate and the development of tachyarrhythmias in subjects aged 65 and above. Material and methods A total of 53 subjects (45 women) aged 77; 68–82 (median; interquartile range) in stable clinical condition were included in the study. Data including medical history, physical examinations, blood biochemistry, chest X-ray, 12-lead electrocardiogram, 24-hour Holter ECG monitoring, bronchodilator test, and echocardiography were obtained. During the Holter ECG monitoring, the bronchodilator test using 400 mg fenoterol (Berotec pMDI) was performed. Results A slight but statistically significant (p = 0.02) increase in heart rate from 71 to 75 per min (median) was noted after the administration of fenoterol. No statistically significant differences were found in the number of extrasystolic beats of either supraventricular (p = 0.42) or ventricular origin (p = 0.50). In addition, the subjects did not show any potentially dangerous arrhythmias or significant signs of coronary artery disease. However, there was a significant increase in the number of supraventricular beats in the subjects who were not taking β-blockers. Conclusions The use of 400 mg fenoterol in a bronchodilator reversibility test in elderly subjects does not entail any significant cardiovascular risk.
Collapse
|
9
|
DiFazio MR, Thomason JD, Carpenter JW. ECG of the Month. J Am Vet Med Assoc 2021; 258:1189-1192. [PMID: 33978443 DOI: 10.2460/javma.258.11.1189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
10
|
Syed SA, Sherwani NZF, Riaz B, Iqbal J, Chaudhry M, Abdullah M, Malik A. Short-Term Effect of Inhaled Salbutamol on Heart Rate in Healthy Volunteers. Cureus 2021; 13:e13672. [PMID: 33824823 PMCID: PMC8018588 DOI: 10.7759/cureus.13672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Objective Tachycardia is a potential side effect of salbutamol inhalation. We aimed to study the short-term effect of salbutamol nebulization on the heart rate of healthy volunteers. Material and methods A randomized, single-blinded, placebo-controlled, cross-over study was conducted with 30 healthy volunteers divided into two groups of 15 each. One group was nebulized with salbutamol (2.5 mg/2 ml dilution) while the other group was given normal saline (2 ml). Each arm underwent administration of the opposite drug the following week. Baseline readings of heart rate and blood pressure were taken at zero (T0), seven (T7), 15 (T15), and 30 (T30) minutes. Results Thirty volunteers between the ages of 20 and 25 years were studied. The mean heart rate value was higher for nebulized salbutamol at each point as compared to saline. When nebulized with salbutamol, the heart rate had a significant rise (p= < 0.00001) at 15 minutes as compared to saline nebulization. Conclusion Salbutamol nebulization, even at a low dose, can lead to a significant increase in heart rate when compared to nebulization with normal saline in healthy individuals.
Collapse
Affiliation(s)
- Salman A Syed
- Department of Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | - Bismah Riaz
- Department of Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Javed Iqbal
- Department of Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | | | - Mohammad Abdullah
- Department of Medicine, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Ayesha Malik
- Department of Medicine, Hameed Latif Hospital, Lahore, PAK
| |
Collapse
|
11
|
Johnson MJ, Ekström M, Currow DC. Observational studies and "the eye of the beholder". Eur Respir J 2020; 56:56/1/2001637. [PMID: 32675295 DOI: 10.1183/13993003.01637-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 05/20/2020] [Indexed: 11/05/2022]
Affiliation(s)
- Miriam J Johnson
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK.,IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| | - Magnus Ekström
- IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia.,Lund University, Faculty of Medicine, Dept of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund, Sweden
| | - David C Currow
- Wolfson Palliative Care Research Centre, University of Hull, Hull, UK.,IMPACCT, Faculty of Health, University of Technology Sydney, Ultimo, Australia
| |
Collapse
|
12
|
Tsuchiya N, Schiebler ML, Evans MD, Cadman RV, Sorkness RL, Lemanske RF, Jackson DJ, Jarjour NN, Denlinger LC, Fain SB. Safety of repeated hyperpolarized helium 3 magnetic resonance imaging in pediatric asthma patients. Pediatr Radiol 2020; 50:646-655. [PMID: 31980848 PMCID: PMC7153994 DOI: 10.1007/s00247-019-04604-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/21/2019] [Accepted: 12/19/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND Hyperpolarized helium 3 magnetic resonance imaging (3He MRI) is useful for investigating pulmonary physiology of pediatric asthma, but a detailed assessment of the safety profile of this agent has not been performed in children. OBJECTIVE To evaluate the safety of 3He MRI in children and adolescents with asthma. MATERIALS AND METHODS This was a retrospective observational study. 3He MRI was performed in 66 pediatric patients (mean age 12.9 years, range 8-18 years, 38 male, 28 female) between 2007 and 2017. Fifty-five patients received a single repeated examination and five received two repeated examinations. We assessed a total of 127 3He MRI exams. Heart rate, respiratory rate and pulse oximetry measured oxygen saturation (SpO2) were recorded before, during (2 min and 5 min after gas inhalation) and 1 h after MRI. Blood pressure was obtained before and after MRI. Any subjective symptoms were also noted. Changes in vital signs were tested for significance during the exam and divided into three subject age groups (8-12 years, 13-15 years, 16-18 years) using linear mixed-effects models. RESULTS There were no serious adverse events, but three minor adverse events (2.3%; headache, dizziness and mild hypoxia) were reported. We found statistically significant increases in heart rate and SpO2 after 3He MRI. The youngest age group (8-12 years) had an increased heart rate and a decreased respiratory rate at 2 min and 5 min after 3H inhalation, and an increased SpO2 post MRI. CONCLUSION The use of 3He MRI is safe in children and adolescents with asthma.
Collapse
Affiliation(s)
- Nanae Tsuchiya
- Department of Radiology, University of Wisconsin-Madison, 111 Highland Ave., 2488 WIMR, Madison, WI, 53705, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin-Madison, 111 Highland Ave., 2488 WIMR, Madison, WI, 53705, USA
| | - Michael D Evans
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert V Cadman
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Ronald L Sorkness
- Department of Pediatrics-Allergy, Immunology & Rheumatology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert F Lemanske
- Department of Pediatrics-Allergy, Immunology & Rheumatology, University of Wisconsin-Madison, Madison, WI, USA
| | - Daniel J Jackson
- Department of Pediatrics-Allergy, Immunology & Rheumatology, University of Wisconsin-Madison, Madison, WI, USA
- Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, Madison, WI, USA
| | - Nizar N Jarjour
- Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, Madison, WI, USA
| | - Loren C Denlinger
- Department of Medicine-Allergy, Pulmonary & Critical Care, University of Wisconsin-Madison, Madison, WI, USA
| | - Sean B Fain
- Department of Radiology, University of Wisconsin-Madison, 111 Highland Ave., 2488 WIMR, Madison, WI, 53705, USA.
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA.
| |
Collapse
|
13
|
shokry AA, Saeed H, Rabea H, Abdelwahab NS, Meabed MH, Abdelrahim ME. Effects of nebulizer fill volume on the efficacy and safety of the bronchodilator. J Drug Deliv Sci Technol 2020. [DOI: 10.1016/j.jddst.2020.101508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Moore LE, Kapoor K, Byers BW, Brotto AR, Ghods-Esfahani D, Henry SL, St James RB, Stickland MK. Acute effects of salbutamol on systemic vascular function in people with asthma. Respir Med 2019; 155:133-140. [PMID: 31349187 DOI: 10.1016/j.rmed.2019.07.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/16/2019] [Accepted: 07/17/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND Asthmatics are at increased cardiovascular disease risk, which has been linked to beta2(β2)-agonist use. Inhalation of β2-agonists increases sympathetic nerve activity (SNA) in healthy individuals, however the systemic impact of salbutamol in asthmatics using β2-agonists regularly is unknown. OBJECTIVES This study compared the systemic vascular responses to a clinical dose of salbutamol (Phase I) and following an acute increase in SNA (Phase II) in asthmatics and controls. METHODS Fourteen controls and 14 asthmatics were recruited for Phase I. On separate days, flow-mediated dilation (FMD) and peripheral arterial stiffness (pPWV) were evaluated at baseline and following either 400 μg inhaled salbutamol or a placebo inhaler. For Phase II, heart rate, blood pressure, vascular conductance, pPWV, and central (c)PWV were evaluated in response to a large increase in SNA brought on by cold-water hand immersion (i.e. cold-pressor test) or body-temperature water hand immersion (i.e. control) in 10 controls and 10 asthmatics. RESULTS Following salbutamol, asthmatics demonstrated reduced FMD (-3.0%, p < 0.05) and increased pPWV (+0.7 m/s, p < 0.05); however, salbutamol had no effect in controls. The cold-pressor test resulted in similar increases in blood pressure, vascular flow rates and conductance, pPWV, and cPWV in both asthmatics and controls, suggesting similar neurovascular transduction in asthmatics and controls. CONCLUSION Inhaled Salbutamol leads to increased arterial stiffness and reduced FMD in asthmatics. As asthmatics and controls had similar vascular responses to an increase in SNA, these findings suggest asthmatics have heightened sympathetic responses to β2-agonists which may contribute to the increased cardiovascular risk in asthma.
Collapse
Affiliation(s)
- Linn E Moore
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada; Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Karishma Kapoor
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada; Department of Psychology, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Bradley W Byers
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada; Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Andrew R Brotto
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada; Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Daniel Ghods-Esfahani
- Department of Biological Sciences, Faculty of Science, University of Alberta, Edmonton, AB, Canada
| | - Shelby L Henry
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada; Department of Rehabilitation Science, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Ryan B St James
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Michael K Stickland
- Pulmonary Division, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, AB, Canada.
| |
Collapse
|
15
|
LAURENT JULIEN, GUINOT MICHEL, LE ROUX MALLOUF THIBAULT, MARILLIER MATHIEU, LARRIBAUT JULIE, VERGES SAMUEL. Effects of Acute Salbutamol Intake on Peripheral and Central Fatigue in Trained Men. Med Sci Sports Exerc 2018; 50:1267-1276. [DOI: 10.1249/mss.0000000000001565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
16
|
Melo JRD, Feitoza MDS, Cucato GG, Medeiros WM, Stelmach R, Cukier A, Carvalho CRFD, Mendes FAR. Efeito agudo do salbutamol no sistema cardiovascular durante o exercício físico em pacientes com asma moderada ou grave: estudo aleatorizado, duplo-cego e cruzado. FISIOTERAPIA E PESQUISA 2018. [DOI: 10.1590/1809-2950/17007725022018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Salbutamol é um β2-agonista de curta duração frequentemente utilizado em pacientes com asma para prevenir os sintomas durante ou após exercício físico. Alterações hemodinâmicas em repouso estão bem descritas. Contudo são escassos os dados sobre os efeitos na frequência cardíaca (FC) e pressão arterial (PA) durante o exercício e na fase de recuperação em pacientes com asma moderada ou grave. Foi realizado um estudo aleatorizado, duplo-cego e cruzado, em que foram inclusos 15 indivíduos com asma moderada e grave, com média de idade de 46,4±9,3 anos. Os pacientes realizaram um teste de esforço máximo em dois dias não consecutivos, com administração de 400mcg de salbutamol ou 4 “puffs” de placebo. Durante todo o protocolo foi monitorada a FC, a PA, a percepção de esforço e o pico de fluxo expiratório (PFE). Após o uso do salbutamol, o valor do PFE aumentou em média de 28,0±47,7L/m, permanecendo maior nos tempos de 5, 10 e 15 minutos de recuperação passiva em relação ao placebo (p<0,05). As variáveis FC, PA e percepção de esforço foram semelhantes entre as intervenções em todas as fases do protocolo (p>0,05). Esses resultados sugerem que o uso de salbutamol é seguro, e que a FC não necessita de ser ajustada para prescrever a intensidade do exercício após a administração de salbutamol em indivíduos com asma moderada ou grave.
Collapse
|
17
|
A Controlled Trial of Inhaled Bronchodilators in Familial Dysautonomia. Lung 2017; 196:93-101. [PMID: 29234869 DOI: 10.1007/s00408-017-0073-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2017] [Accepted: 10/06/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Chronic lung disease is a leading cause of premature death in patients with familial dysautonomia (FD). A significant number of patients have obstructive airway disease, yet it is not known whether this is pharmacologically reversible. METHODS We conducted a double-blind, placebo-controlled, randomized clinical trial comparing the beta 2 agonist albuterol with the muscarinic blocker ipratropium bromide in patients homozygous for the IKBKAP founder mutation. Albuterol, ipratropium bromide, and placebo were administered on 3 separate days via nebulizer in the seated position. Airway responsiveness was evaluated using spirometry and impulse oscillometry 30 min post dose. Cardiovascular effects were evaluated by continuous monitoring of blood pressure, RR intervals, cardiac output, and systemic vascular resistance. RESULTS A total of 14 patients completed the trial. Neither active agent had significant detrimental effects on heart rate or rhythm or blood pressure. Albuterol and ipratropium were similar in their bronchodilator effectiveness causing significant improvement in forced expiratory volume in 1-s (FEV1, p = 0.002 and p = 0.030). Impulse oscillometry measures were consistent with a reduction in total airway resistance post nebulization (resistance at 5 Hz p < 0.006). CONCLUSION Airway obstruction is pharmacologically reversible in a number of patients with FD. In the short term, both albuterol and ipratropium were well tolerated and not associated with major cardiovascular adverse events.
Collapse
|
18
|
Feitoza MDS, Melo JRD, Medeiros WM, Cucato GG, Stelmach R, Cukier A, Carvalho CRFD, Mendes FAR. Effect of salbutamol on the cardiovascular response in healthy subjects at rest, during physical exercise, and in recovery phase: a randomized, double-blind, crossover study. MOTRIZ: REVISTA DE EDUCACAO FISICA 2017. [DOI: 10.1590/s1980-6574201700030012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
|
19
|
Cardiac autonomic modulation induced by doxorubicin in a rodent model of colorectal cancer and the influence of fullerenol pretreatment. PLoS One 2017; 12:e0181632. [PMID: 28727839 PMCID: PMC5519181 DOI: 10.1371/journal.pone.0181632] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 07/04/2017] [Indexed: 12/13/2022] Open
Abstract
The very effective anticancer drug doxorubicin (DOX) is known to have cardiotoxic side effects, which could be accompanied by autonomic modulation. Autonomic disbalance might even be an initiating mechanism underlying DOX-induced cardiotoxicity and can be studied noninvasively by the analysis of heart rate variability (HRV). A number of strategies have been assessed to predict chemotherapy-induced cardiac dysfunction while HRV, a potential detecting tool, has not yet been tested. Thus, we aimed to determine the effect of DOX treatment on HRV in a rat model of colorectal cancer. While pretreatment with fullerenol (Frl) acts protectively on DOX-induced cardiotoxicity, we aimed to test the effect of Frl pretreatment on DOX-induced HRV alterations. After the induction of colorectal cancer, adult male Wistar rats were treated with saline (n = 7), DOX (1.5 mg/kg per week, n = 7) or DOX after pretreatment with Frl (25 mg/kg per week, n = 7) for three weeks (cumulative DOX dose 4.5 mg/kg). One week after treatment rats were anaesthetized, standard ECG was measured and HRV was analyzed in time and frequency domain. During autopsy the intestines and hearts were gathered for biochemical analysis and histopathological examination. DOX treatment significantly decreased parasympathetically mediated high-frequency component (p<0.05) and increased the low-frequency component of HRV (p<0.05), resulting in an increased LF/HF ratio (p<0.05) in cancerous rats. When pretreated with Frl, DOX-induced HRV alterations were prevented: the high-frequency component of HRV increased (p<0.01), the low-frequency decreased (p<0.01), LF/HF ratio decreased consequently (p<0.01) compared to DOX only treatment. In all DOX-treated animals, disbalance of oxidative status in heart tissue and early myocardial lesions were found and were significantly reduced in rats receiving Frl pretreatment. Autonomic modulation accompanied the development of DOX-induced cardiotoxicity in rat model of colorectal cancer and was prevented by Frl pretreatment. Our results demonstrated the positive prognostic power of HRV for the early detection of DOX-induced cardiotoxicity.
Collapse
|
20
|
Karmali SN, Sciusco A, May SM, Ackland GL. Heart rate variability in critical care medicine: a systematic review. Intensive Care Med Exp 2017; 5:33. [PMID: 28702940 PMCID: PMC5507939 DOI: 10.1186/s40635-017-0146-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/03/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Heart rate variability (HRV) has been used to assess cardiac autonomic activity in critically ill patients, driven by translational and biomarker research agendas. Several clinical and technical factors can interfere with the measurement and/or interpretation of HRV. We systematically evaluated how HRV parameters are acquired/processed in critical care medicine. METHODS PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (1996-2016) were searched for cohort or case-control clinical studies of adult (>18 years) critically ill patients using heart variability analysis. Duplicate independent review and data abstraction. Study quality was assessed using two independent approaches: Newcastle-Ottowa scale and Downs and Black instrument. Conduct of studies was assessed in three categories: (1) study design and objectives, (2) procedures for measurement, processing and reporting of HRV, and (3) reporting of relevant confounding factors. RESULTS Our search identified 31/271 eligible studies that enrolled 2090 critically ill patients. A minority of studies (15; 48%) reported both frequency and time domain HRV data, with non-normally distributed, wide ranges of values that were indistinguishable from other (non-critically ill) disease states. Significant heterogeneity in HRV measurement protocols was observed between studies; lack of adjustment for various confounders known to affect cardiac autonomic regulation was common. Comparator groups were often omitted (n = 12; 39%). This precluded meaningful meta-analysis. CONCLUSIONS Marked differences in methodology prevent meaningful comparisons of HRV parameters between studies. A standardised set of consensus criteria relevant to critical care medicine are required to exploit advances in translational autonomic physiology.
Collapse
Affiliation(s)
- Shamir N Karmali
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Alberto Sciusco
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Shaun M May
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK
| | - Gareth L Ackland
- Translational Medicine & Therapeutics, William Harvey Research Institute, Queen Mary University of London, John Vane Science Centre, Charterhouse Square, London, EC1M 6BQ, UK.
| |
Collapse
|
21
|
Management of Chronic Obstructive Pulmonary Disease in Patients with Cardiovascular Diseases. Drugs 2017; 77:721-732. [DOI: 10.1007/s40265-017-0731-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
22
|
Bao FP, Zhang HG, Zhu SM. Anesthetic considerations for patients with acute cervical spinal cord injury. Neural Regen Res 2017; 12:499-504. [PMID: 28469668 PMCID: PMC5399731 DOI: 10.4103/1673-5374.202916] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Anesthesiologists work to prevent or minimize secondary injury of the nervous system and improve the outcome of medical procedures. To this end, anesthesiologists must have a thorough understanding of pathophysiology and optimize their skills and equipment to make an anesthesia plan. Anesthesiologists should conduct careful physical examinations of patients and consider neuroprotection at preoperative interviews, consider cervical spinal cord movement and compression during airway management, and suggest awake fiberoptic bronchoscope intubation for stable patients and direct laryngoscopy with manual in-line immobilization in emergency situations. During induction, anesthesiologists should avoid hypotension and depolarizing muscle relaxants. Mean artery pressure should be maintained within 85-90 mmHg (1 mmHg = 0.133 kPa; vasoactive drug selection and fluid management). Normal arterial carbon dioxide pressure and normal blood glucose levels should be maintained. Intraoperative neurophysiological monitoring is a useful option. Anesthesiologists should be attentive to postoperative respiratory insufficiency (carefully considering postoperative extubation), thrombus, and infection. In conclusion, anesthesiologists should carefully plan the treatment of patients with acute cervical spinal cord injuries to protect the nervous system and improve patient outcome.
Collapse
Affiliation(s)
- Fang-Ping Bao
- Department of Anesthesiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Hong-Gang Zhang
- Department of Anesthesiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Sheng-Mei Zhu
- Department of Anesthesiology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| |
Collapse
|
23
|
Schmidt GA. Lung Deflation and Cardiac Volumes: Not a Simple Relationship. Am J Respir Crit Care Med 2016; 194:916-917. [DOI: 10.1164/rccm.201604-0876le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
24
|
Edgell H, Moore LE, Chung C, Byers BW, Stickland MK. Short-term cardiovascular and autonomic effects of inhaled salbutamol. Respir Physiol Neurobiol 2016; 231:14-20. [PMID: 27236040 DOI: 10.1016/j.resp.2016.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/30/2016] [Accepted: 05/25/2016] [Indexed: 11/18/2022]
Abstract
Asthma independently increases the risk of developing cardiovascular disease. As inhaled β-agonists have systemic cardiovascular effects, and elevations in arterial stiffness and sympathetic nerve activity are associated with increased cardiovascular morbidity/mortality, this study examines the effect of salbutamol use on pulse wave velocity (PWV) and muscle sympathetic nervous activity (MSNA). Healthy men and women (26.2±1.5years) were recruited for: Day 1: 4 inhalations of placebo followed by 4 inhalations of salbutamol (4×100μg); Day 2: placebo only; Day 3: carotid-femoral PWV measurements before/after placebo/salbutamol. Heart rate (HR), mean arterial pressure (MAP), and carotid-radial PWV were obtained on Day 1 and 2. MSNA was obtained on Day 1. Salbutamol increased HR and total MSNA (Baseline1: 2.8±2.8au; Placebo: 2.4±2.1au; Baseline2: 2.7±3.0au; Salbutamol: 3.3±2.9au; p=0.05), with no changes in MAP or PWV. There were no effects of placebo on HR, MSNA, or PWV. Acute salbutamol use increases sympathetic activity suggesting that salbutamol could contribute to cardiovascular morbidity/mortality in individuals using inhaled β-agonists.
Collapse
Affiliation(s)
- Heather Edgell
- Department of Medicine, University of Alberta, Edmonton, T6G 2J3, Canada; School of Kinesiology and Health Sciences, York University, Toronto, M3J 1P3, Canada.
| | - Linn E Moore
- Department of Medicine, University of Alberta, Edmonton, T6G 2J3, Canada
| | - Carol Chung
- Department of Medicine, University of Alberta, Edmonton, T6G 2J3, Canada
| | - Bradley W Byers
- Department of Medicine, University of Alberta, Edmonton, T6G 2J3, Canada
| | - Michael K Stickland
- Department of Medicine, University of Alberta, Edmonton, T6G 2J3, Canada; G.F. MacDonald Centre for Lung Health, Covenant Health, Edmonton, T5K 0L4, Canada
| |
Collapse
|
25
|
Brunetti L, Poiani G, Dhanaliwala F, Poppiti K, Kang H, Suh DC. Clinical outcomes and treatment cost comparison of levalbuterol versus albuterol in hospitalized adults with chronic obstructive pulmonary disease or asthma. Am J Health Syst Pharm 2016; 72:1026-35. [PMID: 26025994 DOI: 10.2146/ajhp140551] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Results of a prospective study comparing clinical outcomes and costs of levalbuterol versus albuterol therapy for exacerbations of asthma or chronic obstructive pulmonary disease (COPD) are presented. METHODS In a single-center open-label study, selected adults hospitalized for asthma or COPD exacerbations over a 21-month period were randomly assigned to receive levalbuterol 1.25 mg three times daily (n = 55) or albuterol 2.5 mg four times daily (n = 57); dosage reductions and other respiratory therapies were permitted. Study outcomes included scheduled and rescue nebulizations, total treatment costs, hospital length of stay, and change in heart rate from baseline. RESULTS The numbers of scheduled nebulizations were similar in the levalbuterol and albuterol groups (mean ± S.D., 19.6 ± 13.4 versus 20.7 ± 14.4; p = 0.692), as were the numbers of rescue nebulizations (mean ± S.D., 0.7 ± 1.4 versus 0.8 ± 2.0; p = 0.849). The mean change from baseline in heart rate did not differ significantly between groups. Mean total treatment costs per patient were significantly greater with the use of levalbuterol ($8003, bootstrap 95% confidence interval [CI], $6628-$9379) versus albuterol ($5772, bootstrap 95% CI, $5051-$6494; p = 0.006). Hospital length of stay was significantly greater in the levalbuterol group (mean ± S.D., 8.5 ± 5.2 days versus 6.8 ± 3.6 days with albuterol use; p = 0.040). CONCLUSION Clinical outcomes were similar with the use of levalbuterol versus albuterol for exacerbations of COPD or asthma. On average, patients receiving levalbuterol had longer and more costly hospital stays.
Collapse
Affiliation(s)
- Luigi Brunetti
- Luigi Brunetti, Pharm.D., M.P.H., is Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, and Clinical Pharmacy Specialist, Internal Medicine, Robert Wood Johnson University Hospital-Somerset, Somerville, NJ. George Poiani, M.D., FACP, FCCP, is Attending Physician, Department of Medicine, Robert Wood Johnson University Hospital-Somerset, and Clinical Associate Professor, Division of Pulmonary/Critical Care Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ. Fatema Dhanaliwala, B.S.Pharm., is Pharmacy Supervisor, Department of Pharmacy, Robert Wood Johnson University Hospital-Somerset. Kristen Poppiti, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Inova Fairfax Hospital, Falls Church, VA; at the time of writing, she was a Pharm.D. student in the Honors Research Program at Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. Haenam Kang, B.S., is Graduate Student, College of Pharmacy; and Dong-Churl Suh, M.B.A., Ph.D., is Professor, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - George Poiani
- Luigi Brunetti, Pharm.D., M.P.H., is Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, and Clinical Pharmacy Specialist, Internal Medicine, Robert Wood Johnson University Hospital-Somerset, Somerville, NJ. George Poiani, M.D., FACP, FCCP, is Attending Physician, Department of Medicine, Robert Wood Johnson University Hospital-Somerset, and Clinical Associate Professor, Division of Pulmonary/Critical Care Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ. Fatema Dhanaliwala, B.S.Pharm., is Pharmacy Supervisor, Department of Pharmacy, Robert Wood Johnson University Hospital-Somerset. Kristen Poppiti, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Inova Fairfax Hospital, Falls Church, VA; at the time of writing, she was a Pharm.D. student in the Honors Research Program at Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. Haenam Kang, B.S., is Graduate Student, College of Pharmacy; and Dong-Churl Suh, M.B.A., Ph.D., is Professor, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Fatema Dhanaliwala
- Luigi Brunetti, Pharm.D., M.P.H., is Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, and Clinical Pharmacy Specialist, Internal Medicine, Robert Wood Johnson University Hospital-Somerset, Somerville, NJ. George Poiani, M.D., FACP, FCCP, is Attending Physician, Department of Medicine, Robert Wood Johnson University Hospital-Somerset, and Clinical Associate Professor, Division of Pulmonary/Critical Care Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ. Fatema Dhanaliwala, B.S.Pharm., is Pharmacy Supervisor, Department of Pharmacy, Robert Wood Johnson University Hospital-Somerset. Kristen Poppiti, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Inova Fairfax Hospital, Falls Church, VA; at the time of writing, she was a Pharm.D. student in the Honors Research Program at Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. Haenam Kang, B.S., is Graduate Student, College of Pharmacy; and Dong-Churl Suh, M.B.A., Ph.D., is Professor, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Kristen Poppiti
- Luigi Brunetti, Pharm.D., M.P.H., is Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, and Clinical Pharmacy Specialist, Internal Medicine, Robert Wood Johnson University Hospital-Somerset, Somerville, NJ. George Poiani, M.D., FACP, FCCP, is Attending Physician, Department of Medicine, Robert Wood Johnson University Hospital-Somerset, and Clinical Associate Professor, Division of Pulmonary/Critical Care Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ. Fatema Dhanaliwala, B.S.Pharm., is Pharmacy Supervisor, Department of Pharmacy, Robert Wood Johnson University Hospital-Somerset. Kristen Poppiti, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Inova Fairfax Hospital, Falls Church, VA; at the time of writing, she was a Pharm.D. student in the Honors Research Program at Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. Haenam Kang, B.S., is Graduate Student, College of Pharmacy; and Dong-Churl Suh, M.B.A., Ph.D., is Professor, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Haenam Kang
- Luigi Brunetti, Pharm.D., M.P.H., is Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, and Clinical Pharmacy Specialist, Internal Medicine, Robert Wood Johnson University Hospital-Somerset, Somerville, NJ. George Poiani, M.D., FACP, FCCP, is Attending Physician, Department of Medicine, Robert Wood Johnson University Hospital-Somerset, and Clinical Associate Professor, Division of Pulmonary/Critical Care Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ. Fatema Dhanaliwala, B.S.Pharm., is Pharmacy Supervisor, Department of Pharmacy, Robert Wood Johnson University Hospital-Somerset. Kristen Poppiti, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Inova Fairfax Hospital, Falls Church, VA; at the time of writing, she was a Pharm.D. student in the Honors Research Program at Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. Haenam Kang, B.S., is Graduate Student, College of Pharmacy; and Dong-Churl Suh, M.B.A., Ph.D., is Professor, College of Pharmacy, Chung-Ang University, Seoul, South Korea
| | - Dong-Churl Suh
- Luigi Brunetti, Pharm.D., M.P.H., is Clinical Associate Professor, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, Piscataway, and Clinical Pharmacy Specialist, Internal Medicine, Robert Wood Johnson University Hospital-Somerset, Somerville, NJ. George Poiani, M.D., FACP, FCCP, is Attending Physician, Department of Medicine, Robert Wood Johnson University Hospital-Somerset, and Clinical Associate Professor, Division of Pulmonary/Critical Care Medicine, Robert Wood Johnson Medical School, New Brunswick, NJ. Fatema Dhanaliwala, B.S.Pharm., is Pharmacy Supervisor, Department of Pharmacy, Robert Wood Johnson University Hospital-Somerset. Kristen Poppiti, Pharm.D., is Postgraduate Year 1 Pharmacy Resident, Inova Fairfax Hospital, Falls Church, VA; at the time of writing, she was a Pharm.D. student in the Honors Research Program at Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey. Haenam Kang, B.S., is Graduate Student, College of Pharmacy; and Dong-Churl Suh, M.B.A., Ph.D., is Professor, College of Pharmacy, Chung-Ang University, Seoul, South Korea.
| |
Collapse
|
26
|
Haarmann H, Mohrlang C, Tschiesner U, Rubin DB, Bornemann T, Rüter K, Bonev S, Raupach T, Hasenfuß G, Andreas S. Inhaled β-agonist does not modify sympathetic activity in patients with COPD. BMC Pulm Med 2015; 15:46. [PMID: 25924990 PMCID: PMC4460951 DOI: 10.1186/s12890-015-0054-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 04/22/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Neurohumoral activation is present in COPD and might provide a link between pulmonary and systemic effects, especially cardiovascular disease. Because long acting inhaled β-agonists reduce hyperinflation, they could reduce sympathoexcitation by improving the inflation reflex. We aimed to evaluate if inhaled therapy with salmeterol reduces muscle sympathetic nerve activity (MSNA) evaluated by microneurography. METHODS MSNA, heart rate, blood pressure, and respiration were continually measured. After baseline recording of 20 minutes, placebo was administered; after further 45 minutes salmeterol (50 μg) was administered which was followed by a further 45 minutes of data recording. Additionally, lung function, plasma catecholamine levels, arterial pulse wave velocity, heart rate variability, and baroreflex sensitivity were evaluated. Following 4 weeks of treatment with salmeterol 50 μg twice daily, measurements were repeated without placebo administration. RESULTS A total of 32 COPD patients were included. Valid MSNA signals were obtained from 18 patients. Change in MSNA (bursts/100 heart beats) following acute administration of salmeterol did not differ significantly from the change following placebo (-1.96 ± 9.81 vs. -0.65 ± 9.07; p = 0.51) although hyperinflation was significantly reduced. Likewise, no changes in MSNA or catecholamines were observed after 4 weeks. Heart rate increased significantly by 3.8 ± 4.2 (p < 0.01) acutely and 3.9 ± 4.3 bpm (p < 0.01) after 4 weeks. Salmeterol treatment was safe and well tolerated. CONCLUSIONS By using microneurography as a gold standard to evaluate sympathetic activity we found no change in MSNA following salmeterol inhalation. Thus, despite an attenuation of hyperinflation, the long acting β-agonist salmeterol does not appear to reduce nor incite sympathoexcitation. TRIAL REGISTRATION This study was registered with the European Clinical Trials Database (EudraCT No. 2011-001581-18) and ClinicalTrials.gov ( NCT01536587 ).
Collapse
Affiliation(s)
- Helge Haarmann
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
| | | | | | | | - Thore Bornemann
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
| | - Karin Rüter
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
| | - Slavtcho Bonev
- Mannheim Biomedical Engineering Laboratories, Medical Faculty at Heidelberg University, Mannheim, Germany.
| | - Tobias Raupach
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
| | - Gerd Hasenfuß
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
| | - Stefan Andreas
- Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
- Lung Clinic Immenhausen, Immenhausen, Krs. Kassel, Germany.
| |
Collapse
|
27
|
Baeza-Trinidad R, Brea-Hernando A, Ponce de León-Martínez L. Síndrome coronario agudo asociado a salbutamol nebulizado. Rev Clin Esp 2014; 214:233-4. [DOI: 10.1016/j.rce.2014.01.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 01/15/2014] [Accepted: 01/19/2014] [Indexed: 11/15/2022]
|
28
|
Kempsford R, Allen A, Bal J, Rubin D, Tombs L. The effect of ketoconazole on the pharmacokinetics and pharmacodynamics of inhaled fluticasone furoate and vilanterol trifenatate in healthy subjects. Br J Clin Pharmacol 2014; 75:1478-87. [PMID: 23116485 DOI: 10.1111/bcp.12019] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 10/28/2012] [Indexed: 11/28/2022] Open
Abstract
AIM To investigate the effects of the cytochrome P450 3A4 (CYP3A4) inhibitor ketoconazole on the pharmacokinetics (PK) and pharmacodynamics of fluticasone furoate (FF) and vilanterol trifenatate (VI). METHODS Two double-blind, randomized, placebo-controlled, two-way crossover studies in healthy subjects. In study 1, subjects received single doses of ketoconazole (400 mg) or placebo on days 1-6, with a single dose of inhaled VI (25 μg) on day 5. Pharmacodynamic and PK data were obtained up to 48 h following the VI dose. In study 2, subjects received once daily ketoconazole (400 mg) or placebo for 11 days, with FF/VI (200/25 μg) for the final 7 days. Pharmacodynamic and PK data were obtained up to 48 h following the day 11 dose. RESULTS In study 1, there was no effect of co-administration of ketoconazole and VI on pharmacodynamic or PK parameters. In study 2, co-administration of ketoconazole and FF/VI had no effect on 0-4 h maximal heart rate or minimal blood potassium {treatment difference [90% confidence interval (CI)] -0.6 beats min(-1) (-5.8, 4.5) and 0.04 mmol l(-1) (-0.03, 0.11), respectively}, whilst there was a 27% decrease in 24 h weighted mean serum cortisol [treatment ratio (90% CI) 0.73 (0.62, 0.86)]. Co-administration of ketoconazole increased [percentage change (90% CI)] FF area under the curve (0-24) and maximal plasma concentration by 36% (16, 59) and 33% (12, 58), respectively, and VI area under the curve (0-t') and maximal plasma concentration by 65% (38, 97) and 22% (8, 38), respectively. CONCLUSION Co-administration of FF/VI or VI with ketoconazole resulted in a less than twofold increase in systemic exposure to FF and VI. There was no increase in β-agonist systemic pharmacodynamic effects, while serum cortisol was decreased by 27%. Co-administration of FF/VI with strong CYP3A4 inhibitors has the potential to increase systemic exposure to both fluticasone furoate and vilanterol, which could lead to an increase in the potential for adverse reactions.
Collapse
|
29
|
Yang J, Stanton J, Wang L, Beckert L, Frampton C, Burton D, Swanney MP. Effect of salbutamol on the measurement of single-breath diffusing capacity. Respirology 2013; 18:1223-9. [DOI: 10.1111/resp.12125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Revised: 04/03/2013] [Accepted: 04/04/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Jun Yang
- Respiratory Physiology Laboratory; Christchurch Hospital; Christchurch New Zealand
| | - Josh Stanton
- Respiratory Physiology Laboratory; Christchurch Hospital; Christchurch New Zealand
| | - Lexin Wang
- School of Biomedical Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | | | | | - Debbie Burton
- School of Biomedical Sciences; Charles Sturt University; Wagga Wagga New South Wales Australia
| | - Maureen P. Swanney
- Respiratory Physiology Laboratory; Christchurch Hospital; Christchurch New Zealand
| |
Collapse
|
30
|
Matera MG, Calzetta L, Cazzola M. β-Adrenoceptor Modulation in Chronic Obstructive Pulmonary Disease: Present and Future Perspectives. Drugs 2013; 73:1653-63. [DOI: 10.1007/s40265-013-0120-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
31
|
van Gestel AJR, Steier J. Autonomic dysfunction in patients with chronic obstructive pulmonary disease (COPD). J Thorac Dis 2012; 2:215-22. [PMID: 22263050 DOI: 10.3978/j.issn.2072-1439.2010.02.04.5] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2010] [Accepted: 10/19/2010] [Indexed: 11/14/2022]
Abstract
It has been recognized that chronic obstructive pulmonary disease (COPD) is a systemic disease which has been shown to negatively affect the cardiovascular and autonomic nerve system. The complexity of the physiologic basis by which autonomic dysfunction occurs in patients with COPD is considerable and the knowledge in this field remains elementary. The purpose of this review is to provide an overview of important potential mechanisms which might affect the autonomic nervous system in patients with COPD. This review aims to summarize the basic research in the field of autonomic dysfunction in patients with COPD. In COPD patients the activity of sympathetic nerves may be affected by recurrent hypoxemia, hypercapnia, increased intrathoracic pressure swings due to airway obstruction, increased respiratory effort, systemic inflammation and the use of betasympathomimetics. Furthermore, experimental findings suggest that autonomic dysfunction characterized by a predominance of sympathetic activity can significantly modulate further inflammatory reactions. The exact relationship between autonomic dysfunction and health status in COPD remains to be elucidated. Treatment aimed to restore the sympathovagal balance towards a reduction of resting sympathetic activity may modulate the inflammatory state, and possibly contributes to improved health status in COPD.
Collapse
|
32
|
Khorfan FM, Smith P, Watt S, Barber KR. Effects of Nebulized Bronchodilator Therapy on Heart Rate and Arrhythmias in Critically Ill Adult Patients. Chest 2011; 140:1466-1472. [DOI: 10.1378/chest.11-0525] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
|
33
|
Snyder EM, Wong EC, Foxx-Lupo WT, Wheatley CM, Cassuto NA, Patanwala AE. Effects of an Inhaled β2-Agonist on Cardiovascular Function and Sympathetic Activity in Healthy Subjects. Pharmacotherapy 2011; 31:748-56. [DOI: 10.1592/phco.31.8.748] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
|
34
|
The influence of tocolytic drugs on cardiac function, large arteries, and resistance vessels. Eur J Clin Pharmacol 2011; 67:573-80. [DOI: 10.1007/s00228-011-1040-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 03/18/2011] [Indexed: 10/18/2022]
|
35
|
Bédard ME, Marquis K, Poirier P, Provencher S. Reduced Heart Rate Variability in Patients with Chronic Obstructive Pulmonary Disease Independent of Anticholinergic or β-agonist Medications. COPD 2010; 7:391-7. [DOI: 10.3109/15412555.2010.528083] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
36
|
Different effects of tocolytic medication on blood pressure and blood pressure amplification. Eur J Clin Pharmacol 2010; 67:11-7. [PMID: 21079937 DOI: 10.1007/s00228-010-0926-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 10/13/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The importance of tocolysis has been discussed extensively. Beta-2 adrenoceptor agonistic drugs like ritodrine have been the reference tocolytic drugs in most countries. Cardiovascular side-effects are frequent. Atosiban, a newer tocolytic drug, is a competitive antagonist of oxytocin and has fewer cardiovascular side effects. Although large studies exist, there is mainly subjective reporting of adverse reactions with a focus on blood pressure data. OBJECTIVES Evaluation of the acute effects of therapeutic doses of ritodrine and atosiban in comparison to placebo on central and peripheral blood pressures, central-to-peripheral blood pressure amplification and the augmentation index (AIx) in healthy non-pregnant female volunteers. METHODS A double-blind, randomized, crossover trial was carried out in 20 healthy non-pregnant female volunteers. Hemodynamic measurements were performed under standardized conditions. RESULTS At steady state, central and peripheral pressures did not differ from placebo in the atosiban group. During ritodrine -infusion, central SBP increased by 11% versus placebo (p = 0.012) and peripheral SBP by 10% (p = 0.004). In contrast to atosiban and placebo, blood pressure amplification was absent in the ritodrine group. While the AIx did not change in the atosiban group, with ritodrine, the AIx tended to decrease. CONCLUSIONS The present study shows the significant effects of ritodrine on the cardiovascular system. Atosiban has no significant effects and may be an appropriate alternative to tocolyticum, particularly in cardiovascularly complicated pregnancies.
Collapse
|
37
|
Ritter JM. Pharmacology, basic & clinical: contrasts & coherence. Br J Clin Pharmacol 2009; 67:383-5. [DOI: 10.1111/j.1365-2125.2009.03409.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|