Addition of anticholinergic solution prolongs bronchodilator effect of β2agonists in patients with chronic obstructive pulmonary disease

Levin, David C.; Little, Katherine S.; Laughlin, Kathryn R.; Galbraith, J. Mark; Gustman, Paul M.; Murphy, Debbie; Kram, Jerrold; Hardie, Grace E.; Reuter, Cindy; Ostransky, David; McFarland, Karen N.; Petty, Thomas L.; Silvers, Wayne; Rennard, Stephen I.; Mueller, Mary Ann; Repsher, Lawrence; ZuWallack, Richard; Vale, Rick

doi:10.1016/s0002-9343(96)80073-8

Cited by 32 publications

(20 citation statements)

References 27 publications

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“…This could be explained by the effect of specific treatments such as bronchodilator medications or diuretics, which had time to act and modified the pathophysiology of the subjects' presentation. [29][30][31][32][33] Patients receiving HFNC should be closely monitored using parameters similar to those used during noninvasive ventilation. Messika et al 34 found that HFNC failure was associated with lower P aO 2 /F IO 2 and higher breathing frequency and Simplified Acute Physiology Score II.…”

Section: Discussionmentioning

confidence: 99%

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

Rittayamai¹,

Tscheikuna²,

et al. 2015

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BACKGROUND: Acute dyspnea and hypoxemia are 2 of the most common problems in the emergency room. Oxygen therapy is an essential supportive treatment to correct these issues. In this study, we investigated the physiologic effects of high-flow nasal oxygen cannula (HFNC) compared with conventional oxygen therapy (COT) in subjects with acute dyspnea and hypoxemia in the emergency room. METHODS: A prospective randomized comparative study was conducted in the emergency department of a university hospital. Forty subjects were randomized to receive HFNC or COT for 1 h. The primary outcome was level of dyspnea, and secondary outcomes included change in breathing frequency, subject comfort, adverse events, and rate of hospitalization. RESULTS: Common causes of acute dyspnea and hypoxemia were congestive heart failure, asthma exacerbation, COPD exacerbation, and pneumonia. HFNC significantly improved dyspnea (2.0 ؎ 1.8 vs 3.8 ؎ 2.3, P ‫؍‬ .01) and subject comfort (1.6 ؎ 1.7 vs 3.7 ؎ 2.4, P ‫؍‬ .01) compared with COT. No statistically significant difference in breathing frequency was found between the 2 groups at the end of the study. HFNC was well tolerated, and no serious adverse events were found. The rate of hospitalization in the HFNC group was lower than in the COT group, but there was no statistically significant difference (50% vs 65%, P ‫؍‬ .34). CONCLUSIONS: HFNC improved dyspnea and comfort in subjects presenting with acute dyspnea and hypoxemia in the emergency department. HFNC may benefit patients requiring oxygen therapy in the emergency room.

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Section: Discussionmentioning

confidence: 99%

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

Rittayamai¹,

Tscheikuna²,

et al. 2015

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“…Several portable peak flow meters are available for personal use and the measurement has been applied as a follow-up regimen of asthma or chronic obstructive pulmonary disease patients. 8,10 Regarding circadian rhythm of airway, it has been reported to dilate most at 1600 and constrict at 0400, 6,7 so that the PEF was measured at these times in the present study. Atropine im included in the premedication had a weak bronchodilator effect at 1600, but a strong effect at 0400.…”

Section: Discussionmentioning

confidence: 74%

Increase of peak expiratory flow by atropine is dependent on circadian rhythm

Furuta

Tanigawa

Ohmizo

et al. 2001

Can J Anesth/J Can Anesth

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Purpose: To examine whether the bronchodilatory effect of atropine differs in the evening from the morning. Methods: Thirteen adult healthy volunteers with no oral medication intake were studied. At 1600, peak expiratory flow (PEF) was measured three times, and the highest value recorded. Subsequently, the volunteer received 0.01 mg·kg -1 atropine im, and the PEF was measured every 30 min for 180 min. On a different day, at 0400, the effect of atropine on the PEF was measured again in the same way. Results:The PEF values before atropine at 1600 and 0400 were 485 ± 92 (350-730) and 458 ± 76 (340-600) l min -1 ,(P < 0.05). There was no difference in PEF values between the 1600 and 0400 time courses after atropine. The PEF value was increased only at 90 min at 1600 (P = 0.0012), but at 30, 60, 90 and 120 min at 0400 (P = 0.0001).Conclusion: Atropine administration has a weak bronchodilatory effect in the evening, but a stronger effect in the morning. Airways are narrower in the morning than in the evening, and this change is inhibited by atropine such that the PEF values are restored to those observed in the evening. Conclusion : L'administration d'atropine a un faible effet broncho-dilatateur en soirée, mais un effet plus important le matin. Les voies aériennes sont plus étroites le matin que le soir. Ce qui est inhibé par l'atropine. On retrouve ainsi, le matin, les valeurs du DEP observées en soirée.

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“…В различных клинических исследованиях пока-зано, что при комбинировании антихолинергиков и β2-адреноагонистов оказывался также дополни-тельный или потенцирующий бронхолитический эффект и снижалось число обострений [58][59][60]. По-добный эффект отмечался и при исследовании ком-бинации длительно действующих бронхолитиков (LABA + LAMA).…”

Section: рис 1 применение 2 бронхолитических препаратовunclassified

Mechanisms of Anticholinergic Effects and Probable Mechanisms of Their Potentiation Using Beta-2-Agonists

Трофимов¹,

Сорокина²

2014

Pulʹmonologiâ (Mosk.)

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SummaryCurrent basic therapy of chronic obstructive pulmonary disease includes inhaled long-acting bronchodilators. This article reviews mechanisms of action of anticholinergic drugs and their potentiation with beta-2-agonists. There are several upcoming fixed combinations of anticholinergics and beta-2-agonists. In 2013, the first fixed combination of anticholinergic glycopyrronium and beta-2-agonist indacaterol has been registered. A beta-2-agonist decreases acetylcholine release due to changes in the cholinergic neuronal transmission via presynaptic beta-2-adrenoreceptors that leads to better smooth muscle relaxation in bronchi caused by anticholinergics. Moreover, anticholinergic drug could reduce acetylcholineinduced constriction and amplify bronchodilation caused by beta-2-agonist. The combination of anticholinergic glycopyrronium and beta-2-agonist indacaterol is to be effective. Key words: chronic obstructive pulmonary disease, bronchodilators, glycopyrronium bromide, indacaterol, beta-2-adrenoreceptors, M-cholinoreceptors. РезюмеВ настоящее время терапия ингаляционными бронхолитическими препаратами длительного и ультрадлительного действия является ос-новой поддерживающей терапии хронической обструктивной болезни легких. В статье описаны патогенетические основы холинолити-ческой терапии и возможные механизмы ее потенцирования под влиянием β2-адреномиметиков. Разрабатываются несколько фиксиро-ванных комбинаций холинолитиков и β2-адреномиметиков ультрадлительного действия. В 2013 г. в Европе зарегистрирована 1-я фик-сированная комбинация, содержащая гликопирроний и индакатерол. Имеются все основания предполагать, что комбинация 2 типов бронхолитиков является фармакологически успешной: во-первых, добавление β2-адреноагонистов снижает высвобождение ацетил-холина (ACh) за счет изменения холинергической нейрональной передачи пресинаптическими β2-адренорецепторами, приводя к уси-лению релаксации гладких мышц бронхов, вызванной холинолитиками; во-вторых, добавление холинолитика может редуцировать констрикторный эффект ACh, чье высвобождение модулируется β2-адреноагонистами, и амплифицировать бронходилатацию, вызван-ную β2-адреноагонистами посредством прямой стимуляции β2-адренорецепторов. Ключевые слова: терапия хронической обструктивной болезни легких, бронхолитики, гликопиррония бромид, индакатерол, β2-адрено-рецепторы, М-холинорецепторы.

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Addition of anticholinergic solution prolongs bronchodilator effect of β2agonists in patients with chronic obstructive pulmonary disease

Cited by 32 publications

References 27 publications

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

Use of High-Flow Nasal Cannula for Acute Dyspnea and Hypoxemia in the Emergency Department

Increase of peak expiratory flow by atropine is dependent on circadian rhythm

Mechanisms of Anticholinergic Effects and Probable Mechanisms of Their Potentiation Using Beta-2-Agonists

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