Drug Intake and Plasma Concentrations in Acute Asthma

J, Bøe; Ljungholm, Karin

doi:10.1159/000194650

Cited by 9 publications

(8 citation statements)

References 8 publications

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“…The study provides evidence suggesting that if indeed high doses of inhaled salbutamol are taken by asthmatics during the development of an acute attack before attending hospital, salbutamol does not enter the systemic circulation in significantly large quantities. This suggestion concurs with the findings in acute asthmatics of Boe and Ljungholm (1984).…”

Section: Discussionsupporting

confidence: 93%

Plasma concentrations of salbutamol in acute severe asthmatics

Lewis

McLaren

Essex

et al. 1990

Australian and New Zealand Journal of Medicine

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We studied prospectively 11 asthmatic patients presenting to the Accident and Emergency department with acute asthma. (Four patients reported historically that they were taking some form of oral salbutamol as part of their maintenance therapy.) Standard cardiovascular and respiratory parameters and plasma salbutamol concentrations were measured before and one hour after treatment with five milligrams of nebulised salbutamol. The median plasma salbutamol concentration before treatment was below the level of detection of the assay (less than 3 micrograms.l-1) with a range from less than 3 micrograms.l-1 to 34.6 micrograms.l-1. One hour post treatment the median plasma salbutamol concentration was 7.4 micrograms.l-1 (range less than 3.0 micrograms.l-1 to 56.0 micrograms.l-1) p less than 0.05. (Wilcoxons test). Correlations were investigated between the measured pretreatment physiological variables and pre-treatment plasma salbutamol concentrations. None were found to be significant. Similar analysis of the measured post-treatment physiological variables and post-treatment plasma salbutamol concentrations again revealed no significant correlations. However, a significant negative correlation was noted between the change in plasma salbutamol concentration with treatment and the change in respiratory rate (Rs = -0.56, p = 0.04). If asthmatics do indeed use high doses of inhaled beta-2-agonists (salbutamol) in an attempt to abort an acute attack (as many clinicians suspect), little, if any, of the drug appears to reach the systemic circulation. In this study the administration of five milligrams of nebulised salbutamol to acute asthmatics did not produce excessive increases in plasma salbutamol concentration, even in those patients taking oral salbutamol as part of their maintenance therapy.

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Section: Discussionsupporting

confidence: 93%

Plasma concentrations of salbutamol in acute severe asthmatics

Lewis

McLaren

Essex

et al. 1990

Australian and New Zealand Journal of Medicine

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“…The regression coefficient between plasma salbutamol before treatment and PEF increase 30 min after treatment was -0.38 (n=17) for the i. v. treated and -0.22 (n=23) for the inhalation group. with an estimated plasma ~2-agonist level (P-terbutaline x 2 + P-salbutamol) of below or above 60 nmoH No significant correlation was found between the reported inhaled 24 h ~2-agonist dose (mg•kg- 1 ) and the change in PEF after inhaled or i. v. salbutamol treatment.…”

Section: Treatment Effects and Relation To Plasma Levelsmentioning

confidence: 87%

“…Some authors have suggested that the excessive use of self-administered sympathomimetic drugs in patients with acute asthma might delay hospital admission, and thus increase the risk of dying from an attack of asthma (19,20]. Other studies have, however, indicated that patients with severe acute asthma are often undertreated (1,21].…”

Section: Discussionmentioning

confidence: 99%

“…The plasma levels of theophylline in patients arriving with acute asthma have been measured in a number of studies [1][2][3][4][5], while the plasma levels of beta 2 -agonist drugs on arrival with acute asthma have been studied less often [1,6]. Also, very little is known about the way the medication prior to hospital admission affects the outcome of acute asthma treatment.…”

mentioning

confidence: 99%

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Bronchodilator intake and plasma levels on admission for severe acute asthma

Janson¹,

J²,

Boman³

et al. 1992

Eur Respir J

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We have measured the plasma levels of salbutamol, terbutaline and theophylline in 140 patients (70 men, mean age 57 yrs) arriving for emergency treatment with severe acute asthma. The aim of the study was to investigate how the measured plasma levels correlated with the reported bronchodilator intake and whether the pretreatment beta 2-agonist levels influenced the effect of emergency salbutamol treatment. We found a highly significant correlation between the reported 24 h dose and the measured plasma concentrations for all three drugs. A plasma concentration less than 40 mumol.l-1 was found in 63 of the 107 patients who had taken theophylline, while no patient had a plasma concentration greater than 110 mumol.l-1. A plasma concentration above the suggested therapeutic range was found in 23 of the 95 patients who had taken terbutaline (greater than 30 nmol.l-1) and in 12 of the 98 patients who had taken salbutamol (greater than 60 nmol.l-1). A significant negative correlation was found between the initial plasma beta 2-agonist levels and the bronchodilation after i.v. salbutamol treatment (5 micrograms.kg-1), while there was no clear indication that high plasma beta 2-agonist levels reduced the bronchodilator effect of a high dose of inhaled salbutamol (0.15 mg.kg-1 x 2). We conclude that some patients arriving with acute asthma have high blood concentrations of beta 2-agonists, which possibly limit the response to i.v. beta 2-agonist treatment, while the effect of high-dose inhaled beta 2-agonists appears to be related to a lesser degree to the drug concentration on arrival. In this study overtreatment with theophylline appears to be uncommon.

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“…14 Low theophylline levels alone were felt to be the cause of the emergency visits, despite clear demonstrations of the poor correlation between drug intake and plasma drug concentration in almost 15% of patients. 15 There has been interest in using salivary theophylline levels to attempt to document compliance. 16 However, there appears to be only lim-ited correlation between salivary levels and the blood theophylline level, which is generally accepted as a measuring standard.…”

Section: Underlying Assumptionsmentioning

confidence: 99%

Treatment Noncompliance in Asthmatic Patients

Moran¹

1987

Semin Respir Crit Care Med

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Drug Intake and Plasma Concentrations in Acute Asthma

Cited by 9 publications

References 8 publications

Plasma concentrations of salbutamol in acute severe asthmatics

Plasma concentrations of salbutamol in acute severe asthmatics

Bronchodilator intake and plasma levels on admission for severe acute asthma

Treatment Noncompliance in Asthmatic Patients

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