Effects of formoterol, salmeterol or oxitropium bromide on airway responses to salbutamol in COPD

Cazzola, Mario; Perna, F. Di; Noschese, Paolo; Vinciguerra, A.; Calderaro, Francesco; Girbino, Giuseppe; Matera, Maria Gabriella

doi:10.1183/09031936.98.11061337

Cited by 36 publications

(16 citation statements)

References 27 publications

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“…Moreover, it turned out that, even after salmeterol plus ipratropium at the conventional dose further bronchodilation was still possible with salbutamol. These results are in keeping with those of CAZZOLA et al [19] who showed that pretreatment with a conventional dose of salmeterol in COPD does not preclude the possibility of inducing further bronchodilation with salbutamol. The hypothesis that higher doses of salmeterol or ipratropium alone could have induced an improvement in airflow obstruction similar to that following the combination of salmeterol and ipratropium was not tested.…”

Section: Discussionsupporting

confidence: 91%

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

et al. 2000

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The efficacy and safety of salmeterol alone was compared with the combination of salmeterol plus ipratropium and with placebo during long-term treatment in patients with stable chronic obstructive pulmonary disease. In addition, the single-dose effect in response to the first dose of treatment was studied over 12 h.The patients (n=144; age 64 7 yrs, forced expiratory volume in one second (FEV1) 44 11% pred) participated in a three-centre double-blind double-placebo parallel group study and were randomized after a run-in period of 2 weeks to receive either salmeterol 50 mg b.i.d., salmeterol 5 mg b.i.d. plus ipratropium 40 mg q.i.d. or placebo for a period of 12 weeks.The single-dose study demonstrated that salmeterol produced a significant increase in FEV1 (peak of 7% pred) and specific airway conductance (sGaw) (maximum of 60% baseline) for $12 h. The combination of salmeterol plus ipratropium elicited a greater bronchodilator response (11% and 94% increases respectively) than salmeterol alone during the first 6 h after inhalation. During treatment there were significant improvements in daytime symptom scores and morning peak expiratory flow in both the salmeterol and the salmeterol plus ipratropium groups (p<0.001), with an associated decrease in the use of rescue salbutamol. Improvements in FEV1 and sGaw were greater in the salmeterol plus ipratropium group than in the patients receiving only salmeterol. Thirty-five patients had an exacerbation; 11 (23%) in the salmeterol group (versus placebo NS), six (13%) in the salmeterol plus ipratropium group (versus placebo p<0.01) and 18 (36%) in the placebo group.In conclusion, in patients with severe stable chronic obstructive pulmonary disease, long-term treatment with either salmeterol alone or salmeterol plus ipratropium is safe and effective. There was added benefit from the combination therapy in terms of improvement in airways obstruction, but not for improvement in symptom control or need for rescue salbutamol. Eur Respir J 2000; 15: 878±885. Chronic obstructive pulmonary disease (COPD) is defined as a disease state characterized by the presence of airflow obstruction, due to chronic bronchitis or emphysema, and is generally progressive but may be partially reversible [1]. The goals of pharmacotherapy in this disorder are to induce bronchodilation and facilitate expectoration in order to improve symptoms, prevent recurrent exacerbations and so enhance the quality of life [2]. In patients with stable COPD, the spirometric response to bronchodilators such as b 2 -agonists, anticholinergic drugs and methylxanthines is at best very modest. However, even in the absence of significant bronchodilation, an improvement in symptoms and exercise tolerance can be demonstrated [3].Salmeterol xinofoate, a long-acting b 2 -agonist, has been shown in single-dose studies to induce a spirometric improvement over a 12-h period in patients with COPD [4± 6]. In addition, three studies in patients with COPD over periods of 1±3 months have found that treatment with salmet...

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Section: Discussionsupporting

confidence: 91%

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

et al. 2000

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“…We must stress that in our study [1] we did not evaluate the effects of salmeterol on airway responses to OTB, but rather the effects of OTB on airway responses to salbutamol. We agree that 200 mg OTB, which is its conventional dose, might be considered an insufficient dose.…”

Section: From the Authorsmentioning

confidence: 95%

“…With great interest, we read the article by CAZZOLA et al [1] concerning the airway responses to salmeterol in combination with another bronchodilator in patients with chronic obstructive pulmonary disease (COPD). The authors concluded that "a pretreatment with a conventional dose of oxitropium bromide (OTB) did not preclude the possibility of inducing a further bronchodilation with salbutamol in patients suffering from partially reversible COPD".…”

mentioning

confidence: 99%

Inhaled oxitropium bromide is currently used as the first-line therapy of patients with chronic pulmonary disease in Japan

Teramoto¹,

Ouchi²

1999

Eur Respir J

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“…a long-acting β 2 -agonist does not preclude the possibility of inducing a further bronchodilation with higher that the customary dose of salbutamol in patients suffering from COPD [16].…”

Section: Introductionmentioning

confidence: 99%

Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropium-induced bronchodilation in patients with stable COPD

Cazzola

Santus

D’Adda

et al. 2009

Pulmonary Pharmacology & Therapeutics

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Please cite this article as: Cazzola M, Santus P, D'Adda A, Pizzolato S, Di Marco F, Centanni S. Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropiuminduced bronchodilation in patients with stable COPD, Pulmonary Pharmacology & Therapeutics (2008), doi: 10.1016/j.pupt.2008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Accepted ManuscriptTitle: Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropium-induced bronchodilation in patients with stable COPD ARTICLE IN PRESS AbstractKnowledge on the effects of the additive bronchodilatory effects of short-acting agents on the top of the effect of long-acting bronchodilators is limited. In this trial, we examined the influence of higher than conventional doses of the shortacting inhaled β2-adrenergic agent salbutamol and the short-acting anticholinergic drug ipratropium bromide on bronchodilation induced by a regular treatment with the long-acting anticholinergic drug tiotropium 18 μg/day in 30 patients with stable COPD. On 3 separate days, a dose-response curve to inhaled salbutamol (100 μg puff-1), ipratropium bromide (20 μg puff-1) or placebo was constructed 3 hours after inhalation of last dose of tiotropium, using one puff, one puff, two puffs and two puffs, for a total cumulative dose of 600 μg salbutamol or 120 μg ipratropium bromide. Doses were given at 30-min intervals and Both drugs did not affect heart rate and SpO2. Our results indicate that there is not much difference in bronchodilation between adding higher than conventional doses of salbutamol or ipratropium bromide to tiotropium in patients with stable COPD. Effective improvement of the pulmonary function may be achieved in such a type of patients by adding salbutamol 600 μg or ipratropium bromide 120 μg to regular tiotropium. These is an interesting finding mainly for those COPD patients suffering from cardiovascular co-morbidities that are at highest risk of myocardial infarction, congestive heart failure, cardiac arrest and sudden cardiac death when treated with elevated doses of a ß2-agonist. (EudraCT number: 2007-001597-82)

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Effects of formoterol, salmeterol or oxitropium bromide on airway responses to salbutamol in COPD

Cited by 36 publications

References 27 publications

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

Inhaled oxitropium bromide is currently used as the first-line therapy of patients with chronic pulmonary disease in Japan

Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropium-induced bronchodilation in patients with stable COPD

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