Efficacy of adding multiple doses of oxitropium bromide to salbutamol delivered by means of a metered-dose inhaler with a spacer device in adults with acute severe asthma

Nakano, Yuichi; Enomoto, Noriyuki; Kawamoto, Atsushi; Hirai, Ritsuko; Chida, Kingo

doi:10.1067/mai.2000.108910

Cited by 13 publications

(12 citation statements)

References 24 publications

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“…A total of 32 randomised controlled trials (16 including children and adolescents [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and 16 including adults [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] ) were therefore selected for further analysis (tables 1 and 2). Five studies were supported by Boehringer Ingelheim.…”

Section: Resultsmentioning

confidence: 99%

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Nitric oxide protects against airway hyperresponsiveness

Kewin

2005

Thorax

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Background: Current guidelines recommend the use of a combination of inhaled b 2 agonists and anticholinergics, particularly for patients with acute severe or life threatening asthma in the emergency setting. However, this statement is based on a relatively small number of randomised controlled trials and related systematic reviews. A review was undertaken to incorporate the more recent evidence available about the effectiveness of treatment with a combination of b 2 agonists and anticholinergics compared with b 2 agonists alone in the treatment of acute asthma. Conclusions: This review strongly suggests that the addition of multiple doses of inhaled ipratropium bromide to b 2 agonists is indicated as the standard treatment in children, adolescents, and adults with moderate to severe exacerbations of asthma in the emergency setting.

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Section: Resultsmentioning

confidence: 99%

“…[28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43] Two trials showed data stratified by severity of obstruction (moderate and severity). 41 42 Eight trials reported FEV 1 (l), 28 29 34-37 39 42 11 reported PEFR (l/min), 29-32 34 38-43 and one reported FEV 1 (% predicted).…”

Section: Spirometric Testingmentioning

confidence: 99%

Nitric oxide protects against airway hyperresponsiveness

Kewin

2005

Thorax

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“…In addition, we found six randomized controlled trials that had not been included in previous systematic reviews that concerned the effectiveness of anticholinergic agents in adults with acute asthma 27,29,30,36,37,39 ( Table 2).…”

Section: Adult Studiesmentioning

confidence: 99%

“…The authors concluded that there was a significant advantage when high doses of ipratropium bromide and albuterol are combined in the ED treatment of adults with acute severe asthma. Nakano et al 30 compared the outcomes of adults with acute severe asthma (ie, PEF, Ͻ 50% of predicted) who had been treated with 4 puffs (400 g) albuterol every 20 min for three doses plus 4 puffs of oxitropium bromide (400 g) with each of the three salbutamol doses to the administration of salbutamol alone by means of an MDI with a spacer device. A randomized, single-blind, placebo-controlled trial was performed in 74 adult patients presenting to the ED for treatment.…”

Section: Adult Studiesmentioning

confidence: 99%

The Role of Anticholinergics in Acute Asthma Treatment

Rodrigo

Rodrigo²

2002

Chest

102

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“…In an analysis of subgroups [41], no evidence was found for efficacy of anticholinergics in patients with ''mild acute asthma'', a category which included all patients with pre-treatment PEF .200 L?min -1 [80] or pre-treatment FEV1 .30% pred [42], i.e. well below the range that would usually be managed at home.…”

Section: Anticholinergics In the Self-management Of Exacerbationsmentioning

confidence: 99%

Pharmacological strategies for self-management of asthma exacerbations

Reddel

Barnes²

2006

European Respiratory Journal

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Written action plans are effective within asthma self-management, but there are few guidelines about the specific medication adjustments which can be recommended for selftreatment of exacerbations.This review examines pharmacological strategies for self-management of asthma exacerbations in adults, including those for inhaled corticosteroid/long-acting b 2 -agonist (ICS/LABA) users.Oral corticosteroids are well-established in clinical practice and clinical trials for the treatment of severe exacerbations, including during combination therapy. Evidence supports 7-10 days treatment, with no need to taper except to reduce side-effects. Doubling the dose of ICS is not effective. Several studies have shown benefit from high-dose ICS (2,400-4,000 mg beclomethasone equivalent) for 1-2 weeks. This may be achieved by adding a high-dose ICS inhaler to maintenance ICS or ICS/LABA therapy. There is inconclusive evidence about acutely increasing the dose of maintenance budesonide/formoterol for exacerbations, and no studies of this approach with fluticasone/salmeterol. For patients taking maintenance budesonide/formoterol, use of the same medication as-needed reduces exacerbations. Short-acting b 2 -agonists are still effective in producing bronchodilation during combination therapy; however, a higher dose may be required.There is a need for further studies to clarify remaining issues about self-management of asthma exacerbations, particularly with regard to side-effects of treatment and patient acceptability.

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Efficacy of adding multiple doses of oxitropium bromide to salbutamol delivered by means of a metered-dose inhaler with a spacer device in adults with acute severe asthma

Cited by 13 publications

References 24 publications

Nitric oxide protects against airway hyperresponsiveness

Nitric oxide protects against airway hyperresponsiveness

The Role of Anticholinergics in Acute Asthma Treatment

Pharmacological strategies for self-management of asthma exacerbations

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