Pretreatment of Exercise‐Induced Asthma in Adults with Aerosols and Pulverized Tablets

Abstract

Eighteen adult asthmatics took part in a double-blind crossover study comparing the effect on exercise-induced asthma (EIA) of pretreatment with aerosolized 1) disodium cromoglycate (DSCG), 2) ipratropium bromide (IPTB), 3) fenoterol, 4) DSCG + IPTB and 5) saline. EIA was completely blocked by pretreatment with the beta 2-agonist, fenoterol. The protective effect of nebulized DSCG and IPTB given alone could not be distinguished from that of isotonic saline. The combination of DSCG and IPTB reduced the post-exercise bronchoconstriction more than any of the two drugs given separately. Thirteen of the 18 patients went on to a double-blind cross-over study of the effect on EIA of pretreatment with the usually recommended dosages off salbutamol, theophylline and their combination administered as pulverized tablets. Seven patients were withdrawn from this part of the study because of side-effects, and in the remaining six none of the oral pretreatments could be distinguished from placebo, despite serum theophylline concentrations within or above the commonly recommended therapeutical range.

Methacholine Challenge as a Clinical Bioassay of Pulmonary Delivery of a Long‐Acting β2‐Adrenergic Agonist

“…29 In addition, tachyphylaxis from frequent use of an SABA may be circumvented by substituting ipratropium HFA MDI for as-needed bronchodilatation, but the onset of action is slower 30 and it does not block exercise-induced bronchospasm. 31 Tiotropium could be substituted for LABAs, but this drug has an effect on methacholine PC 20 for 72 hours, 32 which makes its use less practical than simply excluding patients who require combination therapy with an inhaled corticosteroid and LABA.…”

Management of Exercise-Induced Bronchospasm in Children

“…Controlled clinical trials in adults have demonstrated that pre-treatment with 2 mg inhaled cromolyn delivered by MDI (Intal, Aventis, Bridgewater, NJ), 38 or oral β2-adrenergic agonists 29 (i.e., albuterol) have minimal bronchoprotective effects. Pre-treatment with inhaled ipratropium 38 (Atrovent, Boehringer Ingelheim, Ridgefield, CT), oral ketotifen 39 (a relatively H1 selective histamine antagonist and mast cell stabilizer, not available in the United States), and most antihistamines 21,22 are ineffective in preventing exercise-induced bronchospasm.…”

“…Pre-treatment with inhaled ipratropium 38 (Atrovent, Boehringer Ingelheim, Ridgefield, CT), oral ketotifen 39 (a relatively H1 selective histamine antagonist and mast cell stabilizer, not available in the United States), and most antihistamines 21,22 are ineffective in preventing exercise-induced bronchospasm. Also, it is noteworthy that maintenance therapy with inhaled albuterol, 2 puffs four times a day for only one week, paradoxically increased exercise-induced bronchospasm and decreased the post-exercise bronchodilator response to albuterol in a double-blind, placebo-controlled crossover study in adults with asthma.…”

Current Concepts of Exercise‐Induced Asthma

“…1, 2). Although there is a recent study showing that oral salbutamol in a dose of 0.15 mg kg-I is as effective as aerosol 200 pg salbutamol in children (39), the doses used and the time required for the oral form to take effect make patient compliance unlikely (25).…”