Salmeterol and formoterol in partially reversible severe chronic obstructive pulmonary disease: a dose-response study

Cazzola, Mario; Matera, Maria Gabriella; Santangelo, Giovanni; Vinciguerra, A.; Rossi, F.; D’Amato, Gennaro

doi:10.1016/0954-6111(95)90008-x

Cited by 135 publications

(69 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The results demonstrate that, in patients with stable COPD and severe airflow obstruction, 50 mg of salmeterol produces a significant improvement in lung function as assessed by FEV1 and sGaw, with a peak effect after 2±4 h and a duration of action of $12 h. In addition, the combination of salmeterol 50 mg and ipratropium bromide 40 mg elicited a greater bronchodilator response than salmeterol alone during the first 6 h after inhalation. The present results with salmeterol are in line with those of CAZZOLA et al [4]. These authors, comparing single doses of 25, 50 and 75 mg salmeterol in patients with COPD, found that all doses induced a significant improvement in FEV1 over the 12 h monitoring period.…”

Section: Discussionsupporting

confidence: 92%

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

et al. 2000

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionsupporting

confidence: 92%

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

et al. 2000

View full text Add to dashboard Cite

show abstract

“…Each patient was requested to discontinue all bronchodilating medications starting from at least 24 h before execution of the test [12][13][14]. All subjects performed two types of manoeuvres: no.…”

Section: Methodsmentioning

confidence: 99%

Bronchodilation test in COPD: effect of inspiratory manoeuvre preceding forced expiration

et al. 2003

View full text Add to dashboard Cite

The effects of an inspiratory manoeuvre preceding forced expiration on functional tests performed under routine conditions before and after inhalation of a bronchodilator drug (salbutamol) were assessed on 150 consecutive chronic obstructive pulmonary disease outpatients. The patients performed forced vital capacity manoeuvres either immediately after a rapid inspiration (manoeuvre no. 1) or after a slow inspiration with a 4-6 s pause (manoeuvre no. 2).Under baseline conditions, forced expiratory volume in one second (FEV1) values were 8% (% control) larger with manoeuvre no. 1 than no. 2. FEV1 values increased with salbutamol administration by y8% and were, on average, still 7% larger with manoeuvre no. 1 than no. 2. The incidence of reversibility, assessed according to American Thoracic Society criteria, was 76% when manoeuvre no. 2 was selected to represent baseline conditions and manoeuvre no. 1 was chosen to represent the effects of bronchodilator administration, whereas the lowest incidence (2%) was found when manoeuvre no. 1 was selected to represent baseline conditions and manoeuvre no. 2 was chosen to represent the effects of bronchodilator administration.These results indicate that the time dependence of the forced vital capacity manoeuvre has an important impact on the assessment of routine lung function in a clinical setting and supports the notion that the time course of the inspiration preceding the forced vital capacity manoeuvre should be standardised. The forced vital capacity (FVC) manoeuvre is the most common ventilatory function test in clinical practice and is used both as a screening test and as a test to diagnose and follow-up pulmonary and extrapulmonary respiratory diseases. In particular, the forced expiratory volume in one second (FEV1) is considered to be the most reproducible respiratory function test. The procedure of FVC measurement and its reproducibility have been described in detail previously [1][2][3]. In the early 1990s, D9ANGELO and coworkers [4,5] showed that FEV1, peak expiratory flow (PEF) and the forced expiratory flow at 25, 50 and 75% of FVC both in healthy subjects and in chronic obstructive pulmonary disease (COPD) patients, are affected by the speed of the inspiration and duration of the end-inspiratory pause before the forced expiration. In particular, FEV1 was found to be, on average, 5 and 8% higher in healthy subjects and COPD patients, respectively, when FVC was performed immediately after a rapid inspiration rather than a slow inspiration with an end-inspiratory pause of 4-6 s. Therefore, the suggestion was made that a more precise standardisation of the FVC manoeuvre was required.The purpose of the present study was to assess how the execution of the FVC manoeuvre could affect functional tests performed in everyday clinical practice (i.e. under routine conditions) and to verify the reproducibility of previous results obtained in a small number of COPD subjects after pharmacological bronchodilation with an inhalatory b 2 -agonist [6] on a larger COPD...

show abstract

“…(6) Therefore, COPD patients presenting a poor response to short-acting β 2 -agonists might present significant reversibility to formoterol, with considerable improvement in lung function and relief of symptoms. (4,6,24) Functional changes can be seen for weeks after the baseline testing and might be associated with several variables involved in the therapeutic efficacy of the drug. (23,24) In a study involving 20 patients with partially reversible COPD and similar to the present study in design (formoterol and a placebo were compared), a significant response was observed even within 10 or 20 min after formoterol administration.…”

Section: Discussionmentioning

confidence: 99%

“…(4,6,24) Functional changes can be seen for weeks after the baseline testing and might be associated with several variables involved in the therapeutic efficacy of the drug. (23,24) In a study involving 20 patients with partially reversible COPD and similar to the present study in design (formoterol and a placebo were compared), a significant response was observed even within 10 or 20 min after formoterol administration. (25) In our study, patients with stable COPD presented a substantial improvement in FEV 1 at 30 min after formoterol administration, indicating that formoterol has an immediate bronchodilator effect.…”

Section: Discussionmentioning

confidence: 99%

Resposta broncodilatadora imediata ao formoterol em doença pulmonar obstrutiva crônica com pouca reversibilidade

et al. 2008

View full text Add to dashboard Cite

Objective: To evaluate, using pulmonary function tests, the effectiveness of formoterol as a bronchodilator at 30 min after its administration in patients with poorly reversible COPD. Methods: A prospective study including 40 COPD patients not responding to the short-acting bronchodilator used in the spirometric test-variation of less than 200 mL and less than 7% of predicted in forced expiratory volume in one second (FEV 1 ). All patients were classified as having stage II, III, or IV COPD (Brazilian Thoracic Society/Global Initiative for Chronic Obstructive Lung Disease) and presented FEV 1 ≤ 70% of predicted value. The patients were randomized into two groups of 20, with similar clinical characteristics, receiving, via a dry powder inhaler, either formoterol or a placebo. The pulmonary function testing (plethysmography) was repeated at 30 min after formoterol or placebo administration. Results: In the formoterol group, the mean values obtained for FEV 1 , inspiratory capacity, and forced vital capacity were significantly greater than those obtained in the placebo group (p = 0.00065, p = 0.05, and p = 0.017, respectively), whereas that obtained for airway resistance was significantly lower (p = 0.010). Less pronounced differences were observed for residual volume, vital capacity and specific airway conductance, which were lower, higher and higher, respectively, in the formoterol group. Conclusions: In COPD patients not responding to the short-acting bronchodilator used in the spirometric test, formoterol promoted significant improvement in lung function at 30 min after of administration. Further studies are required to confirm whether formoterol can also be used as a medication for immediate relief of symptoms in COPD.Keywords: Chronic obstructive pulmonary disease; Respiratory function tests; Bronchodilator agents. ResumoObjetivo: Avaliar, por meio de provas de função pulmonar, a eficácia broncodilatadora do formoterol após 30 min de sua administração em portadores de doença pulmonar obstrutiva crônica (DPOC) com pouca reversibilidade. Métodos: Estudo prospectivo incluindo 40 pacientes portadores de DPOC com resposta negativa ao broncodilatador de curta duração utilizado no teste espirométrico-variação menor que 200 mL e 7% do previsto do volume expiratório forçado no primeiro segundo (VEF 1 ). Os pacientes encontravam-se nos estágios II, III ou IV da DPOC (Sociedade Brasileira de Pneumologia e Tisiologia/Global Initiative for Chronic Obstructive Lung Disease) e apresentavam VEF 1 ≤ 70% do previsto. Foram randomizados em dois grupos de 20, com características clínicas semelhantes, e cada grupo recebeu formoterol ou placebo por meio de inalador de pó seco. As provas de função pulmonar (por pletismografia) foram repetidas após 30 min da administração de formoterol ou placebo. Resultados: Observaram-se aumento significativo de VEF 1 (p = 0,00065), capacidade inspiratória (p = 0,05) e capacidade vital forçada (p = 0,017) e redução significativa da resistência das vias aéreas (p = 0,010) no grupo formotero...

show abstract

Salmeterol and formoterol in partially reversible severe chronic obstructive pulmonary disease: a dose-response study

Cited by 135 publications

References 16 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

Bronchodilation test in COPD: effect of inspiratory manoeuvre preceding forced expiration

Resposta broncodilatadora imediata ao formoterol em doença pulmonar obstrutiva crônica com pouca reversibilidade

Contact Info

Product

Resources

About