Bronchodilator Therapy In Patients Research Articles

Bronchodilator therapy in patients with chronic obstructive pulmonary disease: what should be considered in clinical practice when choosing a dosing regimen?

The use of long-acting bronchodilators is central to the chronic obstructive pulmonary disease (COPD) therapy. One of the goals of bronchodilation is to reduce the morning COPD symptoms that are associated with a more severe disease and an increased risk of exacerbations.The aim of the study was to evaluate the clinical efficacy of switching COPD patients with severe morning symptoms who received combinations of long-acting bronchodilators QD to a fixed-dose combination of aclidinium bromide (AB) and formoterol fumarate (FF) BID.Methods. We examined COPD patients treated with combinations of long-acting β2-agonists and M-anticholinergics (but not AB and FF), who continued to complain of severe symptoms in the morning despite the treatment. After examination, the patients were switched to the fixed-dose combination of AB 0.4 mg and FF 0.012 mg (AB/FF) BID in the form of a metered-dose powder inhaler. The patients were examined at baseline and at 6-month follow-up.Results. Of the 115 included COPD patients, 90 completed the study. After 6 months of treatment, they showed a significant decrease in the intensity of cough, sputum amount, severity of distant wheezing, and shortness of breath in the morning (–0.88, –0.38, –0.29, –0.58 on a 4-point scale, the mean score –0.44; p < 0.001). The result of the COPD Assessment test decreased from 28 (24; 34) to 24 (20; 28) (p = 0.011), the distance of a 6-minute walk increased from 319 ± 72 to 354 ± 67 m (p < 0.001). The fixed-dose combination of AB/FF did not cause serious adverse events.Conclusion. The fixed-dose AB/FF combination in COPD patients resulted in a significant clinical improvement and was well tolerated. The AB/FF combination with twice daily dosing regimen is advisable for the patients with morning symptoms persisting despite therapy with other combinations of long-acting bronchodilators with once daily dosing regimen.

Functional parameters of small airways can guide bronchodilator use in idiopathic pulmonary fibrosis

Idiopathic pulmonary fibrosis (IPF) may present comorbid obstructive lung diseases with small airway dysfunction (SAD). Existing guidelines suggest that inhaled bronchodilators should be used if the ratio of forced expiratory volume in the 1st second and forced vital capacity (FEV1/FVC) < 0.7 in IPF. However, most IPF patients have FEV1/FVC > 0.7 even with coexisting emphysema. We retrospectively enrolled IPF patients who were registered at our outpatient clinic. At baseline, 63 patients completed computed tomography (CT) scans, lung function measurements, and symptom questionnaires. Among these patients, 54 (85.71%) underwent antifibrotic treatment and 38 (60.32%) underwent long-acting bronchodilator treatment. The median FEV1/FVC was 0.86. Not all patients treated with bronchodilators showed significant changes in lung function. IPF patients with SAD, determined by IOS parameters, showed significant improvement in FEV1, FEF25–75%, and symptom scores after bronchodilator treatment. Bronchodilator efficacy was not observed in patients without SAD. CT-confirmed emphysema was seen in 34.92% of patients. There were no changes in lung function or symptom scores after bronchodilator treatment in patients with emphysema. In conclusion, FEV1/FVC cannot reflect the airflow limitation in IPF. Emphysema in IPF is not a deciding factor in whether patients should receive bronchodilator treatment. IOS parameters may be useful to guide bronchodilator therapy in patients with IPF coexisting with SAD.

Does perceived responsiveness to bronchodilator therapy in patients admitted for bronchiolitis predict future development of asthma

INTRODUCTION: Bronchiolitis is a common lower respiratory tract infection affecting infants and young children. It is a frequent cause of hospitalization in pediatric patients. Rhinovirus-induced wheezing and RSV bronchiolitis in infancy are associated with future development of asthma. Despite the current AAP clinical guideline recommendations that support against bronchodilator use for bronchiolitis, clinical practice varies and albuterol is still often used in the treatment of bronchiolitis. Physicians often perceive clinical benefits and continue to use albuterol, especially in wheezing bronchiolitis patients. …

Does perceived responsiveness to bronchodilator therapy in patients admitted for bronchiolitis predict future development of asthma?

Does perceived responsiveness to bronchodilator therapy in patients admitted for bronchiolitis predict future development of asthma?

THE POSSIBILITY OF APPLICATIONS OF MODERN METHODS OF BRONCHODILATOR THERAPY IN PATIENTS WITH DIFFERENT FORMS OF PULMONARY TUBERCULOSIS

The paper presents the results of the possibility of applications of modern methods of bronchodilator therapy in patients with different forms of pulmonary tuberculosis, combined with COPD and asthma. On a large contingent of patients, the clinical efficacy of bronchodilator therapy has been demonstrated. In this case, the positive effect of bronchodilator therapy was distributed in three main areas: the general condition of patients, the course of tuberculosis and the course of COPD and asthma. In all three directions, positive results were obtained: the general condition of patients improved, the terms of bacilli were reduced and the rate of regression of the tuberculosis process increased, and the effectiveness of control of COPD and asthma increased. These data are a reliable indicator of the feasibility of cooperation between phthisiology and pulmonology.

The Role of Tiotropium+Olodaterol Dual Bronchodilator Therapy in the Management of Chronic Obstructive Pulmonary Disease.

Bronchodilator therapy is central to the management of chronic obstructive pulmonary disease and are recommended as the preferred treatment by the Global Obstructive Lung Disease Initiative (GOLD). Long acting anti-muscarinics (LAMA) and long acting β2 agonists (LABA) are both more effective than regular short-acting drugs but many patients remain symptomatic despite monotherapy with these drugs. Combination therapy with LAMA and LABA increases the therapeutic benefit while minimizing dose-dependent side effects of long-acting bronchodilator therapy. The TOviTO programme has investigated the benefits of treatment with a combination of tiotropium and olodaterol administered via a single inhaler. Tiotropium+olodaterol 5/5 µg significantly improved forced expiratory volume in 1 second (FEV1) area under the curve from 0 to 3 hours, trough FEV1 health status and breathlessness versus the mono-components and placebo. Tiotropium+olodaterol 5/5 µg also increased endurance time and reduced dynamic hyperinflation during constant work rate cycle ergometry. On the basis of these and other studies the 2017 GOLD report recommends escalating to dual bronchodilator therapy in patients in groups B and C if they remain symptomatic or continue to have exacerbations and as initial therapy for patients in group D.

DIFFERENTIATED APPROACH TO THE APPOINTMENT OF BRONCHODILATOR THERAPY IN PATIENTS WITH COPD. EXAMPLES FROM PRACTICE

The article deals with the issues of differentiated approach to the appointment of bronchodilator therapy in COPD patients on the basis of a comprehensive assessment of the SGRQ quality of life questionnaire, CAT questionnaire, BODE prognostic index, and clinical and functional indicators (FEV1 and MRC index). Clinical examples of patient management are presented. The aim of the study was to study new approaches to the differentiated use of bronchodilator therapy. Material and methods: The study included 49 male patients treated in Regional Clinical Hospital No. 4 and the Pulmonary Center in Chelyabinsk in 2016-17. The analysis of drug therapy in all patients was conducted. The quality of life (QoL) was assessed using two questionnaires: the Russian-language version of the St. George Hospital (SGRQ) questionnaire, and the CAT universal questionnaire. The prognostic evaluation index BODE is calculated. Results and conclusions: 1. Combined preparation of glycopyrronium bromide / indacaterol 50/110 mcg is an effective and safe means for conducting bronchodilator therapy in patients with different variants of the course of COPD. 2. When double bronchodilator therapy is used, the increase in FEV1 by more than 60 ml is observed, especially in patients with a high risk of exacerbations and marked symptoms of the disease. 3. Application of quality of life questionnaires allows to be guided by correctness of the chosen medical tactics both in early, and in the remote periods of supervision of patients with COPD. 4. The use of prognostic indices in the selection of treatment tactics allows to evaluate the correctness of prescriptions at the early stages of patient management.

Vilanterol / umeclidinium bromide combination as a basic therapy for chronic obstructive pulmonary disease

A review of published data on clinical efficacy and safety of a new vilanterol/umeclidinium bromide fixed combination in comparison with its separate components and with other long-acting bronchodilators has been performed in this article. Several randomized controlled large trials demonstrated a higher improvement in the airflow limitation and lung hyperinflation under the treatment with the fixed combination of vilanterol and umeclidinium bromide compared to monotherapy with umeclidinium bromide or vilanterol or tiotropium bromide. Vilanterol/umeclidinium bromide fixed combination also improved exertional dyspnea, quality of life and exercise endurance time in stable patients with moderate to severe or very severe chronic obstructive pulmonary disease (COPD). Good tolerability of the drug was noted in all the studies. Vilanterol/umeclidinium bromide fixed combination is delivered via Ellipta dry powder inhaler which was assessed by most patients as a convenient and easy to use inhaler. The published data confirmed higher clinical efficacy of dual bronchodilator therapy in patients with COPD of categories B, C and D.

Long-acting muscarinic antagonists for the prevention of exacerbations of chronic obstructive pulmonary disease.

Exacerbations of chronic obstructive pulmonary disease (COPD) have important consequences for lung function, health status and mortality. Furthermore, they are associated with high economic costs, predominantly related to hospitalization. They are managed acutely with short-acting bronchodilators, systemic corticosteroids or antibiotics; however, a large proportion of COPD exacerbations are unreported and therefore untreated or self-managed. There is evidence to suggest that these unreported exacerbations also have important consequences for health status; therefore, reducing exacerbation risk is an important goal in the management of COPD. Current guidelines recommend long-acting muscarinic antagonists (LAMAs) as first-line bronchodilator therapy in patients with stable COPD who have a high risk of exacerbation or increased symptoms. To date, three LAMAs, tiotropium bromide, aclidinium bromide and glycopyrronium bromide, have been approved as maintenance bronchodilator treatments for stable COPD. These all provide clinically significant improvements in lung function, reduce symptoms and improve health status compared with placebo in patients with COPD. This paper reviews evidence from randomized, controlled clinical trials demonstrating that tiotropium, aclidinium and glycopyrronium reduce exacerbation risk in patients with COPD. Reductions were seen irrespective of the exacerbation measure used, whether time to first event or annualized exacerbation rate. Furthermore, studies with aclidinium suggest LAMAs can reduce exacerbation risk irrespective of whether exacerbation events are assessed, using an event-based approach or a symptom-based method which includes unreported events. Together these results demonstrate that LAMAs have the potential to provide clinical benefit in the management of exacerbations in patients with stable COPD.

Reversibility of the Pulmonary Function Based on the Partial Flow-volume Curve Predicts the Efficacy of Bronchodilator Therapy for Treating Chronic Cough

Partial expiratory flow-volume curves have the potential to detect mild bronchoconstriction because they are not affected by the modulatory effects of deep inspiration. The aim of this study was to investigate the relationship between the efficacy of bronchodilator therapy (BDT) in treating the cough and to assess the increase in the expiratory flow of the partial flow-volume curve at 40% above the residual volume level (PEF40) caused by treatment with a short-acting beta-2 agonist (SABA) in patients with chronic nonproductive cough. We measured the reversibility of PEF40 caused by a SABA in 42 patients with chronic nonproductive cough at visit 1 (day 0). The patients received BDT for six days. The visual analogue scale (VAS) was used to assess the efficacy of BDT in treating coughing at visit 2 (day 7) (0 mm, 'no cough;' 100 mm, 'no change in coughing'). Reversibility of the PEF40 was correlated (r=0.690, p<0.001) with the VAS score determined at visit 2 and was higher in the patients with cough variant asthma (CVA) (44.9 ± 18.3%) than in those with atopic cough (13.4 ± 10.4%) (p<0.01). Reversibility of the PEF40 predicted the efficacy of BDT in patients with chronic nonproductive cough and helped to identify patients with CVA.

673 Pre and Post Bronchodilator Airway Resistance Values in Children with Asthma Using Airflow Perturbation Device (Apd)

BackgroundAsthma is the most common chronic disease of childhood and pulmonary function testing plays an important role in assessment and management of children with asthma. Pre and post bronchodilator spirometry...

Effect of adjunct fluticasone propionate on airway physiology during rest and exercise in COPD

Combination therapy with corticosteroid and long-acting β(2)-agonists (LABA) in a single inhaler is associated with superior effects on airway function and exercise performance in COPD compared with LABA monotherapy. The physiological effects of adding inhaled corticosteroid monotherapy to maintenance bronchodilator therapy (long-acting anticholinergics and LABA singly or in combination) in COPD are unknown. This was a randomized, double-blind, placebo-controlled, crossover study (NCT00387036) to compare the effects of inhaled fluticasone propionate 500 μg (FP500) twice-daily and placebo (PLA) on airway function during rest and exercise, measured during constant work rate cycle exercise at 75% of maximum incremental cycle work rate, in 17 patients with COPD (FEV(1) ≤ 70% predicted). After treatment with FP500 compared to PLA, there were significant increases in post-dose measurements of FEV(1) (+115 mL, P = 0.006) and the FEV(1)/FVC ratio (+2.5%, P = 0.017), along with decreases in plethysmographic residual volume (-0.32L; P = 0.031), functional residual capacity (-0.30L, P = 0.033), and total lung capacity (-0.30L, P = 0.027) but no changes in vital capacity or inspiratory capacity (IC). Post-treatment comparisons demonstrated a significant improvement in endurance time by 188 ± 362 s with FP500 (P = 0.047) with no concomitant increase in dyspnea intensity. End-inspiratory and end-expiratory lung volumes were reduced at rest and throughout exercise with FP500 compared with PLA (P < 0.05). Inhaled FP500 monotherapy was associated with consistent and clinically important improvements in FEV(1), static lung volumes, dynamic operating lung volumes, and exercise endurance when added to established maintenance long-acting bronchodilator therapy in patients with moderate to severe COPD.

Factors affecting bronchodilator delivery in mechanically ventilated adults

Bronchodilators are increasingly being used in patients undergoing mechanical ventilation. There are multiple factors that affect bronchodilator delivery during mechanical ventilation. These factors can be classified into three categories: ventilator-related factors, circuit-related factors and device-related factors. The purpose of this paper is to review in depth each of the factors affecting bronchodilator delivery during mechanical ventilation. A literature search was undertaken using several databases including Cochrane, Pubmed, Medline, Cinahl and Science Direct. The literature search, although limited to the English language, covered materials from 1985 to May 2009. Aerosolized bronchodilator delivery to mechanically ventilated patients is complex as a result of the multiple factors that affect the amount of aerosol deposited in the lower respiratory tract. When these factors are not carefully controlled and the optimum technique for aerosol delivery is not utilized, a greater proportion of the aerosol will deposit in the ventilator circuits and artificial airways decreasing the available dose to the patient. Attention to these factors and optimizing aerosol delivery techniques will help to reach therapeutic endpoints of bronchodilator therapy in patients receiving ventilatory support. Bronchodilator delivery during mechanical ventilation is factor and technique dependent. A clear understanding of the factors affecting aerosol drug delivery during mechanical ventilation is very important in optimizing the efficiency of bronchodilator delivery in mechanically ventilated adults. Through the recommendations made in this paper, clinicians will be able to optimize both their technique and the therapeutic outcomes of aerosol drug delivery in patients receiving ventilator support.

Advantages of Endurance Treadmill Walking Compared With Cycling To Assess Bronchodilator Therapy

Walking is a familiar daily activity that is generally limited by breathlessness, whereas cycling is an uncommon physical effort typically limited by leg discomfort. The hypothesis was that patients with COPD would exhibit greater improvements in exercise endurance and relief of breathlessness with bronchodilator therapy during treadmill walking compared with cycling. In this randomized, 2 x 2, double-blind, placebo-controlled, crossover trial, 20 patients with COPD (age, 64 +/- 7 years; FEV(1), 56 +/- 14% predicted) performed constant-load endurance exercise on the treadmill and cycle ergometer at 85% of capacity after inhaling normal saline (NS) or arformoterol (ARF) (15 microg). Increases in endurance times and consistency of responses were greater with treadmill walking (Delta: 157 +/- 286 s; P = .024; 80% improved) than with cycle exercise (Delta: 110 +/- 219 s; P = .038; 65% improved) with ARF compared with NS. However, these changes were not significantly different. The slope of breathlessness-time (mean Delta = -29%; P = .007) and the magnitude of oxygen desaturation were significantly lower with ARF compared with NS during treadmill, but not cycle, exercise. Inspiratory capacity values were similar between modes of exercise when comparing the same study medication. Improved endurance times support both constant-load treadmill and cycle exercise to assess the efficacy of bronchodilator therapy in patients with COPD. Unique differences in physiologic and perceptual responses with bronchodilation demonstrate advantages of treadmill walking as an exercise stimulus. clinicaltrials.gov; Identifier: NCT00754546.

Treatment of mild persistent asthma by cutaneous electronic stimulation

To the Editors: The Global Initiative for Asthma (GINA) has emphasised the importance of assessing control in response to treatment in grading asthma severity 1. However, many asthma patients are inadequately controlled despite conventional treatment. GINA also recognises a potential role for complementary medicine in asthma management 1. FenzianTM (Eumedic Ltd, Hungerford, UK) is a device that provides low current cutaneous electronic stimulation (CES) and is Food and Drug Administration licensed under the category of minimal risk (Device # 21 FR 882.5890) for biofeedback and treatment of pain. Biofeedback might influence bronchial smooth muscle constriction or perception of asthma control. We examined the hypothesis that CES, added to conventional treatment over 6 weeks, improves asthma control, pulmonary function, symptoms and reliance on rescue bronchodilator therapy in patients with persistent asthma. In total, 20 subjects were recruited (nine males and 11 females), aged 18–65 yrs with a clinical history of mild-to-moderate persistent asthma for ≥3 months 2 and forced expiratory volume in 1 s (FEV1) between 50% of predicted and the lower limit of normal 3. They reported using short-acting bronchodilator therapy on ≥4 days in 2 weeks. Their treatment regimen …

Bronchodilator Therapy in Patients with Heart Failure: Good, Bad, Neutral, or Uncertain?

Dyspnea is a common presenting complaint that is associated with a broad range of differential diagnoses. Acute decompensated congestive heart failure

Quality of life measurements and bronchodilator responsiveness in prescribing nebulizer therapy in COPD

Nebulized bronchodilators are widely regarded as the optimal treatment for maintenance therapy in patients with severe chronic obstructive pulmonary disease (COPD). The aim of the study was to assess whether detailed physiological, functional and quality of life-related measurements can assist in determining the requirement for nebulized bronchodilator therapy in patients with moderate to severe COPD. This was an unblinded, randomized, crossover study that compared intermediate (120 mcg ipratropium bromide and 600 mcg of salbutamol using metered dose inhaler (MDI) and spacer) and high dose (nebulized 500 mcg ipratropium bromide and 2.5 mg salbutamol) bronchodilator therapy, on physiological, functional and quality of life-related measurements in patients with COPD. A total of 25 patients (12 female), mean (SD) age 68 (7) years, FEV(1) 45 (10) % predicted completed the study. There was no statistically significant difference between the treatments in the pre- and post-bronchodilator lung function values, six-minute walk distance, breathlessness score or quality of life questionnaires. Fifteen patients preferred bronchodilator therapy with nebulizer and 10 with MDI and spacer. In 20 patients at least one positive response in quality of life score, lung function or six-minute walk, was observed on the preferred treatment. Only a proportion of patients with moderate or severe COPD prefer nebulized bronchodilator therapy. This study found that none of the parameters singly or in combination were consistently predictive of patients' preference for nebulized bronchodilator therapy. Therefore, we suggest that clinicians institute a trial of stepping up to an intermediate dose of bronchodilators prior to introducing nebulized therapy.

Formoterol dry-powder inhaler for the treatment of asthma and chronic obstructive pulmonary disease

Formoterol, a long-acting β2-adrenergic agonist, is used as an inhaled bronchodilator therapy for patients with asthma or for the prevention of exercise-induced bronchospasm in children and in chronic obstructive pulmonary disease. Formoterol has unique characteristics of rapid onset and sustained duration of action compared with other bronchodilators. In addition to its effectiveness as regular maintenance therapy in asthma and chronic obstructive pulmonary disease, formoterol is also reported to be effective as an as-needed reliever therapy in patients with asthma. Formoterol is available in several different types of dry-powder inhalers and pressurized metered-dose inhalers.

Combination Inhaled Bronchodilator Therapy in the Management of Chronic Obstructive Pulmonary Disease

The Global Obstructive Lung Disease (GOLD) guidelines suggest the potential use of combination bronchodilator therapy in patients with stage II or higher chronic obstructive pulmonary disease (COPD). Guidelines from the American Thoracic Society also mention that certain combinations of bronchodilators may prevent exacerbations. Combinations of several agents may benefit patients with COPD not only by improving lung function, but also by decreasing exacerbation rates and improving overall symptoms. A MEDLINE search was conducted to gather published data and clinical trial reports regarding the clinical effect of combining bronchodilators in the treatment of COPD. Agents such as oxitropium, which is not available in the United States, were not included in the analysis. Although the data are somewhat limited, trials suggest many potential benefits for combination bronchodilator therapy in patients with COPD. Information on combining long-acting anticholinergic drugs with long-acting beta2-agonists is scarce, but the combination of two long-acting agents may provide additional benefits by improving patient compliance with prescribed regimens. More studies evaluating outcomes in patients with COPD may help solidify the potential benefits of combination inhaled bronchodilator therapy.

Clinical Course of Chronic Obstructive Pulmonary Disease: Review of Therapeutic Interventions

Chronic obstructive pulmonary disease (COPD) is a preventable and treatable disease in which patients experience a progressive decline in lung function. Based on clinical evidence, the management of COPD should focus on (1) earlier diagnosis; (2) risk reduction through smoking cessation, decreased exposure to inhaled irritants, and immunization against respiratory pathogens; (3) symptom reduction with pharmacotherapy and pulmonary rehabilitation; (4) decreasing complications by reducing exacerbations and improving pulmonary function; and (5) improving health-related quality of life (HRQOL). Smoking cessation has been shown to slow lung function decline and to reduce mortality—including deaths due to lung cancer, other respiratory disease (including COPD), and cardiovascular disease. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the American Thoracic Society and European Respiratory Society (ATS/ERS) guidelines advocate interventions according to the severity of COPD and recommend initiation of maintenance long-acting bronchodilator therapy in patients with moderate disease. However, recent evidence from a post hoc analysis of randomized controlled trials of tiotropium suggests that initiation of long-acting bronchodilator therapy at earlier stages of disease may also provide improvements in lung function and HRQOL. The results of ongoing long-term studies may soon provide evidence that in addition to relieving symptoms and improving patient HRQOL, specific pharmacologic therapies may also alter the clinical course of COPD.