Combination Of Salbutamol Research Articles

Comparison of Nebulized Glycopyrronium with a Combination of Salbutamol and Ipratropium on Ventilatory Parameters in Critically Ill Mechanically Ventilated Patients of Chronic Obstructive Pulmonary Disease: An Observational Study.

The present study examined the duration of bronchodilation induced by nebulized glycopyrronium bromide (GB) and compared its effectiveness and incidence of any side effects with the combination of salbutamol and ipratropium bromide (SI) in critically ill mechanically ventilated chronic obstructive pulmonary disease (COPD) patients. This prospective, observational study was conducted in mechanically ventilated adult patients of COPD (18-75 years). Data of two groups of patients were collected for 12 hours each for three consecutive days after the nebulization - Group I: those who received 25 µg of GB, and Group II: those who received 1.25 mg of levo-salbutamol and 500 µg of ipratropium by nebulization. A significantly higher number of patients in group II had copious secretions. The mean static compliance was comparable at all time intervals, whereas the mean airway pressure was significantly lower in group II from 15 minutes to 4 hours post-nebulization. In group I, the onset of bronchodilation was 30 minutes on days 1 and 3, and 60 minutes on day 2, whereas, in group II, it was 60 minutes on days 1 and 2 and 30 minutes on day 3. In group I, bronchodilation was 10 hours on day 1 and 12 hours each on days 2 and 3, whereas in group II, bronchodilation was 4 hours on day 1 and 6 hours each on day 2 and 3. Compared with SI, GB nebulization resulted in lesser respiratory secretions, a longer duration of action in terms of lowered airway resistance, and no adverse effects like hypertension, tachycardia, or desiccation of respiratory secretions. Priya P, Nath SS, Kumar V, Kumar S. Comparison of Nebulized Glycopyrronium with a Combination of Salbutamol and Ipratropium on Ventilatory Parameters in Critically Ill Mechanically Ventilated Patients of Chronic Obstructive Pulmonary Disease: An Observational Study. Indian J Crit Care Med 2024;28(10):963-969.

Retrospective Study on Prescription Pattern on the Management of Chronic Obstructive Pulmonary Disease (COPD)

Background: COPD is a disease caused by chronic bronchitis, emphysema, or combination of both conditions. As per the Global Burden of Disease 2017 prediction, COPD is the second leading cause of death in Nepal, the fourth leading cause of premature death and the third cause for disability-adjusted life years (DALYs) in Nepal. The prevalence of COPD in Nepal was 11.7%. If current situation prevails, the burden of COPD might increase continuously in the nation. Hence, the findings from this study might provide baseline information to medical and paramedical students and other researchers to conduct further study in similar area. Objectives: The study was done to assess the prescription pattern for management of COPD in multispecialty hospital of Nepal. Method: A retrospective study was conducted at 100 bedded multispecialty hospital located at Lalitpur, Nepal. A total of 200 inpatient records, from Baishak 2075 to Chaitra 2078 were reviewed and data was collected as per the objectives and analysed by using SPSS version 16 and MS Excel 2013. Result: Out of 200 COPD patients studied, female patients (58%) were higher than male patients and maximum patients (42.5%) were from the age group 70-79. The most common symptom was shortness of breath (77.5%) followed by cough (50%) and fever (33.5%) Hypertension (38.5%) was the most frequent co morbidity seen among COPD patients followed by corpulmonale (20%) and diabetes mellitus type II (19%). Doxophylline was the most prescribed methylxanthines during hospitalization (47.5%) and discharge (51%) as well. Among inhalers, Tiotropium bromide and combination of Salbutamol and Fluticasone (52.5%) was prescribed most to the hospitalised patients. Hydrocortisone (68.5%) was the most prescribed corticosteroids during hospitalization where as Prednisolone (49.5%) was the most prescribed corticosteroids during discharge. 85.5% of patients were prescribed Ipratropium bromide for nebulisation in hospitalised patients. Pantoprazole (55.5%) was the most prescribed proton pump inhibitors followed by Rabeprazole (34%). Maximum patients (103) preferred Rotacap than metered dose inhaler (MDI) and dry powder inhaler (DPI). Azithromycin (52.5%) was most frequently prescribed antibiotics during hospitalization followed by ceftriaxone (85%), whereas among discharge patients, Cefpodoxime (35%) was most frequently prescribed antibiotics followed by Azithromycin (32%). The drugs prescribed with generic name were 31.31% and from essential drug list (EDL) was 37.72 %. Conclusion: The prescription pattern of COPD was studied and found that Doxophylline, Tiotropium bromide, Hydrocortisone and Azithromycin were most prescribed methylxanthnes, antimuscarinic agents, corticosteroids and antibiotics respectively. The findings from the study showed that prescribing drugs with generic name and from EDL was low so prioritization on prescribing drugs by generic name and EDL needs to be encouraged.

Features of combined mucoactive therapy for bronchopulmonary diseases in children in outpatient practice

In 2022, ARVI rates among the paediatric population were 72281.8 per 100,000, which is 6.2% higher than such rates in 2021 (68062.5 per 100,000; p < 0.05). Estimated influenza rates among the paediatric population were 165.8 per 100,000, which is 2.9 times higher than this rate in 2021. Impaired mucociliary clearance makes a significant contribution to the pathogenesis of acute and chronic bronchopulmonary diseases. Slowing of mucociliary clearance that results from chronic mucus hyperproduction leads to airway obstruction and infection, which acts as a cause of aggravation of the disease. There’s no question, the choice of a drug that can affect the secretory function of the mucous membrane or the bronchial mucous itself and its evacuation requires an individual approach to each patient. The article presents a detailed review of modern literature, as well as the authors’ own experience about cough therapy methods, including those used in broncho-obstructive syndrome. At the same time, the use of combination drugs that have a simultaneous effect on various pathogenetic mechanisms of respiratory diseases are justified more than ever before. Due to synergistic interactions of its components, the modern combination therapy, including a fixed-dose combination of salbutamol, bromhexine, guaifenesin (Bromhekomb), contributes to the productive treatment of acute bronchopulmonary diseases and exacerbations of chronic bronchopulmonary diseases accompanied by cough, mucostasis and events of mild bronchial obstruction, as well as ensures high compliance, including due to consideration of the syrup dosage form, which is especially important in outpatient paediatric practice

THE EFFICIENCY OF NEBULIZED SALBUTAMOL MONOTHERAPY AS COMPARED TO COMBINATION THERAPY WITH IPRATROPIUM BROMIDE IN ACUTE SEVERE ASTHMA AMONG CHILDREN

Introduction: asthma is a prevalent disease among pediatric population and about 300 million people is affected globally. Although there is many drugs available, suggestion and clinical trials of different drugs and combined regimens are continuously making the management more efficient than before. Short Acting Beta Agonists (SABA) is the ones which are used frequently and muscarinic acetylcholine antagonist ipratropium bromide (IB) are also on the line. The use of SABAs are usually done as single regimen but suggestions have been done that combining with IB may result in efficient outcome. This current study explored the efficiency of Salbutamol montherapy with that of combined regimen with IB and expressed the efficiency in terms of Peak Expiratory Flow Rate measured using spirometer.
 Methods: The study was conducted from March, 2021 to November 2021. The study design is prospective cohort and included 127 pediatric patients. The pediatric patients were considered who had confirmed asthma. The study considered Peak Expiratory Flow Rate (PEFR) as the determinant of the study outcome. PEFR was measured using spirometer. The patients were divided into 2 groups, group 1 received salbutomol monotherapy while group 2 received ipratropium bromide along with salbutamol. Then the PEFR at the starting of the treatment was measured and after the receiving the monotherapy or the combination, PEFR was measured at fixed interval. The rise of PEFR was plotted against a chart with time in X-axis.
 Result: it was found that the group 2 patients who received a combination therapy of salbutamol and ipratropium bromide have responded more efficiently as compared to the patients of group 1.
 Conclusion: the authors considered that the combination of salbutamol and ipratropium bromide is more efficacious in managing acute moderate to severe asthma among the pediatric population. 
 Keywords: asthma, salbutamol, ipratropium bromide, pefr.

Comparison between Salbutamol and Salbutamol with Magnesium Sulphate by nebulization in Treatment of Acute Asthma in Asthmatic Patient

Abstract Background Asthma exacerbations are acute or subacute episodes of breathlessness, cough, wheezing, and chest tightness, or any combination of these symptoms. Exacerbations are associated with airways obstruction that should be documented and quantified by PEF or FEVI measurement. Early treatment of asthma exacerbations should be the best strategy for management. Objective To compare fast effectiveness between the nebulized salbutamol with normal Saline and salbutamol with magnesium sulphate by nebulizer in treatment of acute asthma. Patients and Methods: This two armed prospective randomized study included 60 patients admitted to Intensive Care Unit, Ain Shams University Hospital from July 2019 to July 2020. Patients were randomized into two equal groups: group A which included 30 patients on salbutamol nebulization and group B that included 30 patients on combination of salbutamol and magnesium sulphate. Results systolic blood pressure, diastolic Bl. P and FEVI were higher among salbutamol group (A) than combination group (B), meanwhile HR and 02% were significantly lower among group A than group B with statistically insignificant differences (p > 0.05). Group A had significantly higher mean of RR (20±1.33) than group B (17.2 ±1.14) (p < 0.001). Also, Group A had significantly higher mean of PEFR (217.5 ±74.72) than group B (125±78.05) (p = 0.014). There were significant differences between in group A in HR and 02% before and after TTT (p < 0.05). With treatment, the pulse rate rose significantly (p = 0.010) but there was no significant change in the systolic or diastolic blood pressure. The 02% rose significantly (p<O.001). There were significant differences between in group B in RR, HR, 02%, PEFR and FEVI before and after TTT (p < 0.05). With treatment, the respiratory rate declined significantly (p < 0.001), the pulse rate declined significantly (p = 0.013) in but there was no significant change in the systolic or diastolic blood pressure. The PEFR rose significantly (p = 0.001) and also the 02% rose significantly (p < 0.001). Conclusion Nebulized MgS04, either alone or combined with salbutamol, has a clinically significant bronchodilator effect in acute asthma. This suggests that a combination of MgS04 and salbutamol may be the best choice for the management of acute exacerbations of asthma.

Bronchiectasis with accompanying bronchoobstruction: efficacy of nebulizer therapy

Objective. To investigate the efficacy and safety of the combination of salbutamol (Nebutamol®, “Yuria-Pharm”) and hypertonic sodium chloride solution with sodium hyaluronate (Lorde® gial, “Yuria-Pharm”) in complex nebulizer therapy of bronchiectasis with concomitant bronchoobstruction.
 Materials and methods. As a result of initial screening, 74 patients with confirmed bronchiectasis using high-resolution computed tomography of thoracic organs were selected for further study of 45 patients who had <90 % postbronchodilation forced expiratory volume in 1 sec (FEV1) at the first visit. Patients on the second visit (V2) were prescribed 14-day nebulizer therapy with the bronchodilator salbutamol at a dosage of 2 mg / 2 ml and mucolytic sodium chloride solution 3 % with sodium hyaluronate 30 mg and respiratory gymnastics. Inhalation of mucolytic was prescribed 20 min after inhalation of bronchodilators. Subjective assessment of the severity of cough and sputum was performed using the scales of V.M. Savchenko (2001), assessment of the severity of dyspnea – on a modified scale of dyspnea of the Medical Research Council (mMRC). The daily amount of sputum (DAS) was measured by laboratory scales of high accuracy (MOMERT Model 6000). The respiratory function (RF) was measured using computer spirometry MasterLab (Viasis, Germany). Indicators were evaluated before and 15 min after inhalation of 400 μg salbutamol using a metered aerosol inhaler through a spacer. Indicators such as DAS, the severity of cough and sputum according to the Savchenko questionnaire, the severity of shortness of breath according to the mMRC and RF were determined at the first (screening – V1), the third (day 14 – V3), the fourth (day 28 – V4) and the fifth (day 42 – V5) visits. The safety of this therapy was assessed by recording all adverse events and further processing of the data.
 Results and discussion. The average age of patients was 58 (43; 66) years, 14 of them (31.1 %) were men. A comparison of all clinical and laboratory characteristics of patients on four visits was performed using Friedman’s rank analysis of variance (ANOVA). Among patients, no statistically significant differences were found between visits in the severity of dyspnea on the mMRC scale (p=0.05), FEV1 (p=0.22) and the ratio of FEV1/FVCpost (p=0.61). However, there were statistically significant differences in such indicators: subjective assessment of the severity of cough on the scale of Savchenko (F29.3=22.5; p=0.00005) was statistically significantly lower by V3 compared with V1 (p=0.0003), on V4 in comparison with V1 (p=0.006), on V5 in comparison with V1 (p=0.008). Subjective assessment of the amount of sputum on the scale of Savchenko (F29,3=22,2; p=0,00009) was significantly higher before treatment than after: on V1 in comparison with V3 (p=0,0005), on V1 in comparison with V4 (p=0.0005) and on V1 in comparison with V5 (p=0.002). DAS was also lower after treatment (F29.3=26.4; p=0.00001): V3 compared to V1 (p=0.000013), V4 compared to V1 (p=0.000006) and on V5 in comparison with V1 (p=0,00005). The following side effects were identified during therapy: tachycardia – in 4 patients (8.9 %), throat irritation after inhalation – in 2 patients (4.4 %), heartburn – in 1 patient (2.2 %).
 Conclusions. The use of salbutamol in a dosage of 2 mg / 2 ml and a solution of sodium chloride 3 % with sodium hyaluronate 30 mg by inhalation for 14 days had statistically and clinically significant effectiveness in reducing DAS, subjective feelings of the patient regarding the severity of cough and sputum in patients with bronchial obstruction. The use of Nebutamol® and Lorde® gial in complex nebulizer therapy of bronchiectasis has shown its effectiveness and safety, which is confirmed by the results of the study.

Efekt bronchodylatacyjny kombinacji salbutamolu i bromku ipratropium z nebulizatora siateczkowego u dzieci chorych na astmę (doniesienie wstępne)

Porównano bronchodylatacyjną odpowiedź oskrzeli po podaniu kombinacji salbutamolu z bromkiem ipratropium vs sam salbutamol inhalowanych z nebulizatora siateczkowego u dzieci w wieku 6–11 lat z cechami klinicznymi i spirometrycznymi zaostrzenia astmy. Wykazano porównywalny efekt bronchodylatacyjny obu terapii w 15. min po podaniu leku.

Insulin glucose infusion versus nebulised salbutamol versus combination of salbutamol and insulin glucose in acute hyperkalaemia in the emergency room: protocol for a randomised, multicentre, controlled study (INSAKA)

IntroductionHyperkalaemia is a common electrolyte disorder and can be life-threatening. In the emergency room (ER), interventions aim to protect patients from the immediate dangers of elevated serum potassium by redistributing...

Asthmatic children and MDI verbal inhalation technique counseling

ObjectivesThe present work aimed to study the role of metered-dose inhalers (MDI) verbal counseling on asthmatic children patients inhalation technique and their pulmonary functions. MethodsIn this study many children younger than 18 years old with asthma were collected from University hospital outpatient clinics throughout two years period Their MDI inhalation technique was checked and the number of MDI inhalation technique mistakes were detected and corrected at the first visit and every month for two more visits (three visits). Their peak expiratory flow (PEF) and forced expiratory volume in 1 s (FEV1) as a percentage of the forced vital capacity (FVC) were checked at every visit. Results81 asthmatic subjects (54 female) younger than 18 years old were collected with a mean (SD) age 14.4 (1.8) years old. Most of the patients' owned MDI contained salbutamol, however, some patients were using Beclometasone MDI or Beclometasone and salbutamol combination MDI. The mean number of correct steps performed was significantly increased (p < 0.05) as the number of visits increased. “Place the MDI mouthpiece between the teeth and seal with lips” and “To maintain slow inhalation rate until lungs are full” were the least steps correctly performed by the asthmatics children studied. There was a significant increase (p < 0.05) in the pulmonary function test scores at the third visit. ConclusionsMDI's verbal counseling should be repeated and checked at every opportunity, especially with children, to improve and maintain the recommended MDI inhalation technique. That could be a tool to possibly improve patients' pulmonary functions.

Potential effect of one-alpha-hydroxy vitamin D3 (alfacalcidol) on experimentally induced allergic asthma

Background: Alfacalcidol is a vitamin D analog mainly used in the management of osteoporosis. Apart from the well-known role of vitamin D in bone and calcium metabolism, an immune-modulator role of vitamin D in allergic diseases was suggested. Aim: To evaluate the potential effect of alfacalcidol either alone or in combination with salbutamol or/and prednisolone and its role in the protection and management of experimentally induced allergic asthma. Materials and methods: Male guinea pigs were divided into two groups: group A constituted normal guinea pigs (received saline) and group B constituted ovalbumin-sensitized guinea pigs, which were divided into eight subgroups: group B1 (control): groups from B2 to B4 was treated with salbutamol, prednisolone, alfacalcidol, respectively, for 1 week, while group B5 was treated with salbutamol+prednisolone; group B6 was treated with salbutamol+alfacalcidol; group B7 was treated with prednisolone+alfacalcidol; and group B8 was treated with salbutamol, prednisolone, and alfacalcidol for 1 week. Twenty-four hours after the last dose, the animals were subjected to both: (a)pharmacological studies, (b) histopathological studies (group A, group B1, B3, and B4). Results: (a) Pharmacological studies: sensitization of guinea pigs caused a significant increase in amplitude of histamine-induced contractions of isolated tracheal smooth muscles in comparison to that of the normal one. Treatment of sensitized guinea pigs with salbutamol, prednisolone, or alfacalcidol produced a significant reduction in the amplitude of histamine-induced contractions in comparison to sensitized nontreated guinea pigs. Addition of alfacalcidol to salbutamol or prednisolone in the treatment of sensitized guinea pigs caused more decrease in the amplitude of histamine-induced contractions. However, the highest reduction in the amplitude of contractions of isolated tracheal strips was produced by the treatment of guinea pigs with a combination of salbutamol, prednisolone, and alfacalcidol. (b) Histopathological examinations: treatment of sensitized guinea pigs with alfacalcidol resulted in an anti-remodeling effect, while prednisolone showed better anti-inflammatory effect, when it was compared with that of the control group. Conclusion: Alfacalcidol was shown to possess anti-inflammatory and anti-remodeling effects in allergic asthma. It was superior to prednisolone regarding the anti-remodeling effect. So, alfacalcidol could be beneficial in the management of allergic asthma.

Combination therapy for cough and bronchial obstruction in childhood

The inflammatory process in the bronchial mucosa of various origins (infectious, allergic, irritative, etc.) cause changes in the sputum production and its rheological properties, slowing of mucociliary clearance. Mucoactive therapy is one of the important components of the management of bronchopulmonary diseases. The article provides a detailed review of the modern literature, as well as the authors’ own experience regarding the cough therapy methods, including techniques used in the bronchial obstructive syndrome. The use of combination drugs, which simultaneously affect various pathogenetic mechanisms of inflammation and cough, including those in the respiratory diseases with bronchial obstructive syndrome, becomes a promising direction of mucoactive therapy. Due to relative safety and clinical efficacy, the modern combination therapy, including a fixed-dose combination of salbutamol, bromhexine, guaifenesin (Ascoril, Ascoril expectorant), is increasingly becoming the drug of informed choice in mild bronchial obstruction in childhood in pediatric practice.

Current opportunities for the treatment of respiratory diseases in paediatric practice

Immediacy of the problem of combination therapy of respiratory diseases in paediatric practice is caused by their multifactorial pathogenesis in children and the need to achieve a high clinical effect in the use of drugs at relatively low doses and with minimum risks of serious adverse effects and drug interactions. The fixed-dose combination of salbutamol, bromhexine and guaifenesin produced in the form of tablets and syrup fully meets these requirements, which makes it possible to use it in children and adults with acute, chronic infectious (ARVI, bacterial pneumonia, respiratory tuberculosis, etc.) and non-infectious (bronchial asthma, pulmonary cystic fibrosis, primary ciliary dyskinesia, etc.) diseases.

A Comparative Study of Salbutamol Nebulizer versus Salbutamol plus Budesonide Nebulizer in the Treatment of Children with Acute Asthma Exacerbation

Asthma is a common chronic illness of childhood and represents the leading cause of childhood morbidity as measured by school absence,emergency department visit,and hospitalization. Budesonide is an inhaled corticosteroid used as controller agent and recently introduced as an adjuvant treatment in acute attacks of asthma.To evaluate the effect of combination of budesonide plus salbutamol nebulizer versus salbutamol nebulizer monotherapy in children with acute attack of asthma. A randomized double blind standard control clinical study was done in Karbala teaching hospital for children from1st of November 2015 to the end of November 2016 on patients aged 1-12 years presented to emergency department with mild to moderate acute attack of asthma. The patients randomly divided into salbutamol group (50) patients and salbutamol plus budesonide group (50) patients. For each patient the severity of asthma attack was determined by pulmonary index score (PIS) before initiation of treatment,then assessment done each 30 minutes up to 90 minute to detect the decrement in severity of attack and response to treatment. There was significant reduction in PIS (p&lt;0.05) for both group of patients treated with salbutamol and salbutamol plus Budesonide and after 30, 60 minutes as compare with their baseline score. After 30 minutes from ER admission patients who were treated with combination of salbutamol plus budesonide had significantly lower PISs than those treated with salbutamol alone. At end of 90 minute there were 28 patients from salbutamol group and only 14 patients from combination group with significant difference in number of patient between groups (p&lt;0.05). The mean duration of stay in E.R was significantly shorter (p&lt;0.05) in patients treated with nebulized salbutamol +budesonide. The addition of nebulized budesonide to salbutamol significantly lower the PIS and shorten the duration of stay in emergency department in asthmatic children with acute attack.

Validation and Quantification of Theophylline and Salbutamol using Ion Pair Liquid Chromatography

Salbutamol and theophylline are administered in combination orally to provide the sinergistic effect of drugs. The aim of this study is to develop and to validate ion pair liquid chromatography to determine both drugs in pharmaceutical dosage form, especialy in syrup dosage form. Separation of drugs was performed with Spherisorb C-18 column (250 x 4.6 mm; 10 um). The mobile phase used is the mixture of acetic acid 1% : methanol (60 : 40 v/v) which contain 3.5 mM sodium-1-octanesulphonate, as ion pairing reagent. The mobile phase was delivered isocratically with flow rate of 1 mL/min. UV detection was set at wavelength of 277 nm. The developed method was validated in terms of linearity, precision, accuracy, selectivity, and sensitivity. The precision of the method was evaluated using repeatability assay having relative standard deviation (RSD) values of 0.41–0.70 % for theophylline and 0.08 – 0.24 % for salbutamol. The recovery percentages are in the range of 98.28–101.02% (theophylline) and 100.71–101.60% for salbutamol. The developed method meets the validation requirement for analysis of salbutamol and theophylline simultaneously in syrup dosage form. Furthermore, the method also provides acceptable result for syrup and tablet dosage forms containing Salbutamol and theophylline only, and tablet containing the combination of Salbutamol and theophylline. Keywords: teophyllin, salbutamol, HPLC, sodium-1-octanesulphonate, validation.

New complexes of inhaled furosemide and cyclodextrin: assessment of the bronchodilator effect

ObjectivesThe objective of this study was to investigate the efficacy in children of nebulised furosemide administered singly or in combination with β-cyclodextrins (β-CDs) on asthma exacerbations.MethodsA single-blinded randomised controlled study...

A randomized, placebo-controlled, double-blind trial on the management of post-infective cough by inhaled ipratropium and salbutamol administered in combination

Post-viral cough is a type of cough originating from upper respiratory tract infections that persists after the infection is resolved. Although it was hypothesized that bronchodilators might have a role in the management of post-viral cough, a clear demonstration of their efficacy is missing. Therefore, we tested the efficacy of a combination of a β-agonist and an anticholinergic agent in reducing post-viral cough with a randomized, double blind, placebo controlled clinical trial.Patients were treated for 10 days with either a nebulized combination of salbutamol 1.875 mg/0.5 mL and ipratropium bromide 0.375 mg/0.5 mL, or a placebo, and followed up for another 10 days. Daytime and nighttime cough severity and spirometry testing were assessed before starting treatment, after 10 and 20 days.Ninety-two patients were randomized to receive placebo (n = 46) or the active treatment (n = 46); nine of them (4 in the placebo group, 5 in the active treatment group) dropped out from the study. Daytime and nighttime cough severity were significantly reduced in both groups during the study period, but the reduction was more prominent in the active treatment group vs. placebo after 10 days of treatment (P = 0.003 for day cough; P = 0.061 for night cough), whereas at the end of follow-up period cough severity was comparable between the two groups. Small but significant increases in spirometric parameters were observed in the active treatment vs. placebo group, although at the end of follow-up these values returned to be comparable to placebo. The frequency of adverse events was not significantly different between the two groups of patients.We concluded that a combination of a β-agonist and an anticholinergic agent can effectively reduce post-viral cough, and can thus represent a valid option for this type of cough.

Synergistic interaction between PPAR ligands and salbutamol on human bronchial smooth muscle cell proliferation

An important objective in asthma therapy is to prevent the accelerated growth of airway smooth muscle cells which leads to hyperplasia and bronchial hyperreactivity. We investigated the effect of combination of salbutamol and PPARγ agonists on growth factor-stimulated human bronchial smooth muscle cell (BSMC) proliferation. Synergism was quantified by the combination index-isobologram method. Assays used here included analyses of growth inhibition, cell viability, DNA fragmentation, gene transcription, cell cycle and protein expression. The PPARγ gene was highly expressed in BSMC and the protein was identified in cell nuclei. Single-agent salbutamol or PPARγ agonists prevented growth factor-induced human BSMC proliferation within a micromolar range of concentrations through their specific receptor subtypes. Sub-micromolar levels of combined salbutamol-PPARγ agonist inhibited growth by 50% at concentrations from ∼2 to 12-fold lower than those required for each drug alone, without induction of apoptosis or necrosis. Combination treatments also promoted cell cycle arrest at the G1/S transition phase and inhibition of ERK phosphorylation. The synergistic interaction between PPARγ agonists and β(2) -adrenoceptor agonists on airway smooth muscle cell proliferation highlights the anti-remodelling potential of this combination in chronic lung diseases.

Exhaled carbon monoxide levels in preschool‐age children with episodic asthma

The concentration of exhaled carbon monoxide (eCO) in young children with stable asthma and during acute asthma attack is not known. A sampling bag was developed to collect the exhaled air of preschool children. A total of 257 preschool-age children (≥ 3 years and ≤ 6 years old) were studied; 111 had a diagnosis of asthma (43 suffering a mild asthma attack and 68 without active asthmatic symptom), 99 had upper respiratory infection (URI) and 47 were healthy. In preschool-age children, eCO levels of those with asthma attacks (mean ± SE, 2.7 ± 0.3 p.p.m., n= 43) were significantly higher than those of subjects with asymptomatic asthma (0.5 ± 0.1 p.p.m., P < 0.05), URI (0.8 ± 0.1 p.p.m., P < 0.05) and healthy children (0.4 ± 0.1 p.p.m., P < 0.05). A multivariate linear regression model showed that eCO was higher in children with asthma attacks independent of age and gender. In 33 asthmatic children followed before and after treatment, eCO levels during asthma attacks significantly decreased after inhalation therapy with a combination of salbutamol and sodium cromoglycate (before therapy, 2.9 ± 0.4 p.p.m.; after therapy, 0.6 ± 0.1 p.p.m., P < 0.0001). The measurement of eCO using a novel collecting system is useful in the recognition of asthma in preschool children.

Comparison of nebulised bronchodilators in acute exacerbation of chronic obstructive pulmonary disease

Summary. The aim of this study was to compare two nebulised combinations (salbutamol / ipratropium bromide (Ipramol, Steri-Neb, Teva) and fenoterol / ipratropium bromide (Berodual, Boehringer Ingelheim)) with nebulised ipratropium bromide (Ipratropium Steri-Neb, Teva) alone in hospitalized patients with acute exacerbation of chronic obstructive pulmonary disease (COPD). This was a prospective randomized controlled single-blind comparative study. The study involved 45 hospitalized patients with acute exacerbation of COPD (mean age, 65 years; mean FEV1, 1.1 L; mean РаО2, 55.8 mm Hg; mean РаСО2, 54.1 mm Hg). The patients were randomized in 3 groups: the 1st group received salbutamol / ipratropium bromide 2.5 / 0.5 mg, the 2nd group was treated with fenoterol / ipratropium bromide 1.0 / 0.5 mg, and the 3rd group received nebulised ipratropium bromide alone 0.5 mg. All study drugs were given 4 to 5 times daily during 7 days. Demographic and baseline clinical characteristics did not differ between the groups. All the patients completed the study. A significant improvements in SpO2, breath rate, heart beat rate, blood oxygenation and РаСО2 were found during treatment period in all the groups. The greatest improvement in dyspnea rating was noted in the 1st group compared to the 2nd group (1.1 ± 0.9 vs 1.7 ± 0.6; р = 0.045) and in the 2nd group compared to the 3rd group (1.7 ± 0.6 vs 2.0 ± 0.8; р = 0.011). All the groups demonstrated increase in FEV1 which was the most prominent in 1 h, 1 and 7 days of treatment in groups of salbutamol / ipratropium bromide and fenoterol / ipratropium bromide. FVC was significantly increased to the 7th day of the therapy in the 1st group patients compared to the 2nd and the 3rd groups (3.0 ± 0.6 L vs 2.9 ± 0.6 L; р = 0.026, and vs 2.6 ± 0.9 L; р = 0.010, respectively). The lowest adverse event rate was reported in the 1st and the 3rd groups compared to the 2nd group. Therefore, therapy with nebulised combination of salbutamol / ipratropium bromide was as effective as therapy with fenoterol / ipratropium bromide and more effective than therapy with ipratropium bromide alone. All treatment regimens were well tolerated. No serious adverse events and no withdrawals due to adverse events were registered.

The efficacy of nebulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis

Background The mainstay of treatment in bronchiolitis includes oxygenation, aspiration of secretions from the respiratory tract and maintenance of hydration. The first choice medical agent in clinical practice is nebulized bronchodilators, although their place in treatment is controversial. Objectives We investigated the therapeutic benefit of nebulized hypertonic (3%) saline (HS), by comparing four different nebulized regimens in the treatment of bronchiolitis in the emergency department. Methods A total of 120 infants were included in this randomized, double-blind, prospective study. Infants were grouped according to the nebulized treatment they received: group 1 - salbutamol + normal saline (NS), group 2 - salbutamol + HS, group 3 - HS, group 4 - NS. Heart beat, Clinical Bronchiolitis Severity Score (CBSS) and oxygen saturation of the patients were determined before and after the nebulizations and at 48–72 h after admission by the designated study physician. Results Post-treatment mean CBSS were significantly lower than pre-treatment scores in all groups ( p = 0.0001) with no significant difference within groups. Improvement percentages for CBSSs were significantly higher in infants without a history of atopy treated with HS and NS ( p = 0.023, p = 0.0001, respectively). Conclusions The CBSSs of all the infants improved after three doses of nebulized therapy regardless of the treatment regimens. The combination of salbutamol with hypertonic saline did not lead to an additive effect in the improvement of CBSSs compared to the standard salbutamol + NS combination. Atopic children benefited from salbutamol/NS combination whereas non-atopic children improved with HS and NS nebulizations based on improvement percentages of CBSS.