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Substituting levalbuterol for racemic albuterol in the ED management of acute asthma significantly reduced the number of hospitalizations.
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Pulmonary function laboratory at university medical center.
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The weight change per actuation and aerosol particle size and number delivered by albuterol metered dose inhalers (MDIs) were measured in a multiplace hyperbaric chamber at pressures ranging from one atmosphere absolute (1 ATA, 0 feet of seawater, fsw, 101 kPa) to three ATA (66 fsw, 304 kPa). Weight change per actuation by CFC (chlorofluorocarbon) and long canister HFA (hydrofluoroalkane) powered MDIs was 13 +/- 1% and 12 +/- 1% less, respectively, at 3 ATA compared to 1 ATA. However, weight change per actuation by short canister HFA MDIs was not significantly changed with pressure. The geometric mean diameters of nano particles from the CFC and short canister HFA MDIs decreased from 50 nm at 0 fsw to 32 nm at 66 fsw whereas the long canister HFA aerosol diameters were not affected. The numbers of nanometer size particles delivered at 66 fsw were only 4-7% of those delivered at 0 fsw for the CFC and long canister HFA MDIs whereas for the short canister MDIs it was 26%. We conclude that the weight change per actuation of albuterol and the sizes and numbers of aerosol particles emitted from albuterol MDIs actuated in a hyperbaric environment vary by canister type.
In 1997, national guidelines emphasized that inhaled corticosteroids (ICSs) are key therapy for individuals with all classes of persistent asthma, including children.
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Outcome measures included Asthma Quality of Life Questionnaire (AQLQ) global and individual domain scores, FEV1, PEF, nighttime awakenings, asthma symptoms, and supplemental albuterol use. Mean change from baseline for the global and domain AQLQ scores was significantly greater (p < or = 0.005) with salmeterol compared with placebo. At week 12, salmeterol significantly (p < 0.001 compared with placebo) increased mean change from baseline in FEV1, morning and evening PEF, percentage of symptom-free days, percentage of nights with no awakenings due to asthma, and the percentage of days and nights with no supplemental albuterol use. Significant improvements in PEF were observed after treatment with salmeterol regardless of concomitant treatment with theophylline (p < 0.05).
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The effects of frequent high-dose nebulized salbutamol on plasma glucose concentrations were studied in 12 children (mean age 60 months) with acute severe asthma. There was a significant difference between mean initial glucose levels and peak levels. We conclude that hyperglycaemia can be produced in children as a result of nebulized salbutamol.
Compared to placebo, all active treatments led to significant improvements (p < 0.05) in geometric mean AMP-PC(20): placebo, 42 mg/mL; ML(10), 106 mg/mL; SM(50), 115 mg/mL; ML(10) and SM(50), 183 mg/mL; and ML(10) and SM(100), 247 mg/mL. The effects of montelukast and salmeterol were numerically additive, with ML(10) and SM(100) being significantly different (p < 0.05) from ML(10) alone. For mean FEV(1) and forced expiratory flow rate between 25% and 75% of vital capacity, there were significant differences (p < 0.05) between both combination therapies vs ML(10) alone.
Twenty Four patients in each group were studied. INSURE failure was seen in16 (66.7 %) and 10 (41.7 %) of normal saline and salbutamol groups respectively (p = 0.082). The duration of NCPAP in control group was 69.5 ± 54.9 h while in Salbutamol group was 51.6 ± 48.7 h (p = 0.316). All of deaths were related to respiratory failure. No differences in mortality or complications of RDS were observed. The duration of hospitalization was longer in control group than interventional group, 28.3 ± 18.1 and 18.6 ± 8.6 days, respectively. (p = 0.047).
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The influence of salbutamol aerosol on heart rate in patients with chronic atrial fibrillation was examined. The study comprised 15 patients (9 women and 6 man) in age 47-79 (mean 60) treated because of chronic obstructive pulmonary disease (COPD) with concomitant atrial fibrillation. The influence of salbutamol on heart rate was investigated during six hours ecg Holter monitoring (3 hours before and 3 hours after using salbutamol). The analysis showed that salbutamol aerosol in two doses increased heart rate calculated as mean heart rate per hour from 3-hours intervals from 4061 congruent to 1022.5 to 4185 congruent to 976 (p greater than 0.05). Mean value of blood pressure in one hour intervals did not change significantly. In patients with concomitant chronic atrial fibrillation and COPD salbutamol increased heart rate but difference between mean values before and after administration was not significant.
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The aim of this study was to investigate whether beta-2-adrenergic stimulation with inhaled salbutamol is therapeutically useful in hyperkalaemia. Ten patients with renal failure and hyperkalaemia (serum potassium concentration greater than 6 mmol l-1) were given 15 mg salbutamol via a nebulizer over a 30-min period. Serum potassium was measured 30, 60, 180 and 360 min thereafter. All patients had end-stage renal failure on chronic hospital haemodialysis. Serum potassium levels decreased significantly from a pretreatment value of 6.5 +/- 0.6 mmol l-1 to 5.6 +/- 0.6 mmol-1 after 30 min, and this level was maintained for 3 h. Six hours after treatment, the serum potassium concentration was 6 +/- 0.7 mmol l-1. There was a modest increase in heart rate and blood glucose level, but otherwise salbutamol was well tolerated and no serious side-effects occurred. It is concluded that the administration of salbutamol by inhalation is a simple, safe and reasonably effective method for treatment of hyperkalaemia in renal failure.
Within-subject coefficients of variation (WCV) of absolute blood flow responses for each dose of acetylcholine (7.5, 15, 30 micrograms min(-1)) ranged from 24% to 27%, as compared with WCV values of 41% to 62% for the percentage changes in blood flow ratio (infused : noninfused arm). For albuterol (0.3, 1, 3 micrograms min(-1)) the corresponding WCV values were 16% to 19% and 30% to 55% for absolute blood flow and percentage change in blood flow ratio, respectively. WCV for the area under dose-response curve (AUC) for absolute blood flow was 18% and 13% for acetylcholine and albuterol, respectively. Vasodilator responses were similar whether recorded proximal to or at the point of maximal forearm circumference. Distal strain gauge misplacement underestimated responses and the difference was greater for acetylcholine than for albuterol.
The generic albuterol MDI delivers a quantity of albuterol to the beta(2)-receptor site in the lung that is the bioequivalent to Ventolin. Further, this study reinforces the validity of this statistical methodology for determining in vivo bioequivalence.
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In this study, in children with stable asthma, three consecutive doses of arformoterol (7.5 and 15 µg) and levalbuterol were overall well tolerated. Nonetheless, serum potassium levels demonstrated substantial mean declines after dosing. These findings do not address or support the safety and tolerability of arformoterol use in acute exacerbations of asthma in children.
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Albuterol (2.5 to 10 mg) or placebo was given via nebulizer. Volunteers were studied at two sessions, 1 week apart, using a 6-cm manometry assembly and a low-compliance pneumohydraulic pump. The percentage of lower esophageal sphincter (LES) relaxation, the frequency of transient LES relaxations (TLESRs), and the amplitude, duration, and propagation velocity of esophageal contractions were measured at 5 and 10 cm above the LES. Dependent measures were evaluated using two-way, repeated-measures analysis of variance.
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On four separate occasions the patient was challenged advertently or inadvertently, with sustained-release verapamil. Similar symptoms developed after each challenge and resolved after discontinuing this preparation. Although dyspnea associated with verapamil administration has been reported, this is the first report of an elderly asymptomatic asthmatic patient with hypertension who developed an acute asthma attack following sustained-release verapamil administration.