Clinical and Functional Responses to Salbutamol Inhaled Via Different Devices in Asthmatic Patients with Induced Bronchoconstriction

Overview

Journal Br J Clin Pharmacol

Specialty Pharmacology

Date 2004 Nov 4

PMID 15521899

Citations 2

Authors

Federico Lavorini

Pietro Geri

Martina Luperini

Nazzarena M Maluccio

Laura Mariani

Cecilia Marmai

Massimo Pistolesi

Giovanni A Fontana

Affiliations

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Abstract

Aims: This study aimed at evaluating changes in airway patency, lung volumes and perception of breathing discomfort intensity following salbutamol administration via the Diskus dry-powder inhaler (DPI) or a pressurized metered-dose inhaler with the Volumatic valved holding chamber (pMDI + Volumatic) in asthmatic patients with methacholine-induced bronchoconstriction.

Methods: On six different study days, 18 patients inhaled methacholine until forced expiratory volume in 1 s (FEV(1)) decreased by approximately 35% of baseline. Following placebo, 200 and 400 microg of salbutamol through the pMDI + Volumatic or the Diskus, changes in FEV(1), volume-adjusted mean forced expiratory flow from 25 to 75% of the forced vital capacity (isoFEF(25-75)), lung volumes and breathing discomfort intensity, assessed by visual analogue scale (VAS) score, were repeatedly measured over a 60-min observation period.

Results: Induced bronchoconstriction was accompanied by obvious reductions in lung volumes and increases in VAS score. After salbutamol administration, FEV(1) and VAS score changes were similar in all experimental conditions. However, following 400 microg salbutamol via pMDI + Volumatic, isoFEF(25-75) values increased up to 4.48 l s(-1) (95% confidence interval 4.06, 4.90), a significantly (P < 0.01) higher value than those attained in all other experimental conditions. Independently of the salbutamol dose, lung volumes rose to significantly (P < 0.01) higher levels in pMDI + Volumatic than in Diskus trials. The low salbutamol dose via the pMDI + Volumatic and the high dose via the DPI increased isoFEF(25-75) and lung volumes to similar extents.

Conclusions: Salbutamol via the pMDI + Volumatic provides greater isoFEF(25-75) and lung volume increases in asthmatic patients with induced bronchoconstriction; salbutamol-induced changes in VAS scores poorly reflect those in small airway patency. The lack of differences in FEV(1) increases observed after 200 and 400 microg salbutamol may reflect attainment of the flat portion of the dose-response curve using either device.

Citing Articles

The challenge of delivering therapeutic aerosols to asthma patients.

Lavorini F ISRN Allergy. 2013; 2013:102418.

PMID: 23984095 PMC: 3747606. DOI: 10.1155/2013/102418.

Speed of onset of bronchodilator response to salbutamol inhaled via different devices in asthmatics: a bioassay based on functional antagonism.

Lavorini F, Geri P, Mariani L, Marmai C, Maluccio N, Pistolesi M Br J Clin Pharmacol. 2006; 62(4):403-11.

PMID: 16995861 PMC: 1885153. DOI: 10.1111/j.1365-2125.2006.02641.x.

References

Anderson P . Delivery options and devices for aerosolized therapeutics. Chest. 2001; 120(3 Suppl):89S-93S. DOI: 10.1378/chest.120.3_suppl.89s. View

Stanescu D . Small airways obstruction syndrome. Chest. 1999; 116(1):231-3. DOI: 10.1378/chest.116.1.231. View

Chrystyn H . Is inhalation rate important for a dry powder inhaler? Using the In-Check Dial to identify these rates. Respir Med. 2003; 97(2):181-7. DOI: 10.1053/rmed.2003.1351. View

Broeders M, Molema J, Hop W, Vermue N, Folgering H . Does the inhalation device affect the bronchodilatory dose response curve of salbutamol in asthma and chronic obstructive pulmonary disease patients?. Eur J Clin Pharmacol. 2003; 59(5-6):449-55. DOI: 10.1007/s00228-003-0614-2. View

McFadden Jr E, Kiser R, deGroot W . Acute bronchial asthma. Relations between clinical and physiologic manifestations. N Engl J Med. 1973; 288(5):221-5. DOI: 10.1056/NEJM197302012880501. View

Green M, Mead J, Turner J . Variability of maximum expiratory flow-volume curves. J Appl Physiol. 1974; 37(1):67-74. DOI: 10.1152/jappl.1974.37.1.67. View

Cockcroft D, Berscheid B . Volume adjustment of maximal midexpiratory flow. Importance of changes in total lung capacity. Chest. 1980; 78(4):595-600. DOI: 10.1378/chest.78.4.595. View

Orehek J, Beaupre A, Badier M, NICOLI M, Delpierre S . Perception of airway tone by asthmatic patients. Bull Eur Physiopathol Respir. 1982; 18(4):601-7. View

Dolovich M, Ruffin R, Corr D, Newhouse M . Clinical evaluation of a simple demand inhalation MDI aerosol delivery device. Chest. 1983; 84(1):36-41. DOI: 10.1378/chest.84.1.36. View

10.

Wright J, Lawson L, Pare P, Kennedy S, Wiggs B, Hogg J . The detection of small airways disease. Am Rev Respir Dis. 1984; 129(6):989-94. DOI: 10.1164/arrd.1984.129.6.989. View

11.

. Standardization of spirometry--1987 update. Statement of the American Thoracic Society. Am Rev Respir Dis. 1987; 136(5):1285-98. DOI: 10.1164/ajrccm/136.5.1285. View

12.

Wolkove N, Dajczman E, Colacone A, Kreisman H . The relationship between pulmonary function and dyspnea in obstructive lung disease. Chest. 1989; 96(6):1247-51. DOI: 10.1378/chest.96.6.1247. View

13.

. Lung function testing: selection of reference values and interpretative strategies. American Thoracic Society. Am Rev Respir Dis. 1991; 144(5):1202-18. DOI: 10.1164/ajrccm/144.5.1202. View

14.

Noseda A, Schmerber J, Prigogine T, Yernault J . Perceived effect on shortness of breath of an acute inhalation of saline or terbutaline: variability and sensitivity of a visual analogue scale in patients with asthma or COPD. Eur Respir J. 1992; 5(9):1043-53. View

15.

Fontana G, Cardellicchio S, Camiciottoli G, PANUCCIO P, Boddi V . Changes in transcutaneous oxygen partial pressure as an index of response to inhaled methacholine in asthmatic patients. Chest. 1993; 103(5):1375-80. DOI: 10.1378/chest.103.5.1375. View

16.

Noseda A, Schmerber J, Prigogine T, Yernault J . How do patients with either asthma or COPD perceive acute bronchodilation?. Eur Respir J. 1993; 6(5):636-44. View

17.

Kunitoh H, Watanabe K, Sajima Y . Dyspnea in acute bronchial asthma in an emergency room. Ann Allergy. 1994; 72(3):250-4. View

18.

Tonnesen F, Laursen L, Evald T, Stahl E, Ibsen T . Bronchodilating effect of terbutaline powder in acute severe bronchial obstruction. Chest. 1994; 105(3):697-700. DOI: 10.1378/chest.105.3.697. View

19.

Newman S, Newhouse M . Effect of add-on devices for aerosol drug delivery: deposition studies and clinical aspects. J Aerosol Med. 1997; 9(1):55-70. DOI: 10.1089/jam.1996.9.55. View

20.

Marks G, Yates D, Sist M, Ceyhan B, DE Campos M, Scott D . Respiratory sensation during bronchial challenge testing with methacholine, sodium metabisulphite, and adenosine monophosphate. Thorax. 1996; 51(8):793-8. PMC: 472540. DOI: 10.1136/thx.51.8.793. View