Treatment of Acute Asthma*
|
|
- Liliana Richardson
- 6 years ago
- Views:
Transcription
1 Treatment of Acute Asthma* Lack of Therapeutic Benefit and Increase of the Toxicity From Aminophylline Given in Addition to High Doses of Salbutamol Delivered by Metered-Dose Inhaler With a Spacer Carlos Rodrigo, M.D.; and Gustavo Rodrigo, M.D. We conducted a randomized, double-blind, placebocontrolled study to determine if intravenous aminophylline adds any benefit to high doses of inhaled salbutamol in patients ho presented for treatment of acute asthma. We studied 94 patients (mean age, 35.6 ± 11.2 years) ith moderate to severe acute asthma. All patients received therapy ith salbutamol delivered ith metered-dose inhaler (MDI) into a spacer device (Volumatic) in four puffs (400 ~ g at ) 10-min interval, and intravenous hydrocortisone (500 mg). Patients ere randomly assigned to receive either a loading dose of intravenous aminophylline folloed by a routine infusion (n=45) or an equal volume of placebo as a loading dose and infusion (n=49). The to groups shoed no differences in measurements of peak expiratory flo, FEV h and FVC at baseline and at the end of treatment. Hoever, the patients treated ith aminophylline had significantly more adverse effects (p<0.05). There ere no differences in the final mean dose of salbutamol (6.3 ± 44.5 mg for the placebo group and 5.8 ± 4.2 mg for the aminophylline group), hospital admission rate (10.2 percent for the placebo group and 9.0 percent for the aminophylline group), and mean duration of Emergency Department treatment (2.5 ± 1.83 h for the placebo group and 2.37 ± 1.75 h for the aminophylline group). The results ere similar hen the patients ere divided in accord ith the degree of respiratory obstruction (baseline FEV 1 <30 percent of predicted) and theophylline level at 30 min of treatment (placebo group patients ith theophylline level<10 mg/l vs aminophylline group patients ith theophylline level > 10 mg/l). We conclude that intravenous aminophylline adds to the toxicity but not the efficacy of inhaled salbutamol in the treatment of acute exacerbations of asthma. (Chest 1994; 106: ) ED=emergency department; FVC=forced vital capacity; MDI=metered-dose inhaler; PEF=peak expiratory flo; Key ords: inhaled salbutamol, intravenous aminophylline, treatment of acute asthma Intravenously administered aminophylline is idely used together ith inhaled {3-agonists in the treatment of patients ith acute exacerbation of asthma. Early studies have established the superiority of adequate doses of {3-agonists over aminophylline, and subsequently studies ere conducted to examine the question of the usefulness of adding aminophylline to optimal {3-agonist therapy in the setting of acute asthma. 1-7 Additionally, the declining use of aminophylline can be attributed to the lack of ell-designed trials that prove aminophylline's efficacy8 and to the narro therapeutic range, side effects, and toxicity The preponderance of evidence suggested that the addition of aminophylline played no useful role, and this thinking is reflected in the recommendations released by the National Heart, Lung, and Blood Institute, National Asthma Educational Program Expert Panel Report on the diagnosis and manage- *From the Centro de Terapia Intensiva, Asociaci6n Espanola 1a en Socorros Mutuos, and the Departamento de Emergencia, Hospital Central de las FF.AA. and Universidad Cat6lica del Uruguay, Montevideo. Manuscript received May 13, 1992; revision accepted March 11, ment of asthma. 13 They have excluded theophylline from the treatment recommendations for the Emergency Department (ED) management of acute asthma exacerbations in children and adults. Hoever, the question has been reopened by three ne studies that suggest that using aminophylline may lead to improved airflo and reduced duration of treatment among patients ith severe asthma.i 4-16 Therefore, e conducted a randomized, doubleblind, placebo-controlled study to determine if intravenous aminophylline adds any benefit to high doses of inhaled salbutamol and intravenous hydrocortisone therapy in patients ho presented for treatment of acute asthma to our ED. Patients METHODS We studied 94 patients ho presented to the ED of Military Hospital from Montevideo, Uruguay, for treatment of an acute exacerbation of asthma. All patients met the criteria of the American Thoracic Society (ATS). 17 The inclusion criteria for patients ere as follos: (1) age beteen 18 and 50 years; (2) peak expiratory flo (PEF) and FEV 1 belo 50 percent of predicted value; (3) excluded ere patients ith history of chronic cough, cardiac, hepatic, renal, or other medical disease, or pregnancy; CHEST /1 06 I 4 I OCTOBER,
2 and (4) an expressed illingness to participate in the study, ith ritten informed consent obtained. The study as approved by the Hospital Ethics Committee. Treatment Regimens Patients ho agreed to participate in. the study received salbutamol delivered ith metered-dose inhaler (MDI) into a spacer device (Volumatic, Allen & Hanburys Ltd, England) in four puffs actuated one at a time, at 10-min intervals (100 JJ.g per actuation). Volumatic is a pear-shaped extension tube of 750 ml and 22 em length ith a one-ay inhalation valve. Each puff as folloed by to deep inhalations from the spacer. They also received hydrocortisone, 500 mg intravenously. At once, patients ere randomly assigned in a double-blind fashion to receive a loading dose of either aminophylline, 5.6 mg/ kg of body eight over 20 min (n=45), or an equivalent volume of placebo (0.9 sodium chloride) (n=49), folloed by a constant infusion of aminophylline, 0.9 mg/ kg/ h, or an equivalent volume of placebo. Each patient as given Oz by nasal prongs at a rate of 4 L /rnin. Measurements The folloing variables ere measured in each patient immediately before starting treatment and, in 30-min intervals until hospital discharge or hospital admission, ithin the first 6 h after presentation: heart rate, respiratory rate, systolic and diastolic blood pressure, PEF, FEY J, FVC, accessory-muscle use, dyspnea, and heezing. Heart rate as measured from continuous electrocardiogram. The PEF as measured ith a flometer (Mini Wright Peak Flometer, Armstrong Industries Inc, Northbrook, Ill). The highest of three values as recorded. The FEY 1 and FVC ere measured using a spirometer (Vitalograph Compact Spirometer, Vitalograph Ltd, Maids Moreton House, Buckingham, UK) that as calibrated daily using a test syringe. Three successive maximal expiratory curves ere recorded at each assessment, and the highest value as selected, according to the criteria of the ATS 18 Accessory-muscle use as defined as visible retraction of the sternocleidomastoid muscles. Dyspnea as defined as the patient's on assessment of breathlessness. Wheezing as defined as musical or histling breath sounds heard ith a stethoscope during expiration. Serum theophylline concentrations ere determined from all subjects pretreatment and at 30 min of treatment after the completion of the loading infusion. Patients ere admitted to the hospital according to standard and accepted guidelines for admission: previous ED treatment ithin 24 h, the self-reported (patient) inability to attain preexacerbation status, if accessory-muscle use as abated, if heezing as judged minimal to complete resolved, if they ere free of dyspnea, and the inability of the patient to alk 20 m ithout exacerbation of symptoms and signs, despite 6 h of ED treatment. The decision to discharge or admit a patient as made by senior ED staff ithout knoledge of previous patient group allocation. At the end of the therapy (either to hospital admission or to home), the patient as asked to indicate the presence or absence of each five symptoms (nausea, palpitations, tremor, anxiety, and headache). To compare side effects in each group, e compiled a composite symptom score for each subject by arbitrarily assigning each symptom a value of l if present and 0 if absent. Thus, for example, a subject ho reported all five symptoms as assigned a score of 5, and a subject reporting no symptoms as assigned a score of 0. Statistical Analysis Standard sample-size calculations for a FEY 1 increase of 18 percent ith a=0.05 and /3=0.20 yielded a necessary sample size of approximately The Mann-Whitney U test, the x 2 test ith Yates' correction, and unpaired Student's t test ere used to compare baseline and discharge data for both patient groups. Changes in PEF, FVC, and FEY 1 ere evaluated using a to-ay analysis of variance ith one beteen-subject factor (placebo- Table!-Baseline Characteristics of Patients* Placebo Aminophylline (n=49) (n=45) p Value Age, yr 35.0 (13.2) 36.2 (9.4) >0.2 Male,% >0.2 Weight, kg 58.6 (11.3) 64.3 (13.2) >0.2 Height, m 1.6 (0.15) 1.6 (0.10) >0.2 Heart rate, beats/ min (15.4) (17.6) >0.2 Blood pressure, mm Hg Systolic (17.4) (16.8) >0.2 Diastolic 78.3 (13.6) 77.4 (14.6) >0.2 Respiratory rate, / min 23.1 (5.7) 22.8 (5.0) >0.2 Predicted PEF, L/ min (61.6) (68.7) >0.2 PEF, mean % of predicted 33.3 (10.6) 30.4 (16.0) 0.1 PEF, L/ min (51.0) (63.8) 0.1 Predicted FVC, L 3.8 (0.86) 3.5 (0.83) >0.2 FVC, mean % of predicted 43.4 (13.6) 38.8 (16.5) >0.2 FVC, L 1.7 (0.56) 1.5 (0.81) >0.2 Predicted FEY 1, L 3.3 (0.82) 3.0 (0.70) >0.2 FEY 1, mean % of predicted 27.7 (9.27) 26.5 (13.7) >0.2 FEV1, L 0.9 (032) 0.7 (0.36) >0.2 Accessory-muscle usef 1.4 (0.58) 1.4 (0.70) >0.2 Dyspneaf 1.7 (0.48) 1.7 (0.68) >0.2 Wheezingf 1.5 (050) 1.6 (0.58) >0.2 Theophylline, mg/ L 3.3 (4.53) 3.5 (4.65) >0.2 Duration of attack, h 30.6 (21.2) 29.4 (30.4) >0.2 *Results are mean values ( ±SD). x 2 categorical variables; Student's t test for normally distributed continuous variables; Mann-Whitney U test for variables ith nonnormal distributions. fwhere 0 denotes absent, 1 mild, 2 moderate, and 3 severe Lack of Benefit, Increased Toxicity from Aminophylline and Salbutamol (Rodrigo, Rodrigo)
3 t)50 c u.. 0 ' / ~- - ' ' 0 ~ " ~; ] l:j AIIII-TWioll [_,,,' ] *' *' 0 "r c :::40 u..30 ~ 3 0 ~ r 11. u r [:.;;: : ::] 80 70,' 11.40,''! ~,' <f. l u30 20 ' ' ' j j j j 0 _, _, J, 0 j L _l l MINUTES MINUTES MINUTES FIGURE 1. Spirometric values (PEF, FEV 1, and FVC) at 0, 30, 60, and 120 min after administration of placebo or aminophylline. The data points are mean values and the brackets represent 1 SD. aminophylline), and one ithin-subject factor (time, baseline, 30 min, 60 min, and end of treatment), ith the Neman-Keul's multiple range test. All probabilities reported are to tailed. All data are reported as mean ± 1 SD. A p value of less than 0.05 as considered statistically significant. RESULTS The to groups ere comparable ith respect for any measured variable (Table 1). The number of patients ho used corticosteroids ithin the past 7 days as 18 (36.7 percent) in the placebo group and 15 (33.3 percent) in the aminophylline group (p>0.2). Tenty-six patients (53.0 percent) used methylxanthines 24 h before presenting in the placebo group, and 21 (47.7 percent) in the aminophylline group (p>0.2). Finally, 31 patients (63.2 percent) had received!3-agonists pretreatment in the placebo group and 29 (65.9 percent) in the aminophylline group (p>0.2). The spirometric values at 30, 60, and 120 min are shon in Figure 1. Mean PEF improved significantly over baseline values for the placebo and aminophylline groups (p<0.001 by analysis of variance). The magnitude of placebo and aminophylline PEF improvements ere significant at 30 min (75.7 ± 46.0 L/ min and 73.1 ±49.2 L/ min, p<0.01), and at the end of treatment (112.4 ± 52.4 L/ min and ± 62.8 L/ min, p<0.01). Mean FVC improved significantly over pretreatment values for both groups (p<0.001). The placebo and aminophylline improvements ere significant at 30 min (0.68 ± 0.44 L and 0.62 ± 0.47 L, respectively, p<0.01) and at the end of treatment (0.94±0.58 Land 0.87±0.54 L, p<0.01). Finally, the same pattern held for changes in FEV 1 : at 30 min, FEV 1 increased 0.51 ± 0.30 L in the placebo group and 0.48 ± 0.38 L in the aminophylline group (p<0.01), and at the end of treatment, FEV 1 rose ± 0.41 Lin the placebo group and 0.68 ± 0.45 Lin the aminophylline group. Hoever, there as no significant difference beteen both groups for any variable at any time point studied. At final disposition, both groups did not present significant differences. The mean duration of ED treatment as 2.50 ± 1.83 h in the placebo group and 2.37 ± 1.75 h in the aminophylline group (p>0.2). The hospital admission rate did not differ beteen both groups; of nine admitted patients, five (10.2 percent) ere from the placebo group and four (9 percent) ere from the aminophylline group (p>0.2 by x 2 test). Similar results ere obtained hen patients admitted to the hospital ere examined separately (Table 2). The final mean dose of salbutamol as 63 puffs, equivalent to 6.3 mg (range beteen 12 puffs or 1.2 mg and 148 puffs or 14.8 mg) for the placebo group and 58 puffs, equivalent to 5.8 mg (range beteen 12 puffs or 1.2 mg and 148 puffs or 14.8 mg) for the aminophylline group (p>0.2). At discharge from the ED, the mean theophylline level in the patients receiving aminophylline as 14.7 ± 7.4 mg/ L (median, 12.0 mg/ L ith an interquartile range of 10 to 17.5 mg/ L), hereas the mean level in the placebo group as 3.3 ± 4.53 mg/ L (median, 2.6 mg/ L ith an interquartile range of 0 to 4.5 mg/ L) (p<0.001). Further, among subjects receiving aminophylline, at 30 min of treatment, 62 percent of discharged patients had theophylline levels of more than 10 mg/ L, and all the admitted patients had theophylline levels of more than 10 mg/ L. Linear regression analysis did not reveal any signif- CHEST /106/4/ OCTOBER
4 Table 2-Characteristics of All Subjects at Final Disposition and of Patients Who Were Admitted* Placebo (n=49) All Subjects Aminophylline (n=45) Admitted p Placebo Aminophylline p Value (n=5) (n=4) Value Age, yr Baseline PEF, mean % of predicted Final PEF, mean % of predicted 56.4 (18.6) 51.3 (16.7) Baseline FVC, mean % o f predicted Final FVC, mean % of predicted 70.4 (19.6) 66.8 (21.8) Baseline FEV1, mean % of predicted Final FEV 1, mean % of predicted 51.2 (17.9) 50.5 (19.5) Emergency department treatment 2.5 (1.83) 2.3 (1.73) duration, h Accessory-muscle use Dyspnea Wheezing 38.6 (11.9) (10.5) > (6.8) 19.0 (11.4) > (14.5) 24.2 (14.3) > (17.7) 38.8 (18.5) >0.2 > (10.3) 42.8 (14.4) > (4.47) 16.5 (7.76) >0.2 > (14.1) 22.5 (12.9) >0.2 > (0.89) 1.5 (0.57) > (0.20) 1.2 (0.95) > (0.54) 1.7 (0.50) >0.2 *Results are mean values ( ± SD ). icant correlation beteen initial and final plasma theophylline concentrations over the course of the study and improvement in FEV 1 in either placebo group or aminophylline group. The patients ere divided in accord ith the theophylline level at 30 min of treatment (placebo group patients ith serum theophylline level <10 mg/ L, n=40, vs aminophylline group patients ith serum theophylline level >10 mg/ L, n=38). There ere no differences in ED treatment duration (2.43± 1.88 hand 2.36± 1.79 h respectively, p>0.2), baseline PEF as mean percent of predicted (34.0 ± 10.9 percent and 29.7 ± 12.8 percent, respectively, p=0.13), final PEF as mean percent of predicted (56.7 ± 19.4 percent and 51.0 ± 17.6 percent, respectively, p=0.17), baseline FEV 1 as mean percent of predicted (28.2±9.55 percent and 27.9±14.4 percent, respectively, p>0.2), and final FEV 1 as mean percent of predicted (53.6 ± 17.0 percent and 51.9±20.9 percent, respectively, p>0.2). When e considered the severity of respiratory obstruction and the theophylline level at 30 min of treatment, there ere no differences beteen groups (placebo group patients ith FEV 1 <30 percent predicted on admission to the ED, and serum theophylline level <10 mg/ L vs aminophylline group patients ith FEV 1 <30 percent predicted on admission to the ED, and serum theophylline level> 10 mg/ L) (Table 3). The overall symptom score in patients treated ith aminophylline (1.2±1.25, mean±sd) as significantly greater than the score in the placebo group (0.65 ± 0.86, p<0.05, Mann-Whitney U test), and there as a higher incidence in four (nausea, palpitation, anxiety, and headache) of five symptoms monitored (Fig 2). Tremor as the most common side effect in the placebo group (30 percent) and nausea as more frequent in the aminophylline group (37.5 percent). Finally, the to groups produced a nonsignificant decrease in the heart rate. At the end of treatment, the placebo group shoed a decrease of ± 11.9 percent (median, 0 percent ith an interquartile range of to 7.00 percent) and the aminophyl- Table 3-Comparison Beteen Placebo Group Patients With FEV 1 <30 Percent Predicted on Admission to the Emergency Department and Serum Theophylline Level <10 mg/ L to Aminophylline Group Patients With FEV1 <30 Percent Predicted and Serum Theophylline Level ~ 1mg/ 0 L* Placebo Aminophylline (n=13) (n=16) p Value Age, yr Emergency d epartment treatment duration, h Final mean dose of salbutamol, mg Baseline PEF, mean % of predicted Final PEF, mean % of predicted Baseline FEVt, mean % of predicted Final FEV 1. mean % of predicted 39.5 (12.5) 36.1 (10.5) > (1.31) 2.5 (1.66) > (31.1) 62.2 (41.4) > (7.5) 18.2 (6. 6) (16.7) 45.9 (13.7) > (5.9) 18.5 (8.0) > (9.9) 49.2 (13.0) >0.2 *Results are mean values ( ± SD) Lack of Benefit, Increased Toxicity from Aminophylline and Salbutamol (Rodrigo, Rodrigo)
5 40 I 0AMINOPHYLLINE I DPLACEBO I en 1- z ~ 30 l:) z (.) a.. 10 NAUSEA PALPITATIONS TREMOR HEADACHE ANXIETY line group shoed a decrease of ± 16.0 (median, percent ith an interquartile range of -13 to 5.0 percent) (p>0.2). DISCUSSION As in previous studies, 2-5 e found that the addition of intravenous aminophylline in standard doses to a regimen of intensive inhaled salbutamol, for moderate to severe acute exacerbations of asthma, does not improve short-term outcome. At final disposition, placebo and aminophylline groups did not differ in airflo, hospital admission rate, and time in the ED. Moreover, combined therapy ith aminophylline and salbutamol did cause a higher incidence of side effects and a significantly higher overall adverse symptom score than did therapy ith salbutamol alone. With respect to the possibility of drug interaction beteen previous therapy and the study treatments as an explanation of these results, e can reject this possibility. Thus, there ere no significant differences hen e considered the severity of respiratory obstruction and the theophylline level at 30 min of treatment. Additionally, e did not find any positive correlation beteen the initial and final plasma theophylline concentrations over the course of the study and the changes in FEV 1. In the same ay, previous treatments ith corticosteroids and /3-agonists did not differ beteen groups. Recently, in a randomized, double-blind, placebocontrolled study, Wrenn et al 16 reported that the administration of aminophylline to acutely symptomatic patients ith asthma or chronic obstructive pulmonary disease markedly decreased hospital admissions. Surprising, the authors also found that adding aminophylline to /3-agonists had no effect on FIGURE 2. Percent of patients ho reported side effects at the end of treatment. pulmonary function, physician assessment of the response of treatment, or time in the ED. It is difficult to understand ho aminophylline could influence hospital admission rates differentially ithout producing identifiable clinical or physiologic differences (or both) beteen groups. One possibility suggested by the protocol is that factors other than, or in addition to, objective measures of severity ere used in deciding hom to admit. Although the authors did not participate in the disposition of the patients, one must onder about the uniformity of the application of the hospital admission criteria by those ho did. 20 Finally, e did not confirm results from Lalla et al, 14 ho found significant differences beteen placebo and aminophylline groups in FEY 1 at 1 h and 4 h of treatment. Nevertheless, this article presents important methodologic problems, the most significant being an inadequate sample size (n=i8). Similarly, the mean theophylline concentration of the aminophylline group obtained after 4 h of treatment as 8.31 ± 2.71, suggesting that many patients of this group ere undertreated. In summary, our study suggests that intravenous aminophylline adds little or nothing to the short-term bronchodilator effect of an inhaled /3-adrenergic agonist in patients ith acute exacerbated asthma. On the basis of this, e conclude that aminophylline is eak and potentially toxic bronchodilator ith a narro therapeutic indo and numerous drug interactions that make its use complicated. It suggests that repeated inhalation of high doses of a /3-adrenergic alone delivery by MDI ith a spacer device (Volumatic) may be the optimal bronchodilator therapy for ED treatment of acute exacerbations of asthma. When the combination of systemically administered corticosteroid and inhaled salbutamol is CHEST I 106 I 4 I OCTOBER,
6 used in the treatment of patients ith moderate to severe acute asthma, addition of aminophylline may not be justified. REFERENCES Rossing TH, Fanta CH, Goldstein DH, Snapper JR, McFadden ER. Emergency therapy of asthm comparison of the acute effects of parenteral and inhaled sympathomimetics and infused aminophylline. Am Rev Respir Dis 1980; 122: Rossing TH, Fanta CH, McFadden ER. A controlled trial of the use of single versus combined-drug therapy in the treatment of acute episodes of asthma. Am Rev Respir Dis 1981; 123: Fanta CH, Rossing TH, McFadden ER. Emergency room treatment of asthm relationships among therapeutic combinations, severity of obstruction and time course of response. Am J Med 1982; 72: Siegel D, Sheppard D, Gelb A, Weinberg PF. Aminophylline increases the toxicity but not the efficacy of an inhaled beta-adrenergic agonist in the treatment of acute exacerbations of asthma. Am Rev Respir Dis 1985; 132: Clynes ND, Cole RP. Efficacy of emergency room treatment of bronchial asthm the role of intravenous aminophylline. Am Rev Respir Dis 1987; 135:A325 6 Self TH, Abou-Shala N, Burns R, Steart CF, et al. Inhaled albuterol and oral prednisone therapy in hospitalized adult asthmatics: does Aminophylline add any benefit? Chest 1990; 98: Digiulio GA, Kercsmar CM, Krug SE, Alpert SE, Marx CM. Hospital treatment of asthm lack of benefit from theophylline given in addition to nebulized albuterol and intravenously administered corticosteroid. J Pediatr 1993; 122: Litten berg B. Aminophylline treatment in severe, acute asthm a meta-analysis. JAMA 1988; 259: Lam A, Nehouse MT. Management of asthma and chronic airflo limitation: are methylxanthines obsolete? Chest 1990; 98: Rossing TH. Methylxanthines in Ann Intern Med 1989; 110: Sessler CN. Theophylline toxicity: clinical features of 116 consecutive cases. Am J Med 1990; 88: Bittar G, Friedman S. The arrhythmogenicity of theophylline: a multivariate analysis of clinical determinants. Chest 1991; 99: National Heart, Lung and Blood Institute, National Asthma Education Program Expert Panel Report. Guidelines for the diagnosis and management of asthma. Bethesda, Md: National Heart, Lung and Blood Institute Information Center, Lalla S, Saleh A, Farooq J, Lombardo G, Gudi M, Amandarao N. Intravenous aminophylline in acute, severe bronchial asthma, is it useful? Chest 1991; 100(suppl):60S 15 Huang D, Aull L, Reents S, Visser J, Brandes W, et al. Does intravenous aminophylline benefit patients hospitalized for severe asthma? Chest 1991; 100(suppl):62S 16 Wrenn K, Slovis CM, Murphy F, Greenberg RS. Aminophylline therapy for acute bronchospastic disease in the emergency room. Ann Intern Med 1991; 115: American Thoracic Society. Standards for the diagnosis and care of patients ith chronic obstructive pulmonary disease (COPD) and asthma. Am Rev Respir Dis 1987; 136: American Thoracic Society. Standarization of spirometry update. Am Rev Respir Dis 1987; 136: Friedman LM, Furberg CD, De Mets DL. Fundamentals of clinical trials. 2nd ed. Littleton, Mass: PSG Publishing, 1985; McFadden ER. Methylxanthines in the treatment of asthm the rise, the fall, and the possible rise again. Ann Intern Med 1991; 115: Lack of Benefit, Increased Toxicity from Aminophylline and Salbutamol (Rodrigo, Rodrigo)
Individual Study Table Referring to Part of the Dossier. Volume:
Final Report M/100977/21Final Version () 2. SYNOPSIS A Title of Study: A PHASE IIa, RANDOMISED, DOUBLE-BLIND, MULTIPLE DOSE, PLACEBO CONTROLLED, 3 PERIOD CROSS-OVER, ASCENDING DOSE CLINICAL TRIAL TO ASSESS
More informationComparison of the Effect of Short Course of Oral Prednisone in Patients with Acute Asthma
ISPUB.COM The Internet Journal of Pulmonary Medicine Volume 7 Number 1 Comparison of the Effect of Short Course of Oral Prednisone in Patients with Acute Asthma E Razi, G Moosavi Citation E Razi, G Moosavi.
More informationRandomised controlled trial of aminophylline for severe acute asthma
Arch Dis Child 1998;79:405 410 405 Intensive Care Unit, Royal Children s Hospital, Melbourne, Victoria 3052, Australia M Yung M South Correspondence to: Dr South. email: south@cryptic.rch. unimelb.edu.au
More informationOn completion of this chapter you should be able to: discuss the stepwise approach to the pharmacological management of asthma in children
7 Asthma Asthma is a common disease in children and its incidence has been increasing in recent years. Between 10-15% of children have been diagnosed with asthma. It is therefore a condition that pharmacists
More informationRapid Effects of Inhaled Corticosteroids in Acute Asthma Gustavo J. Rodrigo, MD.
Rapid Effects of Inhaled Corticosteroids in Acute Asthma Gustavo J. Rodrigo, MD WWW.chestjournal.org Background: Current reviews on the use of inhaled corticosteroids (ICS) for acute asthma underestimated
More informationADULT ASTHMA GUIDE SUMMARY. This summary provides busy health professionals with key guidance for assessing and treating adult asthma.
ADULT ASTHMA GUIDE SUMMARY This summary provides busy health professionals with key guidance for assessing and treating adult asthma. Its source document Asthma and Respiratory Foundation NZ Adult Asthma
More informationDATE: 09 December 2009 CONTEXT AND POLICY ISSUES:
TITLE: Tiotropium Compared with Ipratropium for Patients with Moderate to Severe Chronic Obstructive Pulmonary Disease: A Review of the Clinical Effectiveness DATE: 09 December 2009 CONTEXT AND POLICY
More informationSupplementary Medications during asthma attack. Prof. Dr Finn Rasmussen PhD. DrMedSc. Near East University Hospital North Cyprus
Supplementary Medications during asthma attack Prof. Dr Finn Rasmussen PhD. DrMedSc. Near East University Hospital North Cyprus Conflicts of Interest None Definition of Asthma Airway narrowing that is
More informationAn Audit on Hospital Management of Bronchial Asthma
An Audit on Hospital Management of Bronchial Asthma Pages with reference to book, From 298 To 300 Javaid A. Khan, Shehryar Saghir, Ghazala Tabassum, S. Fayyaz Husain ( Department of Medicine, The Aga Khan
More informationThis clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. The synopsis
More informationGustavo J. Rodrigo, MD; Mario Rodriquez Verde, MD; Virginia Peregalli, MD; and Carlos Rodrigo, MD
Effects of Short-term 28% and 100% Oxygen on PaCO 2 and Peak Expiratory Flow Rate in Acute Asthma* A Randomized Trial Gustavo J. Rodrigo, MD; Mario Rodriquez Verde, MD; Virginia Peregalli, MD; and Carlos
More informationManagement of acute asthma in children in emergency department. Moderate asthma
152 Moderate asthma SpO2 92% No clinical features of severe asthma NB: If a patient has signs and symptoms across categories, always treat according to their most severe features agonist 2-10 puffs via
More informationNEBULIZED SALBUTAMOL WITH & WITHOUT IPRATROPIUM BROMIDE IN THE TREATMENT OF ACUTE SEVERE ASTHMA
NEBULIZED SALBUTAMOL WITH & WITHOUT IPRATROPIUM BROMIDE IN THE TREATMENT OF ACUTE SEVERE ASTHMA Naveed Inayat*, Riaz Hussain Shah**, Qurban Ali Rahu***, Rubina Sahito* ORIGINAL ARTICLE *Department of Pulmonology,
More informationCOPD. Breathing Made Easier
COPD Breathing Made Easier Catherine E. Cooke, PharmD, BCPS, PAHM Independent Consultant, PosiHleath Clinical Associate Professor, University of Maryland School of Pharmacy This program has been brought
More information2/12/2015. ASTHMA & COPD The Yin &Yang. Asthma General Information. Asthma General Information
ASTHMA & COPD The Yin &Yang Arizona State Association of Physician Assistants March 6, 2015 Sedona, Arizona Randy D. Danielsen, PhD, PA-C, DFAAPA Dean & Professor A.T. Still University Asthma General Information
More informationClinical equivalence of a novel nonchlorofluorocarbon-containing
Clinical equivalence of a novel nonchlorofluorocarbon-containing salbutamol sulfate metered-dose inhaler and a conventional chlorofluorocarbon inhaler in patients with asthma Robert Dockhorn, MD," Jennifer
More informationAsthma is global health problem in children,
Paediatrica Indonesiana VOLUME 52 July NUMBER 4 Original Article Efficacy of salbutamol-ipratropium bromide nebulization compared to salbutamol alone in children with mild to moderate asthma attacks Matahari
More informationSalmeterol, a new long acting inhaled,f2 adrenoceptor agonist: comparison with salbutamol in adult asthmatic patients
Thorax 1988;43:674-678 Salmeterol, a new long acting inhaled,f2 adrenoceptor agonist: comparison with salbutamol in adult asthmatic patients ANDERS ULLMAN, NILS SVEDMYR From the Department of Clinical
More informationSubcutaneous adrenaline versus terbutaline in the
Thorax 1988;43:19-23 Subcutaneous adrenaline versus terbutaline in the treatment of acute severe asthma M A SPITERI, A B MILLAR, D PAVIA, S W CLARKE From the Department of Thoracic Medicine, Royal Free
More informationTreatment. Assessing the outcome of interventions Traditionally, the effects of interventions have been assessed by measuring changes in the FEV 1
58 COPD 59 The treatment of COPD includes drug therapy, surgery, exercise and counselling/psychological support. When managing COPD patients, it is particularly important to evaluate the social and family
More informationLecture Notes. Chapter 3: Asthma
Lecture Notes Chapter 3: Asthma Objectives Define asthma and status asthmaticus List the potential causes of asthma attacks Describe the effect of asthma attacks on lung function List the clinical features
More informationSupplementary Online Content
Supplementary Online Content Regan EA, Lynch DA, Curran-Everett D, et al; Genetic Epidemiology of COPD (COPDGene) Investigators. Clinical and radiologic disease in smokers with normal spirometry. Published
More informationEvaluation of the Use of High-Dose Inhaled Corticosteroids for the Treatment of Acute Asthma
11 Inhaled Corticosteroids for Asthma Attacks ORIGINAL ARTICLE RAMR 2016;1:11-16 ISSN 1852-236X Evaluation of the Use of High-Dose Inhaled Corticosteroids for the Treatment of Acute Asthma Correspondence:
More informationAsthma Care in the Emergency Department Clinical Practice Guideline
Asthma Care in the Emergency Department Clinical Practice Guideline Inclusion: 1) Children 2 years of age or older with a prior history of wheezing, and 2) Children less than 2 years of age with likely
More informationThis is a cross-sectional analysis of the National Health and Nutrition Examination
SUPPLEMENTAL METHODS Study Design and Setting This is a cross-sectional analysis of the National Health and Nutrition Examination Survey (NHANES) data 2007-2008, 2009-2010, and 2011-2012. The NHANES is
More informationMeenu Singh, Joseph L. Mathew, Prabhjot Malhi, B.R. Srinivas and Lata Kumar
Comparison of Improvement in Quality of Life Score with Objective Parameters of Pulmonary Function in Indian Asthmatic Children Receiving Inhaled Corticosteroid Therapy Meenu Singh, Joseph L. Mathew, Prabhjot
More informationCourse Handouts & Disclosure
COPD: Disease Trajectory and Hospice Eligibility Terri L. Maxwell PhD, APRN VP, Strategic Initiatives Weatherbee Resources Hospice Education Network Course Handouts & Disclosure To download presentation
More informationDiagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016
Diagnosis and Management of Asthma in Children based on the British Thoracic Society and Scottish Intercollegiate Guidelines Network September 2016 Diagnosis: There is no lower limit to the age at which
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationG. Boyd on behalf of a UK Study group
Eur Respir J, 1995, 8, 1494 1498 DOI: 10.1183/09031936.95.08091494 Printed in UK - all rights reserved Copyright ERS Journals Ltd 1995 European Respiratory Journal ISSN 0903-1936 Salmeterol xinafoate in
More informationTreatment of acute asthmatic exacerbations with an increased dose of inhaled steroid
12 Paediatrics and Child Health, Dunedin School of Medicine, PO Box 913, University of Otago Medical School, Dunedin, New Zealand J Garrett Preventive and Social Medicine, Dunedin School of Medicine S
More informationPerforming a Methacholine Challenge Test
powder for solution, for inhalation Performing a Methacholine Challenge Test Provocholine is a registered trademark of Methapharm Inc. Copyright Methapharm Inc. 2016. All rights reserved. Healthcare professionals
More informationBronchodilator and Cardiac Effects of Isoprenaline, Orciprenaline, and Salbutamol Aerosols in Asthma
Archives of Disease in Childhood, 1971, 46, 52. Bronchodilator and Cardiac Effects of Isoprenaline, Orciprenaline, and Salbutamol Aerosols in Asthma A. D. MILNER and D. INGRAM From The Hospital for Sick
More informationDecramer 2014 a &b [21]
Buhl 2015 [19] Celli 2014 [20] Decramer 2014 a &b [21] D Urzo 2014 [22] Maleki-Yazdi 2014 [23] Inclusion criteria: Diagnosis of chronic obstructive pulmonary disease; 40 years of age or older; Relatively
More informationIvax Pharmaceuticals UK Sponsor Submission to the National Institute for Health and Clinical Excellence
Ivax Pharmaceuticals UK Sponsor Submission to the National Institute for Health and Clinical Excellence Clinical and cost-effectiveness of QVAR for the treatment of chronic asthma in adults and children
More informationRESPIRATORY CARE IN GENERAL PRACTICE
RESPIRATORY CARE IN GENERAL PRACTICE Definitions of Asthma and COPD Asthma is due to inflammation of the air passages in the lungs and affects the sensitivity of the nerve endings in the airways so they
More informationAsthma in the Athlete
Asthma in the Athlete Jorge E. Gomez, MD Associate Professor Texas Children s Hospital Baylor College of Medicine Assist Team Physician UH Understand how we diagnose asthma Objectives Be familiar with
More informationBronchodilator Delivery and Nebuliser Trials in Adults
Bronchodilator Delivery and Nebuliser Trials in Adults Acute Management Favour the use of MDI (+/- Spacer) If considering nebuliser Short term treatment Approx. < 3 weeks See optimisation of inhaled bronchodilators
More informationSPIROMETRY. Marijke Currie (CRFS) Care Medical Ltd Phone: Copyright CARE Medical ltd
SPIROMETRY Marijke Currie (CRFS) Care Medical Ltd Phone: 0800 333 808 Email: sales@caremed.co.nz What is spirometry Spirometry is a physiological test that measures the volume of air an individual can
More informationGuideline for the Diagnosis and Management of COPD
Guideline for the Diagnosis and Management of COPD Introduction Chronic obstructive pulmonary disease (COPD) is a respiratory disorder largely caused by smoking. It is characterized by progressive, partially
More informationH ospitalisation due to an exacerbation of chronic
713 CHRONIC OBSTRUCTIVE PULMONARY DISEASE Intravenous aminophylline in patients admitted to hospital with non-acidotic exacerbations of chronic obstructive pulmonary disease: a prospective randomised controlled
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome/Efficacy Variable:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationPharmacokinetics Applied to the Treatment of Asthma
Pharmacokinetics Applied to the Treatment of Asthma 2016 edition by David C. McMillan, PhD Department of Pharmacology and Experimental Neuroscience College of Medicine University of Nebraska Medical Center
More informationStep-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide.
Step-down approach in chronic stable asthma: A comparison of reducing dose Inhaled Formoterol/ Budesonide with maintaining Inhaled Budesonide. By: DR MOHD SHAMSUL AMRI Supervisor: Associate Professor Dr
More informationEfficacy of Nebulised Ipratropium in Acute Bronchial Asthma
ORIGINAL ARTICLE JIACM 2002; 3(4): 353-59 Efficacy of Nebulised Ipratropium in Acute Bronchial Asthma Praveen Aggarwal*, Onkar Singh**, Jyoti P Wali***, Rohini Handa*, Sada N Dwivedi****, Ashutosh Biswas*****,
More informationI. Subject: Continuous Aerosolization of Bronchodilators
I. Subject: Continuous Aerosolization of Bronchodilators II. Indications: A. Acute airflow obstruction in which treatment with an aerosolized bronchodilator is desired for an extended period of time, i.e.
More informationSYNOPSIS. First subject enrolled 15 August 2003 Therapeutic confirmatory (III) Last subject completed 03 February 2005
Drug product: SYMBICORT pmdi 160/4.5 μg Drug substance(s): Budesonide/formoterol Study code: SD-039-0728 Edition No.: FINAL Date: 27 February 2006 SYNOPSIS A 52-week, randomized, double-blind, single-dummy,
More informationSCREENING AND PREVENTION
These protocols are designed to implement standard guidelines, based on the best evidence, that provide a consistent clinical experience for AHC II Integrated Clinical Delivery Network patients and allow
More informationaclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A.
aclidinium 322 micrograms inhalation powder (Eklira Genuair ) SMC No. (810/12) Almirall S.A. 05 October 2012 The Scottish Medicines Consortium (SMC) has completed its assessment of the above product and
More informationThe pharmacologic treatment of acute severe asthma includes high-dose inhaled bronchodilators and the early
Efficacy of adding multiple doses of oxitropium bromide to salbutamol delivered by means of a metered-dose inhaler with a spacer device in adults with acute severe asthma Yutaka Nakano, MD, a Noriyuki
More informationTreatment of Acute Asthma Exacerbations in Adults in the Primary Care or Urgent Care Setting Clinical Practice Guideline MedStar Health.
Treatment of Acute Asthma Exacerbations in Adults in the Primary Care or Urgent Care Setting Clinical Practice Guideline MedStar Health Background: These guidelines are provided to assist physicians and
More informationDiagnosis, Treatment and Management of Asthma
Diagnosis, Treatment and Management of Asthma Asthma is a complex disorder characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness, and an underlying inflammation.
More informationTARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS
TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Recommendation PULMONARY FUNCTION TESTING (SPIROMETRY) Conditional: The Expert Panel that spirometry measurements FEV1,
More informationExacerbations. Ronald Dahl, Aarhus University Hospital, Denmark
1st WAO Allied Health Session - Asthma: Diagnosi Exacerbations Ronald Dahl, Aarhus University Hospital, Denmark The health professional that care for patients with asthma exacerbation must be able to Identificafy
More informationAllwin Mercer Dr Andrew Zurek
Allwin Mercer Dr Andrew Zurek 1 in 11 people are currently receiving treatment for asthma (5.4 million people in the UK) Every 10 seconds, someone is having a potentially life-threatening asthma attack
More informationMSRC AIR Course Karla Stoermer Grossman, MSA, BSN, RN, AE-C
MSRC AIR Course Karla Stoermer Grossman, MSA, BSN, RN, AE-C Explain the importance of objective measures in the management of asthma Explain the different types of objective measures used in the management
More informationChronic obstructive pulmonary disease (COPD) is characterized
DANIEL E. HILLEMAN, PharmD ABSTRACT OBJECTIVE: To review the role of long-acting bronchodilators in the treatment of chronic obstructive pulmonary disease (COPD), including the importance of treatment
More informationBronchodilator intake and plasma levels on admission for severe acute asthma
Eur Resplr J 1992, 5, 8--85 Bronchodilator intake and plasma levels on admission for severe acute asthma C. Janson, J. Boe**, G. Boman, B. Mossbergt, N. Svedmyrtt Bronchodilator intake and plasma levels
More informationHistory & Development
RSPT 2317 Anticholinergic Bronchodilators () History & Development Prototypical parasympatholytic agent is atropine an alkaloid found naturally in the plants Atropa belladona (nightshade) and Datura species
More informationSpirometry: Introduction
Spirometry: Introduction Dr. Badri Paudel 1 2 GMC Spirometry Spirometry is a method of assessing lung function by measuring the volume of air the patient can expel from the lungs after a maximal expiration.
More informationSYNOPSIS. Study center(s) This study was conducted in the United States (128 centers).
Drug product: Drug substance(s): Document No.: Edition No.: Study code: Date: SYMBICORT pmdi 160/4.5 µg Budesonide/formoterol SD-039-0725 17 February 2005 SYNOPSIS A Twelve-Week, Randomized, Double-blind,
More information2018 OPTIONS FOR INDIVIDUAL MEASURES: REGISTRY ONLY. MEASURE TYPE: Process
Quality ID #52 (NQF 0102): Chronic Obstructive Pulmonary Disease (COPD): Long-Acting Inhaled Bronchodilator Therapy National Quality Strategy Domain: Effective Clinical Care 2018 OPTIONS FOR INDIVIDUAL
More information1. ASTHMA 1. Eve A. Kerr, MD, MPH and Kenneth A. Clark, MD, MPH
1. ASTHMA 1 Eve A. Kerr, MD, MPH and Kenneth A. Clark, MD, MPH The general approach to developing quality indicators for asthma diagnosis and treatment was based on Guidelines for the Diagnosis and Management
More informationAtrovent Administration
Atrovent Administration ICEMA Training 2007 Sherri Shimshy RN OBJECTIVES Describe the pharmacology of Atrovent Identify the indications for use of Atrovent in the Adult Population Identify the indications
More informationRobert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network
Robert Kruklitis, MD, PhD Chief, Pulmonary Medicine Lehigh Valley Health Network Robert.kruklitis@lvh.com Correlation of a Asthma pathophyisology with basic science Asthma (Physiology) Bronchodilators
More informationTips on managing asthma in children
Tips on managing asthma in children Dr Ranjan Suri Consultant in Respiratory Paediatrics Bupa Cromwell Hospital Clinics: Friday (pm) Asthma in Children Making the diagnosis Patterns of childhood asthma
More informationGINA. At-A-Glance Asthma Management Reference. for adults, adolescents and children 6 11 years. Updated 2017
GINA At-A-Glance Asthma Management Reference for adults, adolescents and children 6 11 years Updated 2017 This resource should be used in conjunction with the Global Strategy for Asthma Management and
More informationExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007
Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma Full Report 2007 TARGET POPULATION Eligibility Inclusion Criterion Exclusion Criterion RECOMMENDATIONS Selecting Initial Therapy
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Papi A, Canonica GW, Maestrelli P, et al. Rescue use of beclomethasone
More informationStudy No.: Title: Rationale: Phase: Study Period: Study Design: Centres: Indication: Treatment: Objectives: Primary Outcome:
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More informationSYNOPSIS. Date 15 June 2004
Drug product Drug substance(s) Document No. Edition No. Study code SYMBICORT pmdi 160/4.5 mg per actuation Budesonide/formoterol SD-039-0719 Date 15 June 2004 SYNOPSIS A Six-Month, Randomized, Open-Label
More informationBETTER SPIROMETRY. Marijke Currie (CRFS) Care Medical Ltd Phone: Copyright CARE Medical ltd
BETTER SPIROMETRY Marijke Currie (CRFS) Care Medical Ltd Phone: 0800 333 808 Email: sales@caremed.co.nz What is spirometry Spirometry is a physiological test that measures the volume of air an individual
More information10/6/2014. Tommy s Story: An Overview of Asthma Mangement. Disclosure. Objectives for this talk.
Tommy s Story: An Overview of Asthma Mangement Clifton C. Lee, MD, FAAP, FHM Associate Professor of Pediatrics Chief, Pediatric Hospital Medicine Children s Hospital of Richmond at VCU Disclosure Obviously,
More informationAcute Wheezing Emergencies: From Young to Old! Little Wheezers in the ED: Managing Acute Pediatric Asthma
Acute Wheezing Emergencies: From Young to Old! Little Wheezers in the ED: Managing Acute Pediatric Asthma Talk Outline Case Delivery of bronchodilators Meter-dose inhalers and spacers Continuous nebulization
More informationUNIT TWO: OVERVIEW OF SPIROMETRY. A. Definition of Spirometry
UNIT TWO: OVERVIEW OF SPIROMETRY A. Definition of Spirometry Spirometry is a medical screening test that measures various aspects of breathing and lung function. It is performed by using a spirometer,
More informationPathology of Asthma Epidemiology
Asthma A Presentation on Asthma Management and Prevention What Is Asthma? A chronic disease of the airways that may cause Wheezing Breathlessness Chest tightness Nighttime or early morning coughing Pathology
More informationCOPD: A Renewed Focus. Disclosures
COPD: A Renewed Focus Heath Latham, MD Assistant Professor Division of Pulmonary and Critical Care Medicine Disclosures No Business Interests No Consulting No Speakers Bureau No Off Label Use to Discuss
More informationVA/DoD Clinical Practice Guideline Management of COPD Pocket Guide
VA/DoD Clinical Practice Guideline Management of COPD Pocket Guide MODULE A: MAAGEMET OF COPD 1 2 Patient with suspected or confirmed COPD presents to primary care [ A ] See sidebar A Perform brief clinical
More informationClinical Practice Guideline: Asthma
Clinical Practice Guideline: Asthma INTRODUCTION A critical aspect of the diagnosis and management of asthma is the precise and periodic measurement of lung function both before and after bronchodilator
More informationThis clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data.
abcd Clinical Study Synopsis for Public Disclosure This clinical study synopsis is provided in line with Boehringer Ingelheim s Policy on Transparency and Publication of Clinical Study Data. The synopsis
More informationAsthma Assessment & Review
ASTHMA RESOURCE PACK Section 5B Asthma Assessment & Review In this section: 1. Primary Care initial assessment and review Asthma Resource Pack Section 5B: Asthma Assessment & Review Version 3.0 Last Updated:
More informationOutline FEF Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications?
Reduced FEF25-75 in asthma. What does it mean and what are the clinical implications? Fernando Holguin MD MPH Director, Asthma Clinical & Research Program Center for lungs and Breathing University of Colorado
More informationAcute Asthma in Adults and Children
Guideline for The Management of Administered by the Alberta Medical Association Acute Asthma in Adults and Children This guideline has been adapted from the CAEP guidelines for Acute Asthma Management
More informationStudy of dynamic lung parameters in bronchial Asthma
20; 4(1): 312-317 ISSN Print: 2394-7500 ISSN Online: 2394-5869 Impact Factor: 5.2 IJAR 20; 4(1): 312-317 www.allresearchjournal.com Received: 20-11-2017 Accepted: 21-12-2017 Dr. Madhuchhanda Pattnaik Associate
More informationS P I R O M E T R Y. Objectives. Objectives 3/12/2018
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
More informationDiagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma
Diagnosis, Assessment, Monitoring and Pharmacological Treatment of Asthma Magnitude of Asthma - India Delhi Childhood asthma: 10.9% Adults: 8% Other Cities 3 to 18% Chhabra SK et al Ann Allergy Asthma
More informationOver the last several years various national and
Recommendations for the Management of COPD* Gary T. Ferguson, MD, FCCP Three sets of guidelines for the management of COPD that are widely recognized (from the European Respiratory Society [ERS], American
More informationCorrelations between pulse oximetry and peak expiratory flow in acute asthma
Brazilian Journal of Medical and Biological Research (2007) 40: 485-490 Pulse oximetry and peak expiratory flow in acute asthma ISSN 0100-879X 485 Correlations between pulse oximetry and peak expiratory
More informationCommunity COPD Service Protocol
Community COPD Service Protocol Acknowledgements This protocol is based on the following documents: 1. Chronic obstructive pulmonary disease: Management of chronic obstructive pulmonary disease in adults
More informationPulmonary Function Testing
Pulmonary Function Testing Let s catch our breath Eddie Needham, MD, FAAFP Program Director Emory Family Medicine Residency Program Learning Objectives The Astute Learner will: Become familiar with indications
More informationDr. Akanksha Kaushal Physiotherapist, District Early Intervention Programme National Health Mission, Ambikapur, Chattisgarh, India
(Volume2, Issue6) Available online at www.ijarnd.com Evaluation of Peak Expiratory Flow Rate and Forced Expiratory Volume in One Second in Indian Children with Suspected Asthma Dr. Akanksha Kaushal Physiotherapist,
More informationAsthma in Pregnancy. Asthma. Chronic Airway Inflammation. Objective Measures of Airflow. Peak exp. flow rate (PEFR)
Chronic Airway Inflammation Asthma in Pregnancy Robin Field, MD Maternal Fetal Medicine Kaiser Permanente San Francisco Asthma Chronic airway inflammation increased airway responsiveness to a variety of
More informationIs reslizumab effective in improving quality of life and asthma control in adolescent and adult patients with poorly controlled eosinophilic asthma?
Philadelphia College of Osteopathic Medicine DigitalCommons@PCOM PCOM Physician Assistant Studies Student Scholarship Student Dissertations, Theses and Papers 2018 Is reslizumab effective in improving
More informationAcute Asthma in the Emergency Room
Acute Asthma in the Emergency Room José A. Castro-Rodríguez, MD, PhD Escuela de Medicina Pontificia Universidad Católica de Chile Potential ConConflict of Interest: In the last three years, I received
More informationInternational Journal of Medical Research & Health Sciences
International Journal of Medical Research & Health Sciences www.ijmrhs.com Volume 2 Issue 3 July - Sep Coden: IJMRHS Copyright @2013 ISSN: 2319-5886 Received: 23 th May 2013 Revised: 24 th Jun 2013 Accepted:
More informationS P I R O M E T R Y. Objectives. Objectives 2/5/2019
S P I R O M E T R Y Dewey Hahlbohm, PA-C, AE-C Objectives To understand the uses and importance of spirometry testing To perform spirometry testing including reversibility testing To identify normal and
More informationSPIROMETRY TECHNIQUE. Jim Reid New Zealand
Jim Reid New Zealand The Basics Jim Reid Spirometry measures airflow and lung volumes, and is the preferred lung function test in COPD. By measuring reversibility of obstruction, it is also diagnostic
More informationThe adult therapeutic substitution protocol follows:
Therapeutic Substitution of Albuterol - Implemented 1/15/2013 After years of evaluation, comparative studies have not consistently demonstrated clinical or safety advantages of levalbuterol over racemic
More informationThe study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not
The study listed may include approved and non-approved uses, formulations or treatment regimens. The results reported in any single study may not reflect the overall results obtained on studies of a product.
More information