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Effects of standard and high doses of salmeterol on lung function of hospitalized patients with cystic fibrosis
Author(s) -
Hordvik Nancy L.,
Sammut Paul H.,
Judy C. Gerald,
Colombo John L.
Publication year - 1999
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/(sici)1099-0496(199901)27:1<43::aid-ppul9>3.0.co;2-e
Subject(s) - salmeterol , medicine , placebo , bronchodilator , anesthesia , crossover study , nebulizer , morning , pulmonary function testing , salbutamol , cystic fibrosis , inhalation , asthma , alternative medicine , pathology
In a recent investigation we found that hospitalized patients with cystic fibrosis who received 0.5 cc of 0.5% albuterol nebulizer solution TID significantly increased their pulmonary function across the day, but fell back to baseline overnight. To determine whether this fall could be prevented by the long‐acting beta‐2 agonist salmeterol at both standard (2 puffs: 42 mcg BID) and high (4 puffs, 84 mcg BID) doses, we evaluated the effects of salmeterol vs. albuterol (2 puffs, 180 mcg QID, and 4 puffs, 360 mcg BID) in a placebo‐controlled three‐way random crossover, double‐blind trial. Eighteen patients in the low‐dose group and 10 of the same 18 patients in the high‐dose group completed the 3 consecutive days of testing and received either salmeterol, albuterol, or placebo with each of four chest physiotherapy sessions given at 7 am , 11 am , 3 pm , and 7 pm . At standard doses (2 puffs), the mean percent changes in FEV 1 pre‐ to post‐7 am therapy for salmeterol (5.5%) and albuterol (9.9%) were significantly greater than with placebo (−1.2%) ( P < 0.05 and 0.01, respectively). The mean percent changes in FEV 1 from morning baseline with salmeterol were also significantly greater than placebo before 3 pm (12.1% vs. 5.4%, P < 0.01), and neither albuterol nor salmeterol were significantly greater than placebo after 3 pm . At standard doses there was a significant carryover effect with salmeterol to the next morning for the FEV 1 (7.3%) when compared to placebo (1.5%) and albuterol (−0.7%) ( P < 0.05 and 0.05, respectively). At high doses (4 puffs), the mean percent change in FEV 1 with pre‐ to post‐7 am therapy increased to 22.7% and remained significantly greater than with placebo until pretherapy at 7 pm . The carryover effect the next morning was 14.7%. Salmeterol at 4 puffs compared favorably to albuterol nebulizer therapy given TID in both the incidence of responders for the FEV 1 (70% vs. 71%) and the mean changes after therapy at 7 am (22.7% vs. 14.9%), and provided greater carryover effects to the next morning (14.7% vs. −0.7%), thus preventing the fall in pulmonary function back to baseline overnight. We recommend the use of high‐dose salmeterol in hospitalized patients with FVC values of 40% of predicted or greater, starting with 2 and increasing to 4 puffs BID as tolerated. Pediatr Pulmonol. 1999; 27:43–53. © 1999 Wiley‐Liss, Inc.