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Pharmacodynamic effects of albuterol nebulization in hospitalized COPD‐patients because of an exacerbation with blocked gastrointestinal absorption
Author(s) -
Cromheecke H.,
Grouls R.,
Creemers J.,
Smeenk F.,
Verboom L.,
Ackerman E.
Publication year - 2002
Publication title -
british journal of clinical pharmacology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.216
H-Index - 146
eISSN - 1365-2125
pISSN - 0306-5251
DOI - 10.1046/j.1365-2125.2002.161321.x
Subject(s) - medicine , anesthesia , copd , spirometry , cardiology , asthma
Despite major improvements in drug output of new nebulizers and differences between nebulizers [1], doses of albuterol nebulizing therapy of hospitalized COPD‐patients has not changed in the last decades. The objective was to determine the optimal dose in the current setting according to a standardized protocol (10 min at flow 8 l min −1 , MICRO MIST nebulizer, Hudson RCI). After a washout of bronchodilators patients nebulized 5 mg (group A; n =21. FEV 1 =47.4 ± 2.9% predicted; Tiffeneau=48.1 ± 2.5%) or 10 mg (group B; n =21, FEV 1 =50.5 ± 3.8% predicted; Tiffeneau=49.5 ± 3.4%) albuterol ( t =−10 to 0 min). Pulmonary function (PF) (FEV 1 , FVC, Tiffeneau), dyspnoea (modified Borg scale) and heart‐frequency (HF), blood pressure (BP), breathing‐frequency (BF), serum potassium (K), fingertremor, QTc‐interval, were measured at t =−30, 10, 30, 60, 120, 240 min. Charcoal was administered to prevent gastrointestinal absorption ( t =−10; 10 min (5 g) and 60 min (10 g). Pharmacodynamic (PD)‐effects, relative to baseline, and correlation between effects, severeness of COPD and patient characteristics were analysed. FEV 1 and FVC increased significantly (FEV 1 : (A) 10–120 min; (B) 10–240 min; Figure 1), leaving Tiffeneau unchanged. FVC at t =10 is significantly greater for group B compared to A ( P =0.009). PD‐parameters ( Table 1) showed significant changes. Figure 1 Mean FEV 1 , FVC in groups A and B. ⧫▵ FEV, A, ▪▵ FEV, B, ▴▵ FVCA, *▵ FVCB.1 PD‐parameter differences relative to t =−30 min, group A and Bt =10 t =30 t =60 t =120 t =240ΔHF (beats min −1 ) A 4.1±1.5 ^ 6.0±1.9 * ^ 7.8±2.0 * 8.5±1.9 * 4.2±1.4 * B 12.5±2.6 * 15.1±3.0 * 14.0±2.4 * 10.0±2.0 * 7.6±2.3 * ΔQTc (ms) A 8.3±4.0 * ^ 6.5±9.0 ^ 28.2±8.0 * 14.3±6.0 * 7.3±4.7 B 26.0±6.0 * 30.7±6.0 * 20.0±6.8 * 16.5±5.6 * 18.0±6.3 * ΔK + (mmol l −1 ) A −0.1±0.1 −0.2±0.0 * −0.5±0.1 * −0.2±0.1 −0.1±0.1 * B −0.2±0.1 * −0.5±0.1 * −0.3±0.1 * −0.3±0.1 * −0.1±0.1*Significant within group;^significant between groups; P <0.05.All changes in group B had an earlier onset and were of the same or longer duration. Parameters not mentioned did not change clinically significant. FEV 1 ‐ and dyspnoeic‐changes and FEV 1 and FVC changes had a significant correlation in both groups. No other correlations or differences were seen. Group B shows no greater PF improvements, only significant and clinical relevant greater changes in some side effects. In moderate to severe COPD‐patients 5 mg albuterol is the highest recommended dose, lower doses should be investigated.