Archive for the ‘Asthma and Chronic Airflow Limitation’ Category - Part 3

Management of Asthma and Chronic Airflow Limitation (Part 12)

In recent years there has been increasing evidence that inhaled anticholinergic receptor antagonists such as atropine, ipratropium bromide, oxytropium bromide and atropine methonitrate may provide greater and more prolonged bronchodilatation in patients with COPD than adrenoceptor agonists. No studies have yet examined the additional clinical and physiologic benefit of theophylline when added to dose-optimized inhaled […]

Management of Asthma and Chronic Airflow Limitation (Part 11)

Two studies included in Hills review reported improved symptoms with theophylline treatment. However, there was no associated improvement in spirometry nor in exercise performance. Thus, although study patients experienced significantly less breathlessness, this was not reflected in greater functional capacity. Moreover, the small number of patients studied in both series limits the generalizability of the […]

Management of Asthma and Chronic Airflow Limitation (Part 10)

Theophylline in Stable Chronic Airflow Limitation The optimal maintenance bronchodilator treatment of COPD remains controversial. Inhaled bronchodilators and/or methylxanthines are widely used, either singly or in combination. Many patients with COPD have severe airflow limitation with symptoms of marked breathlessness and decreased exercise tolerance. Most physicians prescribe methylxanthines as first-line therapy, usually without attempting to […]

Management of Asthma and Chronic Airflow Limitation (Part 9)

These data indicate that patients with acute exacerbations of COPD may be treated effectively with a regimen of oxygen, antibiotics, corticosteroids and frequently administered, appropriately large doses of inhaled bronchodilators. Parenteral aminophylline, while adding considerably to side effects, probably confers no additional therapeutic benefit. Although bronchospasm may be partly responsible for worsening of airflow obstruction […]

Management of Asthma and Chronic Airflow Limitation (Part 8)

Aminophylline in Acute Exacerbations of COPD Patients with COPD, in severe exacerbations of their disease, are usually treated with oxygen, parenteral antibiotics and steroids, inhaled bronchodilators and intravenously administered aminophylline. The major rationale for the use of aminophylline under these circumstances is the presumption that this drug increases bronchodilatation beyond that achieved by adrenoceptor agonists […]

Management of Asthma and Chronic Airflow Limitation (Part 7)

The continued debate about which bronchodilator or bronchodilator combination is most effective for controlling chronic asthma begs the question of whether bronchodilators should ever be considered first-line therapy in these patients. Since the fundamental problem in asthma in virtually all patients is airway inflammation and bronchospasm is simply its most apparent manifestation, treating these patients […]

Management of Asthma and Chronic Airflow Limitation (Part 6)

Because cromolyn is effective, has minimal, if any, side effects, does not require the monitoring of serum concentrations and has a far greater margin of safety, it may be considered as first-line therapy together with inhaled adrenoceptor agonists to control mild to moderate asthma. Aerosol corticosteroids are more effective in the management of more severe […]

Management of Asthma and Chronic Airflow Limitation (Part 5)

A second major weakness is that although the majority of other studies employed aerosol beta agonists, the doses used may have been suboptimal. It has been shown that the dose of these drugs may need to be individualized in patients with chronic asthma. Simple cumulative dose-response curves may need to be done in these patients, […]

Management of Asthma and Chronic Airflow Limitation (Part 4)

Methylxanthines in Maintenance Therapy of Asthma Methylxanthines continue to be used by many physicians, usually in sustained-release formulations, as first-line treatment in the maintenance therapy of asthma. However, this class of drugs has numerous and commonly occurring side effects as will be discussed subsequently. Other drugs such as cromolyn and inhaled corticosteroids, which have minor […]

Management of Asthma and Chronic Airflow Limitation (Part 3)

Patients were initially evaluated in the hospital emergency room and treated with a single 15-mg dose of nebulized metaproterenol. Thirty minutes later, 44 patients who had not improved sufficiently to be discharged were entered into the study. All patients were then treated with 15 mg of inhaled metaproterenol at hourly intervals for 3 h. Furthermore, […]

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