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Regular Article| Volume 95, ISSUE 11, P917-921, November 2001

Formoterol Turbuhaler®for as-needed therapy in patients with mild acute exacerbations of COPD

Open ArchiveDOI:https://doi.org/10.1053/rmed.2001.1172
Formoterol Turbuhaler®for as-needed therapy in patients with mild acute exacerbations of COPD
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      Abstract

      Worsening of underlying bronchospasm may be associated with acute exacerbations of chronic obstructive pulmonary disease (COPD). As airway obstruction becomes more severe, the therapeutic option is to add a short-acting inhaledβ2 -agonist as needed to cause rapid relief of bronchospasm. Unfortunately, however, the most effective dosage may increase above that recommended during acute exacerbations. Formoterol (Oxis®) Turbuhaler®has a rapid onset of action (within minutes) and demonstrates a maintained effect on airway function. In this study, we examined the effects of formoterol used as needed in 20 patients with acute exacerbations of COPD. A dose–response curve to inhaled formoterol (9 μ g per inhalation) or placebo was constructed using three separate inhalations, i.e. a total cumulative dose of 27 μ g. Dose increments were given at 20-min intervals, with measurements being made 15 min after each dose. Formoterol, but not placebo, induced a large and significant (P<0·001) dose-dependent increase in forced expiratory volume in 1 sec (FEV1) [mean differences from baseline = 0·1311 after 9 μ g formoterol (95% Cl: 0·096–0·167)] 0·181 1 after 18μ g formoterol (95% Cl: 0·140–0·222 1) and 0·208 1 after 27 μ g formoterol (95% Cl: 0·153–0·2631). However, 27 μ g formoterol did not induce further benefit [0·0271 (95% Cl: −0·008–0·062 1);P= 0·121] when compared with 18 μ g formoterol. Results of this study suggest the use of higher than customary dose of formoterol for as-needed therapy to provide rapid relief of bronchospasm in patients suffering from acute exacerbations of partially reversible COPD.

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      References

      REFERENCES

        • Tweeddale PM
        • Alexander F
        • McHardy G JR
        Short term variability in FEV1and bronchodilator responsiveness in patients with obstructive ventilatory defects.
        Thorax. 1987; 42: 487-490
        • Ikeda A
        • Nishimura K
        • Izumi T
        Pharmacological treatment in acute exacerbations of chronic obstructive pulmonary disease.
        Drugs Aging. 1998; 12: 129-137
        • Fromm Jr, RE
        • Varon J
        Acute exacerbations of obstructive lung disease. What to do when immediate care is crucial.
        Postgrad Med. 1994; 95: 101-106
      4. Am J Respir Crit Care Med. 1995; 152: 77S-120S
        • Emerman CL
        • Cydulka RK
        Effect of different albuterol dosing regimens in the treatment of acute exacerbation of chronic obstructive pulmonary disease.
        Ann Emerg Med. 1997; 29: 474-478
        • Jaeschke R
        • Guyatt GH
        • Cook D
        The effect of increasing doses of β -agonists on airflow in patients with chronic airflow limitation.
        Respir Med. 1993; 87: 433-438
        • Newhouse N
        • Dolovich M
        Aerosol therapy: nebulized vs metered dose inhaler.
        Chest. 1987; 91: 799-800
        • Barclay J
        • Whiting B
        • Addis GJ
        The influence of theophylline on maximal response to salbutamol in severe chronic obstructive pulmonary disease.
        Eur J Clin Pharmacol. 1982; 22: 389-393
        • Prior JG
        • Cochrane GM
        Assessment of optimum dose of inhaler terbutaline in patients with chronic asthma: the use of simple cumulative dose–response curves.
        Br J Dis Chest. 1982; 72: 266-268
        • Corris PA
        • Neville E
        • Nariman S
        Dose-response study of inhaled salbutamol powder in chronic airflow obstruction.
        Thorax. 1983; 38: 292-296
        • Karpel JP
        • Pesin J
        • Gentry E
        A comparison of the effects of ipratropium bromide and metaproterenol sulfate in acute exacerbations of COPD.
        Chest. 1990; 98: 835-839
        • Lloberes P
        • Ramis L
        • Montserrat JM
        Effect of three different bronchodilators during an exacerbation of chronic obstructive pulmonary disease.
        Eur Respir J. 1988; 1: 536-539
        • Bernasconi M
        • Brandolese R
        • Poggi R
        Dose–response effects and time course of effects of inhaled fenoterol on respiratory mechanics and arterial oxygen tension in mechanically ventilated patients with chronic airflow obstruction.
        Int Care Med. 1990; 16: 108-114
        • Siefkin AD
        Optimal pharmacologic treatment of the critically ill patient with obstructive airways disease.
        Am J Med. 1996; 100: 54S-61S
        • Calverley P MA
        Symptomatic bronchodilator treatment.
        in: Calverley P MA Pride NB Chronic Obstructive Pulmonary Disease. Chapman and Hall, London1995: 419-445
        • Cazzola M
        • Spina D
        • Matera MG
        The use of bronchodilators in stable chronic obstructive pulmonary disease.
        Pulm Pharmacol Ther. 1997; 10: 129-144
        • Cazzola M
        • Matera MG
        • Santangelo G
        Salmeterol and formoterol in partially reversible severe chronic obstructive pulmonary disease: a dose–response study.
        Respir Med. 1995; 89: 357-362
        • Ullman A
        • Löfdahl CG
        • Melander B
        Formoterol inhaled as dry powder or via pressurized metered-dose inhaler in a cumulative dose–response study.
        Allergy. 1996; 51: 745-748
        • Jeppsson AB
        • Nilsson E
        • Waldeck B
        Formoterol and salmeterol are both long acting compared to terbutaline in the isolated perfused and ventilated guinea-pig lung.
        Eur J Pharmacol. 1994; 257: 137-143
        • Faulds D
        • Hollingshead LM
        • Goa KL
        Formoterol. A review of its pharmacological properties and therapeutic potential in reversible obstructive airways disease.
        Drugs. 1991; 42: 115-137
        • Ringdal N
        • Derom E
        • Wahlin-Boll E
        Onset and duration of action of single doses of formoterol inhaled via Turbuhaler.
        Respir Med. 1998; 92: 1017-1021
        • Cazzola M
        • Santangelo G
        • Piccolo A
        Effect of salmeterol and formoterol in patients with chronic obstructive pulmonary disease.
        Pulm Pharmacol. 1994; 7: 103-107
        • Maesen BL
        • Westermann CJ
        • Duurkens VA
        Effects of formoterol in apparently poorly reversible chronic obstructive pulmonary disease.
        Eur Respir J. 1999; 13: 1103-1108
      24. Thorax. 1997; 52: 1S-28S
        • Rodriguez-Roisin R
        Toward a consensus definition for COPD exacerbations.
        Chest. 2000; 117: 398S-401S
      26. Am Rev Respir Dis. 1987; 136: 1285-1298

      27. Veteran Health Administration Clinical Practice Guideline for the Management of Person with COPD or Asthma, http://www.va.gov/health/pulmonary/clin.prac/content.htm

        • Berg E
        In vitro properties of pressurized metered dose inhalers with and without spacer devices.
        J Aerosol Med. 1995; 83: 3S-10S
        • Tönnesen F
        • Laursen LC
        • Evald T
        Bronchodilating effect of terbutaline powder in acute severe bronchial obstruction.
        Chest. 1994; 105: 697-700
        • Löfdahl CG
        • Andersson L
        • Bondesson E
        Differences in bronchodilating potency of salbutamol in Turbuhaler as compared with a pressurized metered-dose inhaler formulation in patients with reversible airway obstruction.
        Eur Respir J. 1997; 10: 2474-2478
        • Borgstrom L
        • Derom E
        • Stahl E
        The inhalation device influences lung deposition and bronchodilating effect of terbutaline.
        Am J Respir Crit Care Med. 1996; 153: 1636-1640
        • Maesen FP
        • Costongs R
        • Smeets SJ
        Formoterol as dry powder inhalation.
        Chest. 1992; 101: 1376-1381

      Article info

      Publication history

      Accepted: June 28, 2001
      Received: June 11, 2001

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      DOI: https://doi.org/10.1053/rmed.2001.1172

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      © 2001 Harcourt Publishers Ltd. Published by Elsevier Inc.

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