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Tony S Brar, Neeka Akhavan
This is a 78 year old male with a past medical history of coronary artery disease (CAD), chronic obstructive pulmonary disease (COPD), hypertension (HTN), and gastroesophageal reflux disorder (GERD) who presented to the emergency room with worsening shortness of breath (SOB) and low-grade fevers for one week prior to admission. He was originally diagnosed with healthcare associated pneumonia (HCAP) and an acute on chronic COPD exacerbation and treated with prednisone, inhalers, ipratropium/albuterol, and broad-spectrum antibiotics...
2016: Respiratory Medicine Case Reports
Kelly M Pennington, Erik K St Louis
Unilateral fixed mydriasis can be an ominous sign; however in many cases, it is benign and represents pharmacologic mediated action on the iris dilator or sphincter. Differentiation between pharmacologic mediated anisocoria and physiologic anisocoria can be challenging but may save on costly imaging. An 83 year-old woman was admitted with critical limb ischemia and subsequently developed respiratory failure treated with positive pressure ventilation and ipratropium nebulizers. She was noted to have left unilateral mydriasis without other neurologic deficits...
June 2016: General Medicine: Open Access
Jiayin Chen, Jürgen Brockmöller, Tina Seitz, Jörg König, Xijing Chen, Mladen V Tzvetkov
Tropane alkaloids and their derivatives are anticholinergic drugs with narrow therapeutic range. Here we characterize the organic cation transporters from the SLC22 (OCT1, OCT2, and OCT3) and the SLC47 families (MATE1 and MATE2-K) as potential mediators of the renal and extra-renal excretion, the two major roads of elimination of these substances. All analyzed compounds inhibited and the quaternary amine derivatives ipratropium and trospium were strongly transported by OCTs and MATEs. Overexpression of OCTs or MATEs in HEK293 cells resulted in up to 63-fold increase in the uptake of ipratropium (Km of 0...
September 27, 2016: Biological Chemistry
Steven Pascoe, Wei Wu, Chang-Qing Zhu, Dave Singh
Categorization of patients with COPD as reversible or nonreversible to a bronchodilator may change over time. This post hoc analysis aimed to determine if an individual's reversibility, when treated as a continuous variable, could predict his/her future response to two short-acting bronchodilators: albuterol and ipratropium. The analysis was completed using data from a 4-week, randomized, open-label, two-period crossover study (NCT01691482; GSK study DB2114956). Patients received albuterol (doses: UK =4×100 μg/puff; US =4×90 μg/puff) followed 1 hour later by ipratropium (4×20 μg/puff) or vice versa during treatment Period 1...
2016: International Journal of Chronic Obstructive Pulmonary Disease
F Zhao, J Yang, P Chen, Y Wang, H Zhang, Q Zhang
This study aimed to investigate the role of M3 acetylcholine receptor (M3-AChR) expression in airway remodeling. Additionally, we aimed to evaluate the effects of ipratropium bromide solution inhaled in an early phase of asthma on airway remodeling in ovalbumin (OVA)-sensitized and challenged mice. Thirty BALB/c mice were divided into three groups, namely, control group (saline sensitized/challenged mice), asthma group (OVA sensitized/challenged mice), and treatment group (OVA sensitized/challenged mice treated by ipratropium bromide)...
2016: Genetics and Molecular Research: GMR
Amal Bhattacharya, Salil Bhargava, Virendra Singh, Deepak Talwar, Jagdeep Whig, Juliet Rebello, Shrinivas Purandare, Jaideep Gogtay
BACKGROUND: The use of chlorofluorocarbons (CFCs) has contributed to the depletion of the stratospheric ozone layer resulting in serious health concerns. Ipratropium bromide/salbutamol sulphate CFC-pressurized metered-dose inhalers (IB/SAL-CFC pMDI) have been in widespread use for many years without any apparent ill consequences. This combination has now been reformulated using the hydrofluoroalkane (HFA) propellant. This study sought to establish the clinical noninferiority of a new HFA-containing IB/SAL pMDI to the conventional IB/SAL-CFC pMDI in subjects with mild/moderate COPD...
2016: International Journal of Chronic Obstructive Pulmonary Disease
Michael Hansen, Thomas Hachenberg
Treatment of patients with acute severe or life-threatening asthma in the emergency department or in rescue services is a challenge for the physician. The decision on which therapy is needed depends on the clinical assessment of severity. Early administration of bronchodilators, ipratropium bromide and oral or intravenous corticosteroids is the cornerstone of treatment. If these treatments fail, systemic administration of bronchodilators, MgSO4 and theophylline should be carried in order to avoid intubation...
June 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
H J Zar, S A Madhi, D A White, R Masekela, S Risenga, H Lewis, C Feldman, B Morrow, P Jeena
Management of acute viral bronchiolitis is largely supportive. There is currently no proven effective therapy other than oxygen for hypoxic children. The evidence indicates that there is no routine benefit from inhaled, rapid short-acting bronchodilators, adrenaline or ipratropium bromide for children with acute viral bronchiolitis. Likewise, there is no demonstrated benefit from routine use of inhaled or oral corticosteroids, inhaled hypertonic saline nebulisation, montelukast or antibiotics. The last should be reserved for children with severe disease, when bacterial co-infection is suspected...
April 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Şule Cömert, Esen Kıyan, Gülfer Okumuş, Orhan Arseven, Turhan Ece, Halim İşsever
INTRODUCTION: Conflicting results has been achieved in a small number of clinical studies evaluating the efficiency of magnesium sulphate (MS) in COPD exacerbations. We aimed to investigate the efficiency of nebulised MS in COPD exacerbations. PATIENTS AND METHODS: Twenty patients who met the study criteria were randomized into two groups. All patients were treated with O2, antibiotics and oral corticosteroids. Additionally one group received ipratropium bromide (IB) 500 µg together with MS 151 mg/dose, while the other group received IB together with placebo...
March 2016: Tüberküloz Ve Toraks
Gregory Gipson, Janet L Kelly, Christy M McKinney, Andrew A White
Current literature does not consistently show a benefit to providing medication cost information to inpatient health care prescribers. This study assessed the effectiveness of computerized provider order entry alerts that displayed the cost of a high-cost medication alongside a lower cost alternative, targeting 3 high-cost medications. Medication utilization during the one year prior to the intervention was compared to usage in the year after implementation. Reduced utilization of high-cost medications was found when comparing pre to post...
May 16, 2016: American Journal of Medical Quality: the Official Journal of the American College of Medical Quality
Suzanne Schuh, Judy Sweeney, Stephen B Freedman, Allan L Coates, David W Johnson, Graham Thompson, Jocelyn Gravel, Francine M Ducharme, Roger Zemek, Amy C Plint, Darcy Beer, Terry Klassen, Sarah Curtis, Karen Black, Darcy Nicksy, Andrew R Willan
BACKGROUND: Up to 30 % of children with acute asthma are refractory to initial therapy, and 84 % of this subpopulation needs hospitalization. Finding safe, noninvasive, and effective strategies to treat this high-risk group would substantially decrease hospitalizations, healthcare costs, and the psycho-social burden of the disease. Whereas intravenous magnesium (Mg) is effective in severe refractory asthma, its use is sporadic due to safety concerns, with the main treatment goal being to prevent intensive care unit admission...
May 24, 2016: Trials
Xiaoxi Liu, Tian Yu, Joseph E Rower, Sarah C Campbell, Catherine M T Sherwin, Michael D Johnson
BACKGROUND: Asthma is the most common pediatric chronic disease and currently affects 7.1 million children in the United States. Many children experience acute asthma exacerbations. Many children also require hospitalization despite treatment in an emergency department with current standard therapy (corticosteroids, albuterol, and ipratropium). These hospitalizations may be avoided if effective adjunctive therapies can be developed to adequately treat severe exacerbations. METHODS: Publications were searched in the PubMed database using the following keywords: magnesium AND asthma AND children AND randomized controlled trial...
May 24, 2016: Pediatric Pulmonology
R Venkatasamy, D Spina
BACKGROUND AND PURPOSE: We investigated the effectiveness of RPL554, a dual PDE3 and 4 enzyme inhibitor, on airway smooth muscle relaxation and compared it with that induced by salbutamol, ipratropium bromide, glycopyrrolate or their combination on bronchomotor tone induced by different spasmogenic agents. EXPERIMENTAL APPROACH: Guinea pig tracheal preparations were suspended under 1 g tension in Krebs-Henseleit solution maintained at 37°C and aerated with 95% O2 /5% CO2 and incubated in the presence of indomethacin (5 μM)...
August 2016: British Journal of Pharmacology
Yun Li, Yin-Huan Li, Shuo Li, Yu-Wen Luo, Rui Xiao, Yu-Xia Huang, Jin-Lun Huang, Yi-Tai Chen, Rong-Chang Zhi, Xin Chen
BACKGROUND: Conventional lung function parameters, such as forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and inspiratory capacity (IC) are often used to assess the therapeutic outcomes of bronchodilators, but they lack sensitivity. A novel indicator, namely efficiency of neural respiratory drive (NRD), may objectively evaluate the physiological changes in patients with chronic obstructive pulmonary disease (COPD). We investigated whether this indicator could be used to more accurately assess the responsiveness to inhaled bronchodilators...
May 2016: Journal of Thoracic Disease
Kanika Jetmalani, David G Chapman, Cindy Thamrin, Claude S Farah, Norbert Berend, Cheryl M Salome, Gregory G King
BACKGROUND AND OBJECTIVE: Cigarette smoke exposure increases airway smooth muscle (ASM) contractility. Abnormalities in peripheral airway function in smokers with normal spirometry could be due to the effects of ASM tone. We aimed to determine the contribution of ASM tone to peripheral airway function in smokers with normal spirometry from the response to bronchodilator (BD). METHODS: Ventilation heterogeneity in peripheral conductive (Scond) and acinar (Sacin) airways were measured in 50 asymptomatic smokers and 20 never-smokers using multiple breath nitrogen washout, before and 20 min after inhalation of 200 µg salbutamol and 80 µg ipratropium bromide...
October 2016: Respirology: Official Journal of the Asian Pacific Society of Respirology
James F Donohue, Robert Wise, William W Busse, Sandra Garfinkel, Valentina B Zubek, Mo Ghafouri, Raymond C Manuel, Rozsa Schlenker-Herceg, Eugene R Bleecker
BACKGROUND: Many patients with asthma require frequent rescue medication for acute symptoms despite appropriate controller therapies. Thus, determining the most effective relief regimen is important in the management of more severe asthma. This study's objective was to evaluate whether ipratropium bromide/albuterol metered-dose inhaler (CVT-MDI) provides more effective acute relief of bronchospasm in moderate-to-severe asthma than albuterol hydrofluoroalkaline (ALB-HFA) alone after 4 weeks...
2016: BMC Pulmonary Medicine
Fernando Rodríguez-Ramos, Miguel Ángel Andrade-Moreno, Alejandro Alfaro-Romero, José Luis Balderas-López, Andrés Navarrete
OBJECTIVE: This work was aimed to investigate the pharmacodynamic interactions between gnaphaliins A and B with ipratropium bromide (IBR) and salbutamol (SAL) using the guinea pig trachea model through application of the combination index (CI)-isobologram equation. METHODS: The guinea pig trachea rings in isolated chamber with Krebs-Henseleit solution (37°C) were contracted with carbachol (3 μm), and then, concentration-relaxant effect curves were constructed for individual drugs and in combination at fixed constant ratios (1 : 1, 3 : 1 and 1 : 3)...
April 2016: Journal of Pharmacy and Pharmacology
Ariel Berlinski, Brandy Cooper
BACKGROUND: Some pediatric tracheostomized patients who receive inhaled drugs undergo decannulation, and it is unknown whether the dose has to be adjusted. Pressurized metered-dose inhalers (pMDIs) and soft mist inhalers (SMIs) used with valved holding chambers (VHCs) made of non-electrostatic material are available. We hypothesized that using an SMI and changing the delivery route from tracheostomy to oronasal would increase lung dose. METHODS: Four units of a metallic VHC were studied with albuterol hydrofluoroalkane (pMDI) and albuterol/ipratropium bromide with an SMI using an anatomically correct in vitro model of a 5-y-old spontaneously breathing tracheostomized child...
July 2016: Respiratory Care
Bilquis Naeem Memon, Arit Parkash, Khalid Mahmood Ahmed Khan, Murtaza Ali Gowa, Chandra Bai
OBJECTIVE: To compare the efficacy of nebulised salbutamol alone and in combination with ipratropium bromide in acute severe asthma in children. METHODS: The randomised controlled trial was conducted at the National Institute of Child Health, Karachi, from October 2012 to March 2013, and comprised patients with acute severe asthma who were randomised into two equal groups. Group A patients received 3 doses of nebulised salbutamol alone (0.03 ml/kg/dose) at 15-minute intervals and Group B received 3 similar doses of salbutamol along with ipratropium (250 ug/dose)...
March 2016: JPMA. the Journal of the Pakistan Medical Association
T R MacGregor, R ZuWallack, V Rubano, M A Castles, H Dewberry, M Ghafouri, C C Wood
The propellant-free Combivent Respimat Soft Mist Inhaler (CVT-R) was developed to replace the chlorofluorocarbon-propelled Combivent metered-dose inhaler (CVT-MDI). This steady-state pharmacokinetic (PK) substudy evaluated drug lung-delivery efficiency, using data from two phase III safety and efficacy trials. PK parameters were obtained from well-controlled population PK analyses. Area under the plasma concentration-time curve (AUC), maximum observed plasma concentration (C(max)), and minimum observed plasma concentration (C(min)) showed systemic exposure to ipratropium bromide and albuterol delivered via the CVT-R was proportional to ex-mouthpiece delivered dose...
April 2016: Clinical and Translational Science
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