Respiratory drugs, inhalers and nebulisers
Information on the use of respiratory medicines in the UK (2010):
www.impressresp.com/LinkClick.aspx?fileticket=9S_oJrfujwQ%3d&tabid=77
AARC Clinical Practice Guideline (1995) Assessing response to bronchodilator therapy at point of care. Respir Care, 40, 12, 13001307
www.rcjournal.com/cpgs/arbdcpg.html
ERS GUIDELINES on the use of NEBULISERS. Boe J et al (2001) European Respiratory Society Guidelines on the use of nebulizers. Euro Respir J, 18, 228-42
www.ers-education.org/pages/default.aspx?id=2006&idBrowse=37490&det=1
Abelson JL (1996) Respiratory psychophysiology and anxiety. Psychosom Med, 58, 302-13
doxapram can cause panic attacks
Adnet F et al (2001) Complication profiles of adult asthmatics requiring paralysis during mechanical ventilation. Int Care Med, 27, 1729-36
neuromuscular blocking agents increase complications in ventilated asthmatics
Angus (1996) Comparison of the acute effects on gas exchange of nasal ventilation and doxapram in exacerbations of COPD. Thorax, 51, 1048-50.
doxapram is unsuited to ventilatory failure caused by fatigue
Argyropoulou P (1993) Buspirone effect on breathlessness and exercise in patients with COPD. Respiration, 60, 216-20.
buspirone reduces SOB and increases exercise tolerance, without sedation effects
Ashfield TA, Syddall HE, Martin HJ (2010) Grip strength and cardiovascular drug use in older people. Age Ageing, 39, 185-91
ageing.oxfordjournals.org/cgi/content/abstract/39/2/185
some cardiac drugs (furosamide, nitrates and calcium channel blockers) are associated with reduced grip strength
Barnes PJ (1995) COPD. Update, 51,91-7.
respiratory stimulants may override the protective function of fatigue
Bauer A, McGlynn P, Bovet LL (2009) The influence of breathing pattern during nebulization on the delivery of arformoterol using a breath simulator. Respir Care, 54, 11, 1488-92
a long inspiratory pause increases inhaled dose
Bolland MJ, Barber PA, Doughty RN (2010) Vascular events in healthy older women receiving calcium supplementation. BMJ, 341:c3691
www.bmj.com/cgi/content/full/341/jul29_1/c3691
meta-analysis of 11 RCTs showed calcium supplements (not co-administered with vitamin D) to be associated with approx 30% increase in incidence of MI (particularly in subjects with above-average dietary intake of calcium), though no individual trial reported a statistically significant effect
confirmation that calcium supplements increase bone density.
Brijker F et al (2002) Discontinuation of furosemide decreases PaCO2 in patients with COPD. Chest, 121, 377-82.
stable COPD patients showed an increase in ventilation and a reduction in PaCO2 when their furosemide was stopped.
Britton J (2000) Interferon gamma-1b therapy for cryptogenic fibrosing alveolitis. Thorax, 55 (suppl.1), 537-40
interferon + steroids can lead to substantial improvement in CFA
Calverley P (2005) Long-acting inhaled bronchodilators in COPD. Eur Respir J, 26, 190 1
erj.ersjournals.com/cgi/content/full/26/2/190
atrovent should be given in higher-than-recommended doses
Casaburi R, Kukafka D, Cooper CB et al (2005) Improvement in exercise tolerance with the combination of tiotropium and pulmonary rehabilitation in patients with COPD. Chest, 127, 80917
www.chestjournal.org/cgi/content/abstract/127/3/809
Cates CJ, Bara A, Crilly JA, Rowe BH (2003) Holding chambers versus nebulisers for beta-agonist treatment of acute asthma. Cochrane Issue 2
www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD000052/frame.html
metered-dose inhaler with spacer performs at least as well as wet nebulisation in delivering beta2-agonists in acute asthma.
Cazzola M (2006) Should the choice of a long-acting bronchodilator in the long-term therapy of COPD depend entirely on the onset of action? Respiration, 73, 410-11
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ProduktNr=224278&Ausgabe=231972&ArtikelNr=93346&filename=93346.pdf
FEV1 is only weakly correlated with patient-centered outcomes such as dyspnoea
tiotropium reduces lung hyperinflation
tolerance to bronchodilation occurs with long-acting beta2-agonists
Charan NB (2001) Does Sildenafil also improve breathing? Chest, 120, 305 - 6
Viagra may reduce breathlessness and pulmonary hypertension in COPD patients
Chowdhury BA et al (2011) Assessing the safety of adding LABAs to inhaled corticosteroids for treating asthma. N Engl J Med, 364, 2473-2475
long-acting beta-agonists have been associated with serious adverse outcomes such as asthma-related hospitalization, need for intubation and death.
Chung KF (2005) Drugs to suppress cough. Expert Opinion on Investigational Drugs, 14, 1, 19-27(9)
www.ingentaconnect.com/content/apl/eid/2005/00000014/00000001/art00002
Colice GL (2009) Getting back to the basics: administering inhaled bronchodilators. Respir Care, 54, 4, 455-7
Cooper CB, Decramer M (2008) Inhaled steroids and COPD. Eur Respir J, 32, 2, 5234
erj.ersjournals.com/cgi/content/full/32/2/523
trials of tiotropium might be subject to bias due to withdrawal of previously prescribed anticholinergics
Corsico (1993) Anti-asthma drugs and quality of life. Eur Resp Rev, 3, 366-8
intal or tilade may take 4/52 to show effect in 33% of pts, 12/52 to show effect in 84% of pts
Currie GP. Douglas, JG (2006) Oxygen and inhalers. BMJ, 333, 34-36
www.bmj.com/cgi/content/extract/333/7557/34
Daviskas E (1997) Inhalation of dry-powder mannitol increases mucociliary clearance. Eur Resp J, 10, 2449-54
Demedts M (2005) High-dose acetylcysteine in idiopathic pulmonary fibrosis. N Engl J Med, 353, 2229-42
www.nejm.org/doi/pdf/10.1056/NEJMoa042976
600 mg tds, added to prednisone and azathioprine, preserves vital capacity and diffusion capacity
Dicpinigaitis (1998) Treatment of chronic refractory cough with baclofen. Respiration, 65, 86-8
Dorisanne D (2003) Aerosol delivery and modern mechanical ventilation. Am J Respir Crit Care Med, 168, 1205-9
Drugs & Ther.Bulletin (1997) Long-acting β2-stimulants in asthma. 35, 1-4
regular β2-stimulants show worse control of asthma than Intal, Tilade or inhaled steroids
Drummond MB, Dasenbrook EC, Pitz MW et al (2008) Inhaled corticosteroids in patients with stable COPD: a systematic review and meta-analysis. JAMA, 300(20): 24072416
jama.ama-assn.org/cgi/content/abstract/300/20/2407
inhaled steroids do not reduce mortality in COPD and are associated with higher risk of pneumonia
Eurich DT (2010) Recurrent community-acquired pneumonia in patients starting acid-suppressing drug. Am J Med, 123, 1, 47-53
www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6TDC-4Y0T775-D&_user=5942824&_coverDate=01%2F31%2F2010&_rdoc=13&_orig=browse&_srch=doc-info%28%23toc%235195%232010%23998769998%231578166%23FLA%23display%23Volume%29&_cdi=5195&_sort=d&_docanchor=&_ct=27&_acct=C000050221&_version=1&_urlVersion=0&_userid=5942824&_fmt=full&md5=02669f10f7d81d6f9a454ed763b763fe#sec4
anti-acid drugs increase the risk of nosocomial pneumonia
Feldman G, Siler T, Prasad N (2010) Efficacy and safety of indacaterol 150 μg once-daily in COPD. BMC Pulm Med, 10, 11. doi:10.1186/1471-2466-10-11
www.biomedcentral.com/1471-2466/10/11
double-blind study showing that this once-daily inhaled long-acting β2-agonist provides sustained bronchodilation with minimal side effects
Ferguson GT (2000) Update on pharmacologic therapy for COPD. Clin Chest Med, 21, 4, 723-37
β2-agonists more than standard dose may reduce quality of life.
Atrovent 2 puffs q.d.s (standard) is minimal may need 3-4 q.d.s.
Gallagher CG (1994) Respiratory steroid myopathy. Am J Resp Crit Care Med, 150, 4-6.
steroids may cause respiratory muscle atrophy which may increase SOB
Gan WQ, Man SFP, Sin DD (2005) Effects of inhaled corticosteroids on sputum cell counts in stable COPD. BMC Pulm Med, 5, 3
www.biomedcentral.com/1471-2466/5/3#B12
a trial of inhaled steroids for at least six weeks is required to identify COPD patients whose airways show a reduction in inflammation
Gerrits CMJM, Herings RMC et al (2003) N-acetylcysteine reduces the risk of re-hospitalisation among patients with COPD. Eur Respir J, 21, 795-8
erj.ersjournals.com/cgi/content/abstract/21/5/795
N-acetylcysteine reduces risk of re-hospitalisation for COPD by 30%
Gillissen A (2008) Is Salmeterol/Fluticasone Propionate equivalent to Tiotropium Bromide in the treatment of COPD? Am J Respir Crit Care Med, 178, 1, 10510
ajrccm.atsjournals.org/cgi/content/full/178/1/105
Seretide and tiotropium are equally efficacious
Girault C (1996) Effects of repeated administration of zolpidem on sleep, respiratory function, vigilance and physical performance. Chest, 110, 1203-11
www.chestjournal.org/cgi/reprint/110/5/1203?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&andorexactfulltext=and&searchid=1&FIRSTINDEX=0&sortspec=relevance&volume=110&firstpage=1203&resourcetype=HWCIT
medication to assist sleep, without affecting oxygenation or ventilation
inclusion of psychotherapy in rehab programme reduces anxiety and depression
Golab M (2007) Mechanisms involved in the anti-inflammatory action of inhaled tea tree oil in mice. Experimental Biol Med, 232, 420-26
Goldschlager N, Epstein AE, Naccarelli G (2000) Practical guidelines for clinicians who treat patients with amiodarone. Arch.Int,Med, 160, 1741-8
amiodarone can cause pulmonary fibrosis
Gross NJ (2004) Tiotropium bromide. Chest, 126, 1946 53
www.chestjournal.org/cgi/content/abstract/126/6/1946
tiotropium is a once-daily anticholinergic which decreases breathlessness, ¬increases quality of life and decreases exacerbations
Gross CA, Bowler RP, Green RM (2010) Beta2-agonists promote host defense against bacterial infection in primary human bronchial epithelial cells. BMC Pulm Med, 10, 30. doi:10.1186/1471-2466-10-30
www.biomedcentral.com/content/pdf/1471-2466-10-30.pdf
Heslop K, Harkawat R (2000) Nebulizer therapy from a practical perspective. Eur Resp J, 10, 213-15
Holgate ST (1996) Inhaled sodium cromoglycate. Respir Med, 90, 387-90
Intal is effective in 70% of asthma patients
Houtmeyers E, Gosselink R, Gayan-Ramirez G (1999) Effects of drugs on mucus clearance. Eur Resp J, 14, 452-67
www.erj.ersjournals.com/content/14/2/452.full.pdf+html
Huib AMK (1999) Stable COPD. BMJ, 319, 495-500
bronchodilators should be used according to need, not continuously
Korhonen K (1999) Lung function in school-aged asthmatic children with inhaled cromoglycate, nedocromil and steroid therapy. Eur Resp J,13, 82-6
70% of children can be treated with chromones and avoid steroids
Lanes SF (2002) Respiratory medications and risk of asthma death. Thorax, 57, 683-6
excessive use of short-acting β2-agonists increase risk of death
Light RW (1989) Effects of oral morphine on breathlessness and exercise tolerance in patients with COPD. Am Rev Respir Dis, 139, 126-33.
Lee TA, Weiss KB (2005) Fracture risk associated with inhaled corticosteroid use in COPD. Am J Respir Crit Care Med, 169, 855-9
inhaled steroids in high doses increase fracture risk
Liu C, Douglas RM (1998) Chinese herbal medicines in the treatment of acute respiratory infections. MedJAust, 169, 579-82
Chinese herbal medicines are effective in lower respiratory tract infections
NeLH (2002) Aspirin may reduce the risk of developing lung cancer. National electronic Library For Health (www.nelh.nhs.uk)
Nichols GA, Wang F, Pedula KL (2010) Comparison of evidence-based versus nonevidence-based pharmacotherapy on the risk of cardiovascular hospitalization and all-cause mortality among patients with established cardiovascular Disease. Am J Cardiol, 105, 6, 786-91
www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%234876%232010%23998949993%231783208%23FLA%23&_cdi=4876&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=2e0dd6b645177674dda40952fe70410d
mortality in people with cvd is reduced by aspirin/antiplatelets, statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, or β blockers
Nursing2002. Reviewing common cardiovascular drugs. Nursing2002, 32, 3, 56-7
tabulated presentation with action, indications and side effects
ODonnell V (1998) The pharmacological management of respiratory tract secretions. Intern J Pall Nurs, 4, 4, 199-203
O'Donnell DE, Lam M, Webb KA (1999) Spirometric correlates of improvement in exercise performance after anticholinergic therapy in COPD. Am J Respir Crit Care Med, 160, 5429
ajrccm.atsjournals.org/cgi/content/full/160/2/542?maxtoshow=&HITS=10&hits=10&RESULTFORMAT=&titleabstract=Spirometric+Correlates+of+Improvement+in+Exercise+Performance+after+Anticholiner&searchid=1122747740266_1667&stored_search=&FIRSTINDEX=0&journalcode=ajrccm
high-dose atrovent allows hyperinflated lungs to deflate enough to improve exercise tolerance in COPD
Palatnik AM (2001) How cardiac drugs do what they do. Nursing2001, 31, 5, 54-60
mechanism of action, including useful tabular presentation
Piιrart F, Wildhaber JH, Vrancken I (1999) Washing plastic spacers in household detergent reduces electrostatic charge. Eur.Resp.J, 13, 673-8
wash large spacers with detergent without rinsing, then air-dry
Postma (1991) Inhaled therapy in COPD. Respir Med, 85, 447-49.
regular β2-agonists may worsen the course of COPD
Rabe KF (2010) Anticholinergic drugs for the treatment of COPD are safe are they? Chest, 137, 1-3
Rubin BK (2002) The pharmacologic approach to airway clearance. Respir Care, 47, 818-22
classification of mucoactive agents
Satya K (2004) Prescription of oxygen therapy and nebuliser driving gas. Eur Respir J, 24: Suppl. 48, 229s
www.ersnet.org/ers/lr/browse/media.aspx?id_dossier=15814&id_fiche=119751
the driving gas should be prescribed
Setoguchi S, Higgins JM, Mogun H (2010) Propranolol and the risk of hospitalized myopathy: translating chemical genomics findings into population-level hypotheses. Am Heart J, 159, 3, 428-433
www.sciencedirect.com/science?_ob=PublicationURL&_tockey=%23TOC%236683%232010%23998409996%231783274%23FLA%23&_cdi=6683&_pubType=J&_auth=y&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=a1865c9bbed6eee4d2a3324d0aa44cf1
propranolol may be associated with a 45% increased risk of myopathy in the elderly.
NEW
Singanayagam A, Chalmers JD, Hill AT (2010) Inhaled corticosteroids and risk of pneumonia: evidence for and against the proposed association. QJM, 103, 6, 37985
qjmed.oxfordjournals.org/cgi/content/abstract/103/6/379
pro and con arguments for the association between inhaled steroids and increased pneumonia risk
Singh S (2008) Inhaled anticholinergics and risk of major adverse cardiovascular events in patients with COPD. J Am Med Ass, 300, 12, 1439-50
inhaled anticholinergics are associated with a significantly increased risk of cardiovascular death, MI, or stroke among patients with COPD.
BUT ABOVE IS DISPUTED BY VINCKEN et al, BELOW.
Singh S, Loke YK, Enright PL, Furberg CT (2011) Mortality associated with tiotropium mist inhaler in patients with chronic obstructive pulmonary disease. BMJ, 342, d3215
www.bmj.com/content/342/bmj.d3215.full?sid=0bf6e6a3-3dab-4dc0-961f-69b702b23d6b
meta-analysis indicating a 52% increased risk of mortality associated with tiotropium via Respimat inhaler in people with COPD
Sitte T (2008) Intranasal fentanyl for episodic breathlessness. J Pain Symptom Manage, 36, 6, e3-36.
Smith JA, Redman P, Woodhead MA (1999) Antibiotic use in patients admitted with exacerbations of COPD. Eur Resp J, 13, 835-8
antibiotics show only a small benefit in acute COPD but those most likely to benefit show ¬ dyspnoea, ¬ sputum volume, ¬ sputum purulence
Spooner CH (2001) Nedocromil sodium for preventing exercise-induced bronchoconstriction. Cochrane Review, Issue 3
Stey C et al (2000) The effect of oral N-acetylcysteine in chronic bronchitis. Eur Respir J, 16, 253-62.
systematic review showing that mucolytics reduce exacerbations and improve symptoms in COPD.
Taylor DR (2000) Interactions between corticosteroids and β2 agonists. Thorax, 55, 595-602
β2-stimulants may counterbalance the benefits of steroids
Thomas S, Andrews AM, Hay NP (1999) The anti-microbial activity of maggot secretions. J.Tissue Viability, 9, 127-31
maggot therapy for antibiotic-resistant wound infections
Valacio (1994) Diuretics and ACE inhibiters. Care of the Elderly, 6,294-6.
60% serious adverse drug reactions in the elderly are due to diuretics, often given for oedema,
most cases of oedema being caused by immobility
Van Hees HWH, Dekhuijzen PLR, Heunks LMA (2009) Levosimendan enhances force generation of diaphragm muscle from patients with COPD. Am J Respir Crit Care Med, 173, 1, 41-7
inotropic drugs may improve the strength of the diaphragm
Verkindre C (2006) The effect of Tiotropium on hyperinflation and exercise capacity in COPD. Respiration, 73, 420-7
content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=224278&Ausgabe=231972&ArtikelNr=89655
Tiotropium reduces hyperinflation and improves walking distance and quality of life in patients with COPD and lung hyperinflation.
Vincken W et al (2010) The ADMIT series issues in inhalation therapy 4) How to choose inhaler devices for the treatment of COPD. Primary Care Respir J, 19, 1, 10-20
comprehensive information on drugs and delivery devices.
balanced comparison of inhalers and nebulisers.
contradicts Singh (above)
Weiner P et al (2000) The cumulative effect of long-acting bronchodilators, exercise, and inspiratory muscle training on the perception of dyspnea in patients with advanced COPD. Chest, 118, 672-8
chestjournal.chestpubs.org/content/118/3/672.full
all interventions reduced breathlessness cumulatively, inspiratory muscle training showing the greatest effect
Weinstein RS (2011) Glucocorticoid-induced bone disease. N Engl J Med, 365, 62-70
Whetstone JG (2006) Functional recovery after neuromuscular blockade in mechanically ventilated critically ill patients. Heart Lung, 35, 3, 178-89
prolonged recovery of muscle activity and extreme weakness may occur after neuromuscular blockade.
Willcox M (2005) An evaluation of tea tree oil as an alternative microbicide. Nurs Times, 101, 11, 32-3
antiseptic, antibacterial and antifungal properties of tea tree oil
Wills PJ, Cole PJ (1996) Mucolytic and mucokinetic therapy. Pulm Pharmacol, 9, 4, 197-204
Wόrtz M, Grove EL (2010) The antiplatelet effect of aspirin is reduced by proton pump inhibitors in patients with coronary artery disease. Heart, 96, 5, 368-371
heart.bmj.com/content/96/5/368.abstract
patients with CHD treated with PPIs for reflux have a reduced platelet response to aspirin
Yuksel B (1994) Comparison of the effects on lung function of two methods of bronchodilator administration. Respir Med, 88, 229-33.
inhaler better than nebuliser for neonates
CFA = cryptogenic fibrosing alveolitis
JAMA = Journal of American Medical Association
MI = myocardial infarction
RCT = randomised controlled trial
SOB = shortness of breath
tds = three times a day
Information on inhalers for patients:
www.patient.co.uk/showdoc/23069155/