VERHAMME et al. [1] recently compared the possible mortality effect of two delivery systems of tiotropium in their Dutch observational cohort study of 11 287 chronic obstructive pulmonary disease (COPD) first-time users of tiotropium in primary care. They concluded that ‘‘until further data become available, physicians should be aware that patients with arrhythmia or a history of cardiovascular...

Bronchoconstriction in bronchial asthma and chronic obstructive pulmonary disease (COPD) may be due to decreased airway calibre and/or to the inability of the airways to distend after a deep inhalation (DI). The purpose of this review is to discuss the physiological and clinical relevance of this latter mechanism. During induced constriction, DI shows remarkable bronchodilatation in normal subj...

In a double-blind, cross-over study, 9 children (7-13 yrs old) with stable, moderate asthma inhaled formoterol (6, 18 and 54 micrograms) and salbutamol (100, 300 and 900 micrograms) at hourly intervals, in order to compare the peak effect of cumulative doses of the two drugs. One hour after the last dose, 1 mg salbutamol was inhaled to ensure that maximum bronchodilatation was obtained. The for...

Theophylline (3-methyxanthine) has been used to treat airway diseases for over 70 years. It was originally used as a bronchodilator but the relatively high doses required are associated with frequent side effects, so its use declined as inhaled β₂-agonists became more widely used. More recently it has been shown to have anti-inflammatory effects in asthma and COPD at lower concentrations. The m...

Editor’s key points † Enoximone is a phospodiesterase III inhibitor, primarily used in treatment of heart failure. † The author presents a case report of eight patients with status asthmaticus refractory to treatment. † Enoximone was effective in all these patients in reversing bronchospasm. † Enoximone may have a role in refractory status asthmaticus in preventing tracheal intubation and mecha...

Airway obstruction in asthma and chronic obstructive pulmonary disease (COPD) is often associated with lung hyperinflation. In this review, we examine the mechanisms that may cause functional residual capacity (FRC), residual volume (RV) and total lung capacity (TLC) to increase during acute and chronic airway obstruction. Normally, FRC at rest is determined by the static characteristics of the...

The time course for recovery of the arterial oxygen saturation (SaO2) in acute childhood asthma is unknown. Serial measurements of SaO2 were made in 47 children during an acute attack of asthma that required admission to hospital. Adequate serial peak expiratory flow (PEF) measurements were possible in 28 children (mean age 8.3 years; group A), but not in the other 19 children (mean age 3.2 yea...

This study demonstrates a highly significant improvement in peak flow rate when terbutaline is given in a higher dose adjusted for weight than that used in adults. Peak plasma levels within a range known to be non-toxic in adults4 were reached 2 hours after the dose and only one patient complained of slight headache during this part of the study. The lower dose also improved PEFR but not signif...

Most drugs targeted to the respiratory tract are used for their local action. For example, ephidrine for nasal decongestion, beta-2 agonists for bronchodilatation, and inhaled steroids to suppress the inflammation seen in asthmatic airways. Since the drug is delivered directly to its required site, only a small quantity is needed for an adequate therapeutic response, and consequently there is a...

BACKGROUND Patients with chronic obstructive pulmonary disease (COPD) often report greater relief of breathlessness with nebulised bronchodilators than with the same medicine administered from a metered dose inhaler (MDI). This suggests that the nebulised medicines may have an effect on breathlessness over and above changes in lung function resulting from bronchodilatation. METHODS Twenty-fou...