Combination bronchodilator therapy for chronic obstructive pulmonary disease (COPD) is available widely throughout the world except in North America. Previous studies have yielded conflicting results regarding the advantages of combining anticholinergic therapy with sympathomimetic therapy in COPD. We report the results of a 12-week prospective, double-blind, parallel-group evaluation of the us...

An 11-year-old boy experienced almost daily wheezing, dyspnea on exertion, and sleep perturbation because of cough. In addition, nadir peak expiratory flow (PEF) was below 100 L/min, which was 30% of predicted (328 L/min),1 compatible with severe persistent asthma.2 After the initiation of therapy with 180 g of albuterol 3 times per day, the patient’s domiciliary PEF rose to 200 L/min and his s...

To the Editor Wilkinson et al. (1) recently compared racemic albuterol (RAC) 7.5 mg/h to levalbuterol (LEV) 3.75 mg/h in continuous nebulization for the treatment of acute pediatric asthma exacerbations. The trial duration was limited to 2 hours. The LEV group had significantly higher rate of controller medication use (ICS, LTRA, LABA) at baseline suggesting they are likely more severe asthmati...

The beta(2) adrenoreceptor is a large molecule of some 413 amino acids. The duration of stimulation of this receptor depends on where and for how long a beta(2) adrenergic drug attaches itself to the beta(2) adrenoreceptor. beta(2) adrenergic drugs have been used for over 5,000 years, but only recently have we had the advantage of adrenergic drugs specific to the beta(2) adrenoreceptor. The sho...

Objective: The object ive of this trial was to determine the ef f icacy of frequent nebul ized ipratropium added to high-dose albuterol therapy in chi ldren with severe asthma. Methods: One hundred twenty chi ldren (5 to 17 years) of age) with severe acute asthma ( forced expiratory volume in I second [FEV1], <50% of the predicted value) were enrol led into a randomized double-b l ind three-arm...