scholarly journals Comparison of Intramuscular Betamethasone and Oral Pprednisone in the Prevention of Relapse of Acute Asthma

2001 ◽  
Vol 8 (3) ◽  
pp. 147-152 ◽  
Author(s):  
John S Chan ◽  
Robert L Cowie ◽  
Gerald C Lazarenka ◽  
Cinde Little ◽  
Sandra Scott ◽  
...  
Keyword(s):  
Relapse Rate ◽  
Intramuscular Injection ◽  
Inhaled Corticosteroids ◽  
Acute Asthma ◽  
Oral Prednisone ◽  
Double Blind ◽  
Intention To Treat ◽  
Single Intramuscular Injection ◽  
Acute Exacerbations ◽  
Long Acting

OBJECTIVE: To compare the relapse rate after a single intramuscular injection of a long acting corticosteroid, betamethasone, with oral prednisone in patients discharged from the emergency department (ED) for acute exacerbations of asthma.PATIENTS AND METHODS: Patients with acute exacerbations of asthma who were suitable for discharge from the ED were enrolled in a double-blind, randomized, placebo controlled pilot study. At discharge, patients were randomly assigned to receive either intramuscular betamethasone 12 mg and placebo capsules, or a placebo intramuscular injection and prednisone 50 mg daily for seven days. At days 7 and 21, patients were contacted by telephone to determine relapse. Relapse was defined as an unscheduled visit to a physician for treatment of continuing or worsening symptoms of asthma.RESULTS: One hundred and seventy-one patients were enrolled, of whom 87 were randomly assigned to the betamethasone group and 84 to the prednisone group. Baseline char- acteristics were matched evenly between the groups, with the exception of asthma duration (15.5 versus 21.2 years, respectively) and use of inhaled corticosteroids (46% versus 64.3% respectively) (P<0.05). Using intention-to-treat analysis, the relapse rates for betamethasone and prednisone at day 7 were 14.9% (13 of 87 patients) and 25% (21 of 84 patients), respectively (P=0.1), and at day 21, the rates were 36.8% (32 of 87 patients) and 31% (26 of 84 patients), respectively (P=0.4). There were no differences in symptom score, peak flows and adverse effects between the two groups at days 7 and 21.CONCLUSIONS: A single dose of intramuscular betamethasone 12 mg was safe and as efficacious as prednisone in preventing the relapse of acute asthma. There was a trend toward a reduced relapse rate at seven days. In select ED patients discharged for acute asthma, intramuscular betamethasone may be an effective alternative to prednisone.

scholarly journals A Randomised Controlled Trial of High Dose, Inhaled Budesonide Versus Oral Prednisone in Patients Discharged from the Emergency Department following an Acute Asthma Exacerbation

2000 ◽  
Vol 7 (1) ◽  
pp. 61-67 ◽  
Author(s):  
J Mark FitzGerald ◽  
David Shragge ◽  
Jennifer Haddon ◽  
Barbara Jennings ◽  
Joanna Lee M Math ◽  
...  
Keyword(s):  
Emergency Department ◽  
Relapse Rate ◽  
Acute Asthma ◽  
Controlled Trial ◽  
Oral Prednisone ◽  
Final Visit ◽  
High Dose ◽  
Forced Expiration ◽  
Double Blind

OBJECTIVE:Prednisone (PRED) is recommended at discharge to reduce the relapse rate following emergency treatment for an asthmatic attack. However, PRED has systemic side effects. Inhaled anti-inflammatory medications, such as budesonide (BUD), are well tolerated. This study was designed to compare the effectiveness of PRED and BUD on relapse rate.DESIGN:A prospective, randomized, double-blind, double dummy, parallel group design.SETTING:Tertiary referral emergency departments.POPULATION STUDIED:One hundred and eighty-five patients with acute asthma who received standard treatment with bronchodilators and systemic glucocorticosteroids in the emergency department, had a forced expiration volume in 1 s (FEV1) greater than 50% predicted and who were deemed well enough to be discharged from the emergency department.INTERVENTION:Patients were randomized to receive either BUD Turbuhaler 600 µg qid or PRED 40 mg in the morning for seven to 10 days. At discharge and final visit, symptoms, medication use, FEV1,peak expiratory flow (PEF) and quality of life (QoL) were assessed. Relapse rate to the emergency department during the follow-up was determined by a yes and/or no questionnaire.MAIN RESULTS:The PRED (n=85) and BUD (n=90) treatment groups were comparable at baseline (emergency department discharge) for age (mean ± SD; 27.6±8.5 years and 29.2±8.7 years) and prebronchodilator FEV1(1.77±0.79 L and 1.75±0.78 L), respectively. BUD was at least as effective as PRED in preventing a relapse to the hospital; relapse rate was 10 (11.8%) during PRED treatment and nine (10.0%) for BUD treatment (95% CI PRED-BUD, -7.5% to 11.0%). Improvements in FEV1, asthma symptoms, PEF and QoL were not significantly different between treatments.CONCLUSIONS:In  patients whose acute asthma has been stabilized in the emergency department, high dose BUD may be an alternate to PRED as a follow-up treatment.

scholarly journals Maintained therapeutic effect of revefenacin over 52 weeks in moderate to very severe Chronic Obstructive Pulmonary Disease (COPD)

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
James F. Donohue ◽  
Edward Kerwin ◽  
Sanjay Sethi ◽  
Brett Haumann ◽  
Srikanth Pendyala ◽  
...  
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Health Outcomes ◽  
Pulmonary Disease ◽  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Chronic Obstructive ◽  
Open Label ◽  
Double Blind ◽  
Obstructive Pulmonary Disease ◽  
Long Acting

Abstract Background Revefenacin is a long-acting muscarinic antagonist that was recently approved for the nebulized treatment of chronic obstructive pulmonary disease (COPD). Although shorter duration studies have documented the efficacy of revefenacin in COPD, longer-term efficacy has not been described. In a recent 52-week safety trial, revefenacin was well tolerated and had a favorable benefit-risk profile. Here we report exploratory efficacy and health outcomes in patients receiving revefenacin 175 μg or 88 μg daily during the 52-week trial. Methods In this randomized, parallel-group, 52-week trial (NCT02518139), 1055 participants with moderate to very severe COPD received revefenacin 175 μg or 88 μg in a double-blind manner, or open-label active control tiotropium. Results Over the 52-week treatment period, both doses of revefenacin, as well as tiotropium, elicited significant (all p < 0.0003) improvements from baseline in trough forced expiratory volume in 1 s (FEV1). The trough FEV1 profile (least squares mean change from baseline) for revefenacin 175 μg ranged from 52.3–124.3 mL and the trough FEV1 profile for tiotropium ranged from 79.7–112.8 mL. In subgroup comparisons, the effect of revefenacin on trough FEV1 was comparable in patients taking concomitant long-acting β-agonists, with or without inhaled corticosteroids, with patients who were not taking these medications. There were statistically significant (p < 0.05) improvements in all measured health status outcomes (evaluated using St. George’s Respiratory Questionnaire, COPD Assessment Test, Clinical COPD Questionnaire and Baseline and Transition Dyspnea Index) from 3 months onward, in all treatment arms. Conclusions Significant sustained improvements from baseline in trough FEV1 and respiratory health outcomes were demonstrated for 175-μg revefenacin over 52 weeks, further supporting its use as a once-daily bronchodilator for the nebulized treatment of patients with COPD. Trial registration NCT02518139; Registered 5 August 2015.

Acute Asthma Therapy

1996 ◽  
Vol 17 (11) ◽  
pp. 404-404
Keyword(s):  
Inhaled Corticosteroids ◽  
Acute Asthma ◽  
Current Treatment ◽  
Asthma Therapy ◽  
Concerted Effort ◽  
Inhaled Steroids ◽  
Acute Exacerbations ◽  
Asthma In Children ◽  
Exercise Induced

A reader noted: "I am surprised to find no mention of inhaled steroids in the article by Drs. Murphy and Kelly `Advances in Management of Acute Asthma in Children' (July 1996). Their article is the only one I have come across that avoids mentioning the use of inhaled corticosteroids in children during the last 4 to 5 years when there seems to be a concerted effort to get pediatricians to use them." Drs. Kelly and Murphy respond: "We appreciate your concerns about our lack of discussion of inhaled corticosteroids. However, our charge for the article was to review the current treatment of acute exacerbations of asthma, including exercise-induced bronchospasm.

Single-Dose Intramuscular Ceftriaxone for Acute Otitis Media in Children

PEDIATRICS ◽  
1993 ◽  
Vol 91 (1) ◽  
pp. 23-30
Author(s):  
Steven M. Green ◽  
Steven G. Rothrock
Keyword(s):  
Single Dose ◽  
Confidence Interval ◽  
Otitis Media ◽  
Intramuscular Injection ◽  
Acute Otitis Media ◽  
Oral Suspension ◽  
Double Blind ◽  
Double Blind Clinical Trial ◽  
Single Intramuscular Injection

This study evaluated the efficacy of a single dose of intramuscular ceftriaxone for acute otitis media in children, using amoxicillin as a control. (There is currently no established single-dose treatment for this condition.) In a prospective, randomized, double-blind, clinical trial, 233 children, aged 5 months to 5 years, with uncomplicated acute otitis media were randomly assigned to receive either a single intramuscular injection of ceftriaxone (50 mg/kg) plus placebo oral suspension for 10 days, or a placebo injection plus amoxicillin oral suspension (40 mg/kg per day divided three times per day) for 10 days in a double-blind fashion. Demographic and clinical characteristics were similar in both groups. Treatment was successful in 107 of 117 given amoxicillin (91%, 95% confidence interval 86% to 97%) and 105 of 116 given ceftriaxone (91%, 95% confidence interval 85% to 96%). Rates of improvement, failure, relapse, and reinfection were similar in both groups, as were the otoscopic and tympanometric evaluations at the 14- and 60-day follow-up visits. It is concluded that a single intramuscular injection of ceftriaxone (50 mg/kg) is as effective as 10 days of oral amoxicillin for the treatment of uncomplicated acute otitis media in children.

A Comparative Trial of Minocin (Minocycline Hydrochloride) and Ampicillin in the Treatment of Acute Exacerbations of Chronic Bronchitis

1975 ◽  
Vol 3 (5) ◽  
pp. 304-308 ◽  
Author(s):  
G R F Burrow ◽  
A S Fox ◽  
R J E Daniel
Keyword(s):  
Clinical Trial ◽  
Side Effects ◽  
Chronic Bronchitis ◽  
Therapeutic Efficacy ◽  
Comparative Trial ◽  
Double Blind ◽  
Significant Difference ◽  
Acute Exacerbations ◽  
Minocycline Hydrochloride ◽  
Long Acting

One hundred and fifteen patients suffering from acute exacerbations of chronic bronchitis took part in a double-blind, multicentre, clinical trial designed to compare the therapeutic efficacy and tolerability of ampicillin and minocycline hydrochloride, a new, long-acting, semi-synthetic tetracycline. Both antibiotics were equally successful in treatment, there being no statistically significant difference between the two in any of the parameters studied. Side-effects were few and far between. Only one patient out of the 57 who took minocycline, complained of dizziness.

β 2-Adrenoceptor polymorphism and bronchoprotective sensitivity with regular short- and long-acting β2-agonist therapy

1999 ◽  
Vol 96 (3) ◽  
pp. 253-259 ◽  
Author(s):  
B. J. LIPWORTH ◽  
I. P. HALL ◽  
I. AZIZ ◽  
K. S. TAN ◽  
A. WHEATLEY
Keyword(s):  
Inhaled Corticosteroids ◽  
Forced Expiratory Volume ◽  
Double Blind ◽  
Geometric Means ◽  
Once Daily ◽  
Regular Treatment ◽  
Parallel Group ◽  
Long Acting ◽  
To Receive ◽  
Β2 Agonist

The aim of the present study was to investigate bronchoprotective sensitivity in patients receiving regular treatment with short- and long-acting β2-agonists and to evaluate any possible association with genetic polymorphism. Thirty-eight patients with stable mild to moderate asthma and receiving inhaled corticosteroids were randomized in a parallel group, double-blind, double-dummy fashion to receive 2 weeks of treatment with either formoterol (12μg once daily, 6μg twice daily or 24μg twice daily) or terbutaline (500μg four times daily). Bronchoprotection against methacholine challenge (as a provocative dose to produce a 20% fall in forced expiratory volume in 1.0 ;s: PD20) was measured at baseline (unprotected) after an initial 1 week run-in without β2-agonist, and at 1 ;h after the first and last doses of each treatment. The PD20 values were log-transformed and calculated as change from baseline. Percentage desensitization of log PD20 for first- versus last-dose bronchoprotection was calculated and analysed according to effects of treatment and β2-adrenoceptor polymorphism at codon 16 or 27. The mean degree of desensitization for bronchoprotection was comparable with all four treatments and there were no significant differences in absolute PD20 values after 2 weeks of chronic dosing. The PD20 values were (as μg of methacholine, geometric means±S.E.M.): formoterol, 12μg once daily, 99±42μg; formoterol, 6μg twice daily, 107±44μg; formoterol, 24μg twice daily, 108±45μg; terbutaline, 500μg four times daily, 88±37μg. All patients receiving formoterol, 24μg twice daily, exhibited a loss of protection greater than 30% which was unrelated to polymorphism at codon 16 or 27. For codon 16, the use of lower doses of formoterol (12μg once daily or 6μg twice daily) showed wider variability in the propensity for protection loss in patients who were heterozygous, in contrast to a more uniform protection loss seen with homozygous glycine patients. The amount of protection loss was not significantly related to polymorphism at codon 16 or 27, expressed as values (mean±S.E.M.) for percentage desensitization according to each genotype (pooled treatments): Gly-16, 66±11%; Het-16, 53±8%; Arg-16, 69±18%; Glu-27, 68±12%; Het-27, 58±8%; Gln-27, 52±12%. The results of this preliminary study showed that bronchoprotective desensitization occurred readily in response to short- or long-acting β2-agonist exposure irrespective of β2-adrenoceptor polymorphism at codon 16 or 27. Further studies with larger patient numbers are required to further evaluate the effects of polymorphisms with lower doses of regular formoterol.

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