 Clinical
characteristics of asthmatic patients prescribed various beta-agonist metered-dose
inhalers at Yamagata University Hospital.
Reference: Yakugaku Zasshi 2001;121(1):79-84.
To determine the prescription characteristics of beta-agonist metered-dose
inhalers (MDI), we
retrospectively investigated all prescriptions containing one of five types
of beta-agonist MDIs
available at Yamagata University Hospital in 1997, as well as patients'
characteristics. The total
number of asthmatic patients was 225 (age, 11-79, mean, 47.2) in 1997.
Fenoterol MDI was
prescribed to patients who visited the hospital at regular periods and
had more severe asthma.
Isoprenaline MDI also was not prescribed for first-time patients. Patients
who were prescribed
tulobuterol MDI had mild or moderate asthma and some of them were only
occasional or
first-time visitors. Salbutamol and procaterol MDIs were also prescribed
for first-time patients;
however, tulobuterol MDI was the most frequently prescribed for first-time
patients. Patients
prescribed fenoterol and isoprenaline MDIs had adequate knowledge of proper
asthma
management, because sufficient information had been provided about the
use of MDIs in the
past. Patients prescribed tulobuterol MDI should be provided with detailed
instructions because
they had little knowledge of handling MDIs and self-management of asthma
as many of them
were first or intermittent visitors. Patients prescribed salbutamol or
procaterol MDIs should be
evaluated regarding their past medications and some of them should be instructed
regarding the
use of the MDI. Although these clinical aspects might be applicable only
to our hospital, the same
or other prescription patterns will be found in other hospitals and/or
by other physicians.
Adequate instructions to individual patients who are prescribed a particular
beta-agonist MDI
should be provided by the medical staff, especially to outpatients, to
reduce hospitalization and
death from asthma.
Treatment
of intermittent claudication with pentoxifylline and cilostazol.
Reference: Am J Health Sys Pharm 2001;58(6):485-93.
The pathophysiology of intermittent claudication (IC) and the role of pentoxifylline
and cilostazol
for treating IC are discussed. IC, a result of inadequate blood flow to
the musculature, is the
primary symptom of occlusive peripheral vascular disease (PVD). Patients
with IC often have a
decreased quality of life because of mobility limitations. PVD is a sign
of generalized
atherosclerosis and increases the risk of cardiac morbidity and mortality.
Smoking, hypertension,
diabetes mellitus, and increasing age may hasten the progression of PVD.
Strategies for treating
IC are aimed at improving symptoms and reducing the progression of atherosclerosis
and include
risk-factor modification, exercise, and antiplatelet therapy. Cilostazol
and pentoxifylline are the
only two drugs with FDA-approved labeling for use in treating IC. Both
drugs have been shown
to increase pain-free walking time and total distance walked, although
there is some conflicting
evidence for pentoxifylline. Cilostazol and pentoxi-fylline are fairly
well tolerated; the most
common adverse effects involve the gastrointestinal tract and central nervous
system. Inhibitors of
cytochrome P-450 isoenzymes 3A4 and 2C19 should be used cautiously in patients
taking
cilostazol, and this drug is contraindicated in patients with congestive
heart failure. Cilostazol is
more costly than pentoxifylline. Initiation of therapy with either pentoxifylline
or cilostazol may be
reasonable if risk-factor modifications, lifestyle changes, and antiplatelet
therapy are not effective.
The mainstays of therapy for IC are risk-factor modification, exercise,
and antiplatelet therapy. If
these prove inadequate, treatment with pentoxifylline or cilostazol may
be reasonable.
Short-term
effects of branched-chain amino acids on liver function tests in cirrhotic
patients.
Reference: Southeast Asian J Trop Med Public Health 2000;31(1):152-7.
A randomized study was conducted in 29 ambulatory cirrhotic patients to
determine the
short-term effects of branched-chain amino acids (BCAA) on nutritional
status, biochemical liver
function tests and caffeine clearance. Each patient received a 4-week period
of isonitrogenous
and isocaloric regimens, either a standardized diet contained 40 g protein
with supplementation of
BCAA 150 g daily (group I) or only a standardized diet contained 80 g protein
daily (group II).
At the end of treatment, only group I showed significant improvements in
transaminase levels as
well as the caffeine clearance test compared with those of the pre-treatment
levels. Nonetheless,
significant improvements in nutritional parameters and additional liver
function tests were not yet
detected. We conclude that the short-term nutritional supplementation of
BCAA is well tolerated
and leads to improvement in hepatic metabolic capacity assessed by the
caffeine clearance test.
Regular
versus as-needed short-acting inhaled beta-agonist therapy for chronic
obstructive pulmonary disease.
Reference: Am J respir Crit Care Med 2001;163(1):85-90.
Regular short-acting inhaled beta-agonist therapy is of uncertain benefit
in patients with chronic
obstructive pulmonary disease (COPD). We conducted a randomized, concealed,
double-blind,
placebo-controlled crossover trial in two periods, each of 3-mo duration,
involving 53 patients
with a smoking history of > 20 pack-years, an FEV1 of < 70% predicted,
and an FEV1/VC
ratio of < 0.7 after inhalation of 200 microg albuterol. All patients
received regular ipratropium
bromide at 20 microg per puff in 2 puffs four times daily, beclomethasone
at 250 microg per puff
or equivalent corticosteroid in 2 puffs twice daily, and open-label inhaled
albuterol as needed.
Interventional therapy consisted of regular inhaled albuterol (100 microg
per puff, in 2 puffs four
times daily) versus placebo. Patients used twice as much active albuterol
in the regular use period
(mean: 8.07 puffs of coded and 4.68 puffs of open-label medication; total:
12.75 puffs daily) than
during the as-needed period (mean: 6.34 puffs of open-label albuterol daily).
Despite greater
beta-agonist use, patients showed similar results during treatment and
control periods for all
outcomes. Differences between active and placebo periods were: FEV1: -0.04
L (95%
confidence interval [CI]: -0.09 to 0.01 L); slow vital capacity: 0.04 L
(95% CI: -0.12 to 0.20 L);
6-min walk test distance: -3.1 m (95% CI: -16.8 to 10.5 m); and Chronic
Respiratory
Questionnaire scores for dyspnea: 0.02 (95% CI: -0.13 to 0.16); fatigue:
-0.02 (95% CI: -0.25
to 0.20); mastery: 0.01 (95% CI: -0.20 to 0.24); and emotional function:
0.02 (95% CI: -0.20 to
0.24). We found that in patients with COPD, use of regular short-acting
inhaled beta-agonists
resulted in twice as much beta-agonist use without physiologic or clinical
benefit as did use on an
as-needed basis.
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Volume
4, Number 5:May 2001
