Recommended schedule for bronchodilator therapy - Tips from Other Journals

Date: May, 1992

Inhaled [beta.sub.2]-adrenergic drugs are firstline therapy for progressive obstructive airways diseases such as asthma and chronic bronchitis. In the past, treatment emphasized the regular use of these drugs in the belief that continuous bronchodilation was important to overcome obstruction. Recent studies have raised concerns about the efficacy and safety of continuous [beta.sub.2]-adrenergic therapy, leading to recommendations that these drugs be reserved only for symptomatic relief. To compare continuous with on-demand treatment using beta2-adrenergic agents, van Schayck and colleagues studied patients with moderate airways obstruction.

The study included 223 patients from 29 general practices in the Netherlands. Patients were eligible for inclusion in the study if they could safely be treated with only bronchodilator therapy. Patients were excluded if they had other pulmonary or life-threatening diseases or if they were dependent on corticosteroids. After an eight-week washout period, patients were randomly assigned to either a continuous or on-demand treatment schedule. Two drugs were used in the study, albuterol and ipratropium. After one year, patients switched medications but remained on the same treatment schedule.

In the 160 patients who completed the study, forced expiratory volume at one second was significantly reduced in patients who used the inhaler on a prescribed schedule, compared with those who used the inhaler for symptomatic relief, regardless of the drug used. Neither regimen significantly affected the number, severity or duration of exacerbations, or patient reports of symptoms or quality of life. Patients reported a preference for albuterol, probably because of its more rapid onset of action.

The authors conclude that inhaled beta2adrenergic agents should be used for symptomatic relief in patients with moderate airways obstruction. Continuous use of these agents seems to worsen rather than improve prognosis. If patients appear to have an increased need for bronchodilators, additional treatment, such as corticosteroids, should be considered. (BMJ, December 7, 1991, vol. 303, p. 1426. )

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