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Pulmonary diseases in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Leah Lande, Abraham Sanders, Dana Zappetti
Airway inflammation is treated with inhaled corticosteroids and bronchial hyper-responsiveness is treated with short- or long-acting bronchodilators. In addition, leukotriene receptor antagonists, theophylline, and cromolyn appear to be safe during pregnancy and may be considered in select patients (21). Most data on the safety of asthma medications in pregnancy are observational, with the most extensively studied being albuterol and inhaled budesonide (21–23). Albuterol appears to be safe based on a review of six published studies including 1599 women and a prospective study including 1828 women, in whom no significant relationship was found between the use of inhaled beta-2 agonists and adverse pregnancy outcomes (21,24). The National Asthma Education and Prevention Program Working Group reviewed 10 studies, including 6113 patients who were treated with inhaled corticosteroids during pregnancy and found no increases in congenital malformations or adverse perinatal outcomes in these patients (24).
Symptom Control in Hospice-State of the Art
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
J. Cameron Muir, Lisa M. Krammer, Jacqueline R. Cameron, Charles F. von Gunten
Bronchodilators (albuterol), given orally or nebulized, are useful for bronchospasm, while the methylxanthines (aminophylline/theophylline), in addition to their bronchodilatory effect, may exert an additional benefit of stimulating the heart and improving respiratory muscle strength.30
β2-Agonists: Terbutaline, Albuterol, and Fenoterol GüNther Hochhaus and Helmut MöLlmann
Published in Hartmut Derendorf, Günther Hochhaus, Handbook of Pharmacokinetic/Pharmacodynamic Correlation, 2019
Hartmut Derendorf, Günther Hochhaus
A recent study investigated PK/PD relationships of albuterol in rabbits.128 Albuterol was given orally, intratracheally, and intravenously and the hypokalemic effects were measured. A PK/PD model, using a hypothetical effect compartment (similar to the one shown in Scheme 3a), linked plasma levels and the effects after intravenous and intratracheal administration. The mode of administration affected Emax as well as EC50. After intratracheal administration EC50 values were five times lower than after IV administration. After oral administration, the reduction in plasma potassium did not correlate with the concentration of albuterol in the effect compartment. The authors concluded that the route of administration modulates the response.
Inpatient albuterol spacing as an indicator of discharge readiness
Published in Journal of Asthma, 2023
Burton H. Shen,, Brianna Aoyama,, Brian Lee,
The institution at which this study was performed is an 87-bed, free-standing, tertiary-care pediatric hospital. The institution standard of care for patients admitted with asthma is that bronchodilators are weaned by respiratory therapists (RTs) using our institutions standard CPG. Specifically, RTs use the Pediatric Respiratory Score (PRS) to determine whether a patient should be on continuous albuterol, every 2-h albuterol, or every 4-h albuterol (Table 1).5 For PRSs of ≥10, continuous nebulized albuterol is started. For PRSs between 7 and 9, albuterol treatments are given every 2 h. For PRSs less than 6, albuterol is given every 4 h. While admitted, albuterol is administered by nebulization, MDI, or a combination at the discretion of the respiratory therapist. Patients who tolerate two sequential albuterol treatments each spaced apart by ≥4 h are deemed stable for discharge. We hypothesized that few, if any, patients would require escalation of care (as defined by more frequent bronchodilator administration) once able to tolerate albuterol ≥3.5 h from prior administration. A cutoff of 3.5 h was used in this study to allow for variance in administration times. Secondary outcomes included re-presentation and re-admission to the hospital. Chart review was done by two authors (B.H.S. and B.A.) between April 2018 and April 2019.
State-of-the-art beta-adrenoreceptor agonists for the treatment of asthma
Published in Expert Opinion on Pharmacotherapy, 2022
W. Tatiana Garzon-Siatoya, Ismael Carrillo-Martin, Sergio E Chiarella, Alexei Gonzalez-Estrada
Albuterol (Salbutamol) is created by modifying the primary catechol nucleus common to the naturally occurring adrenergic neurotransmitters adrenaline and noradrenaline. Albuterol is longer lasting than isoprenaline and isoetharine because it is not broken down by COMT [30]. The albuterol molecule (Figure 3) can directly reach the β2-receptor from the extracellular compartment because of its hydrophilic properties. Because of this, albuterol can effectively bronchodilate in as little as 2–3 minutes and reach maximum bronchodilation within 15 minutes after inhalation. It binds to the AR weakly, which allows it to diffuse into the systemic circulation only after a short (3–6 hours) duration of action [36]. Given these characteristics, albuterol is considered the preferred go-to relief medication for asthma management [9].
Incidence of supraventricular tachycardia after inhaled short-acting beta agonist treatment in children
Published in Journal of Asthma, 2021
Stephanie Woodward, Michael Mundorff, Cindy Weng, David G. Gamboa, Michael D. Johnson
Tachycardia can trigger SVT in adults and children even in the absence of asthma, likely due to tachycardia being a side effect of adrenergic stimulation of the AV node. Other important triggers of SVT include electrolyte abnormalities, direct mechanical stimulation of the AV node by central lines, and thyroid disease. SABA medications used in asthma are selective for the beta-2 receptor, producing bronchial smooth muscle relaxation (11) and subsequent symptomatic relief. Albuterol is typically well tolerated, with the most common side effects being tachycardia due to reflex cardiac stimulation from peripheral vasodilation, direct stimulation of atrial beta-2 receptors, and possibly from myocardial beta-1 receptors with large doses of SABA. In addition to tachycardia, increased potassium entry into skeletal muscle from SABA can lead to hypokalemia (12), and vasodilation in previously constricted pulmonary blood vessels can produce temporary ventilation-perfusion mismatch (13), all pro-arrhythmic conditions in addition to the direct beta-1 stimulation of the myocardium by SABA.