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Inhaler technique
Published in Ian Mann, Alastair Noyce, The Finalist’s Guide to Passing the OSCE, 2021
In order to add a layer of complexity, the patient will often be using both a short-acting beta agonist (blue inhaler) and a preventative steroid (brown inhaler). You must emphasise the roles of each. Blue (short-acting beta agonist) inhalers should be used on an ‘as required’ basis. They cause bronchodilatation through a mechanism of smooth muscle relaxation.Brown (steroid) inhalers should be used as regular preventative therapy. They are used in asthmatics that are requiring their blue inhaler regularly. A normal regimen for the brown inhaler is two puffs twice per day.
Asthma
Published in T.M. Craft, P.M. Upton, Key Topics In Anaesthesia, 2021
Intraoperative bronchospasm may manifest as increased inflation pressures or wheeze. Adequacy of oxygenation is the first priority. Other causes of intraoperative wheezing should be excluded (e.g. endobronchial intubation, pulmonary oedema, pneumothorax, anaphylaxis). Bronchodilatation may be achieved by increasing the concentration of volatile agent, or administering a non-anaesthetic bronchodilator. β-adrenergic agonists are the drugs of choice, stimulation of the β2 receptors on bronchial smooth muscle causing muscle relaxation. Administering the agents via inhalation produces less systemic toxicity. Salbutamol and epinephrine (adrenaline) remain the agents of choice with newer, longer-acting agonists being too slow in onset to be of use in the acute attack.
Asthma Mortality and Beta Receptor Agonists: A Perspective
Published in Richard Beasley, Neil E. Pearce, The Role of Beta Receptor Agonist Therapy in Asthma Mortality, 2020
The second study by van Schayk et al.43 compared the regular versus on-demand use of two bronchodilators, salbutamol and ipratropium bromide, in parallel groups over 1 year and showed a greater deterioration in baseline forced expiratory volume in 1 s for both salbutamol and ipratropium when given regularly compared with on demand. No other parameter was significantly different for the two treatment regimens. That these effects may not relate to the beta agonists alone but to other bronchodilators suggests a more general effect associated with bronchodilatation.
The safety of indacaterol for the treatment of COPD
Published in Expert Opinion on Drug Safety, 2018
Evgenios I. Metaxas, Evangelos Balis
Indacaterol, 5-[(R)-2-(5,6-Diethyl-indan-2-ylamino)-1-hydroxy-ethyl]-8-hydroxy-1H-quinolin-2-one, also known as QAB149, is a pure β2- adrenoreceptors agonist presenting nearly complete affinity for the human β2-adrenoreceptors [3]. β2-adrenoreceptor agonists induce bronchodilatation by activating adenylate cyclase, which in turn increases intracellular cAMP levels that results in direct relaxation of airway smooth muscles. In addition, indacaterol is an effective inhibitor of the release of mediators from human lung mast cells, a characteristic that may add an additional therapeutic benefit [4]. As it comes to other β-receptors, indacaterol has a weak relative affinity at the β1-adrenoreceptors and is a full agonist at the β3-adrenoreceptors.
Effects of dexmedetomidine infusion during spinal anesthesia on hemodynamics and sedation
Published in Libyan Journal of Medicine, 2018
Ebru Tarıkçı Kılıç, Gaye Aydın
In the present study, we observed no excessive sedation in any of the cases (BIS < 50%), and there were no changes in respiratory rate or SpO2. In another study reporting on volunteers who received IV dexmedetomidine infusion for 24 h with a target plasma concentration of 0.3–1.25 μg L−1, no respiratory depression was observed, and oxygen saturation was maintained above 90% in all individuals [30]. One of the limitations of our study was atropine midazolam premedication. We used intramuscular atropine to dry the secretions, help to produce bronchodilatation, and prevent vasovagal reactions. It has superior benefits with the use of dexmedetomidine. Other future studies could be planned with other premedication agents.
Attitude and practice of substance misuse and dietary supplements to improve performance in sport
Published in Journal of Substance Use, 2019
Inhaled β2 agonists, which are among the drugs of choice for treatment of asthma, are prohibited for non-asthmatic athletes according to the most recent list of prohibited substances released by WADA (Mazzeo, 2016). This means that an athlete with asthma or EIA has to prove the presence of the disease to a medical committee of their national or an international ruling body and wait for grant of a therapeutic use exemption (TUE) before they can start β2 agonist treatment. Long-acting β2-agonists (LABAs) such as formoterol and salmeterol are used in non-asmathic athletes for prolonged bronchodilatation and its claimed ergogenic potential effects (Mazzeo, 2016; Perrotta et al., 2017).