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Pulmonary Pharmacology & Therapeutics Apr 2018Inhaled airway challenges provoke bronchoconstriction in susceptible subjects and are a pivotal tool in the diagnosis and monitoring of obstructive lung diseases, both... (Review)
Review
Inhaled airway challenges provoke bronchoconstriction in susceptible subjects and are a pivotal tool in the diagnosis and monitoring of obstructive lung diseases, both in the clinic and in the development of new respiratory medicines. This article reviews the main challenge agents that are in use today (methacholine, mannitol, adenosine, allergens, endotoxin) and emphasises the importance of controlling how these agents are administered. There is a danger that the optimal value of these challenge agents may not be realised due to suboptimal inhaled delivery; thus considerations for effective and reproducible challenge delivery are provided. This article seeks to increase awareness of the importance of precise delivery of inhaled agents used to challenge the airways for diagnosis and research, and is intended as a stepping stone towards much-needed standardisation and harmonisation in the administration of inhaled airway challenge agents.
Topics: Administration, Inhalation; Bronchial Provocation Tests; Bronchoconstriction; Bronchoconstrictor Agents; Drug Delivery Systems; Humans; Lung; Lung Diseases, Obstructive; Reproducibility of Results; Tissue Distribution
PubMed: 29331645
DOI: 10.1016/j.pupt.2018.01.004 -
The Journal of Allergy and Clinical... Aug 1999Nebulized bronchodilator solutions are available in the United States as both nonsterile and sterile-filled products. Sulfites, benzalkonium chloride (BAC), or... (Review)
Review
Nebulized bronchodilator solutions are available in the United States as both nonsterile and sterile-filled products. Sulfites, benzalkonium chloride (BAC), or chlorobutanol are added to nonsterile products to prevent bacterial growth, but there have been reports of contaminated solutions containing preservatives. Ethylenediamine tetraacetic acid (EDTA) is added to some products to prevent discoloration of the solution. With the exception of chlorobutanol, all of these additives are capable of inducing bronchospasm in a concentration-dependent manner. However, it is rarely apparent to the patient or health care provider that the additive diminishes the bronchodilator effects. Older products (eg, isoproterenol and isoetharine) contain enough sulfites to produce bronchospasm in most patients with asthma, even in those without a prior history of sulfite sensitivity. Bronchoconstriction from inhaled BAC is cumulative, prolonged, and correlates directly with basal airway responsiveness. The multidose dropper bottle of albuterol contains 50 microg BAC/dose, which is below the threshold for bronchoconstriction whereas the screwcap unit-dose vial contains 300 microg/dose, which is above the threshold for many patients. If the screwcap product is used in the emergency department, a patient could receive as much as 1800 microg of BAC in the first hour. Three sterile-filled unit dose albuterol products contain no additives, whereas a fourth, (manufactured by Dey Laboratories) contains 300 microg of EDTA, which is also below the threshold dose for bronchoconstriction. Only additive-free sterile solutions should be used for hourly or continuous nebulization of albuterol. The multidose dropper bottle or the Dey product can be used when the interval between doses is longer, whereas the screwcap product should not be used for acute therapy. Ipratropium is available only as a sterile, additive-free unit-dose vial, as is levalbuterol.
Topics: Administration, Inhalation; Animals; Benzalkonium Compounds; Bronchoconstriction; Bronchoconstrictor Agents; Bronchodilator Agents; Chlorobutanol; Drug Contamination; Edetic Acid; Humans; Nebulizers and Vaporizers; Preservatives, Pharmaceutical; Sulfites; United States
PubMed: 10452789
DOI: 10.1016/s0091-6749(99)70274-5 -
The American Review of Respiratory... Jun 1991
Review
Topics: Administration, Inhalation; Asthma; Bronchi; Bronchoconstrictor Agents; Dose-Response Relationship, Drug; Humans; Lung Diseases, Obstructive
PubMed: 2048833
DOI: 10.1164/ajrccm/143.6.1433 -
Chest Mar 2003Airway hyperresponsiveness is a characteristic feature of asthma and consists of an increased sensitivity of the airways to an inhaled constrictor agonist, a steeper... (Review)
Review
Airway hyperresponsiveness is a characteristic feature of asthma and consists of an increased sensitivity of the airways to an inhaled constrictor agonist, a steeper slope of the dose-response curve, and a greater maximal response to the agonist. Measurements of airway responsiveness are useful in making a diagnosis of asthma, particularly in patients who have symptoms that are consistent with asthma and who have no evidence of airflow obstruction. These tests can be performed quickly, safely, and reproducibly. Certain inhaled stimuli, such as environmental allergens, increase airway inflammation and enhance airway hyperresponsiveness. These changes in airway hyperresponsiveness are of much smaller magnitude than those seen when asthmatic patients with persistent airway hyperresponsiveness are compared to healthy subjects. They are, however, similar to changes occurring in asthmatic patients that are associated with worsening asthma control. The mechanisms of the transient allergen-induced airway hyperresponsiveness are not likely to fully explain the underlying mechanisms of the persistent airway hyperresponsiveness in asthmatic patients.
Topics: Asthma; Bronchoconstriction; Bronchoconstrictor Agents; Humans; Respiratory System
PubMed: 12629006
DOI: 10.1378/chest.123.3_suppl.411s -
Chest Oct 2008
Topics: Administration, Inhalation; Asthma; Bronchial Provocation Tests; Bronchoconstrictor Agents; Forced Expiratory Volume; Humans; Methacholine Chloride; Nebulizers and Vaporizers
PubMed: 18842907
DOI: 10.1378/chest.08-1306 -
Annals of Allergy, Asthma & Immunology... Jul 2012
Topics: Asthma; Bronchial Hyperreactivity; Bronchial Provocation Tests; Bronchoconstrictor Agents; Cohort Studies; Forced Expiratory Volume; Humans; Inhalation; Methacholine Chloride
PubMed: 22727163
DOI: 10.1016/j.anai.2012.04.020 -
Bulletin of Experimental Biology and... Aug 2022We studied contractile responses of isolated airway smooth muscle segments from rats with metabolic syndrome. Metabolic syndrome was induced in rats by high-fat and...
We studied contractile responses of isolated airway smooth muscle segments from rats with metabolic syndrome. Metabolic syndrome was induced in rats by high-fat and high-carbohydrate diet. It was shown that metabolic syndrome was associated with an increase of bronchoconstrictor action of cholinergic receptor activator carbacholine (0.1-100 μM) and a decrease of the dilatory effect of β-adrenoreceptor activator salbutamol (0.1-100 μM). The observed effects of agonists are epithelium-dependent. Disorders in contractile activity in the airway smooth muscles were accompanied by bronchial epithelium destruction, immune inflammation in the bronchial wall, muscular and peribronchial adipose tissue hypertrophy.
Topics: Albuterol; Animals; Bronchi; Bronchoconstrictor Agents; Carbachol; Carbohydrates; Metabolic Syndrome; Muscle Contraction; Muscle, Smooth; Rats; Receptors, Cholinergic
PubMed: 36058975
DOI: 10.1007/s10517-022-05566-4 -
Stomatologiia 2017The paper presents the analysis of studies of local anesthesia in patients with bronchial asthma. It was found that the diagnosis of hypersensitivity to sodium... (Review)
Review
The paper presents the analysis of studies of local anesthesia in patients with bronchial asthma. It was found that the diagnosis of hypersensitivity to sodium metabisulfite in patients with bronchial asthma must be optimized for development of local anesthesia selection algorithm in outpatient dentistry.
Topics: Algorithms; Anesthesia, Dental; Anesthesia, Local; Asthma; Bronchoconstrictor Agents; Dental Care; Drug Hypersensitivity; Female; Humans; Sulfites
PubMed: 28617409
DOI: 10.17116/stomat201796352-54 -
American Journal of Respiratory and... Nov 1998Airway smooth muscle contributes to changes in airway caliber not only through the variations in its tone but also through its contribution to thickness of the airway... (Comparative Study)
Comparative Study Review
Airway smooth muscle contributes to changes in airway caliber not only through the variations in its tone but also through its contribution to thickness of the airway wall. Until recently, most attention was paid to the agents that altered airway smooth muscle tone, their receptors, the signal transduction pathways they activated, and the mechanisms of contraction and relaxation themselves. Lately, the regulation of smooth muscle proliferation has received increasing attention, and, most recently, the possible role of smooth muscle as a source of inflammatory mediators has been recognized. Airway smooth muscle cells are now seen as playing an important interactive role with inflammatory and structural cells in the response to injury and repair of the airways.
Topics: Asthma; Bronchi; Bronchoconstriction; Bronchoconstrictor Agents; Bronchodilator Agents; Cell Division; Humans; Muscle Contraction; Muscle, Smooth
PubMed: 9817735
DOI: 10.1164/ajrccm.158.supplement_2.13tac800 -
Lung Feb 2012The pathophysiology of cough variant asthma is poorly understood. In particular, the mechanisms that cause different symptoms in typical asthma (in which wheeze... (Review)
Review
The pathophysiology of cough variant asthma is poorly understood. In particular, the mechanisms that cause different symptoms in typical asthma (in which wheeze predominates) compared with cough variant asthma (in which cough predominates) have not been determined. Traditional explanations include higher wheezing thresholds, differences in cough sensitivity, and/or differences in small airway function. Recent studies using high-dose methacholine challenge testing suggest that altered small-airway function plays a role. Preservation or loss of the bronchoprotective effect of a deep inspiration may be a fundamental pathophysiologic difference between asthma, cough variant asthma, methacholine-induced cough with normal sensitivity, and eosinophilic bronchitis.
Topics: Asthma; Bronchial Provocation Tests; Bronchoconstriction; Bronchoconstrictor Agents; Cough; Eosinophils; Humans; Inflammation; Inhalation; Methacholine Chloride
PubMed: 22139550
DOI: 10.1007/s00408-011-9348-6