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The role of intrinsic efficacy in determining response to a beta2-agonist in acute severe asthma.
Respir Med. 2007 May; 101(5):1007-14.RM

Abstract

BACKGROUND

Current guidelines recommend repeated doses of albuterol for the emergency treatment of acute asthma. However, approximately one-third of patients show little or no initial response to this partial beta(2)-agonist.

METHODS

We conducted a randomized, double-blind, proof-of-concept study to investigate whether a full beta(2)-agonist, isoproterenol, offers a therapeutic advantage in adults presenting with acute severe asthma (FEV(1)<50%) who fail to respond to an initial treatment of the partial beta(2)-agonist, albuterol. Study subjects were randomized to receive a 2-h continuous nebulization of either albuterol (7.5mg/h) (n=10, mean FEV(1)=37% predicted) or isoproterenol (7.5mg/h) (n=9, mean FEV(1)=33% predicted). Respiratory symptoms, vital signs and pulmonary function measures were collected.

RESULTS

Subjects from both treatment groups had similar baseline characteristics. The percent improvements from baseline FEV(1) at 60 and 120min were significantly higher in subjects receiving isoproterenol than those receiving albuterol (44 vs. 17% and 63 vs. 24%, respectively, P<0.05). The change in symptoms measured by the modified Borg score was also significantly greater in subjects receiving isoproterenol (P<0.01). Both treatments were well tolerated, though the mean increase in pulse rate at 60 and 120min (21 vs. 1 and 23 vs. 6beats/min, respectively, P<0.05) and the mean change in serum potassium at 120min (-0.52 vs. -0.07meq/L, P<0.05) from baseline were significantly greater in the isoproterenol group.

CONCLUSIONS

Our data suggest that in subjects presenting with acute severe asthma who fail to show an initial response to albuterol, the use of a beta(2)-agonist of higher intrinsic efficacy can be more effective in improving lung function and symptoms.

Authors+Show Affiliations

Department of Medicine, Baylor College of Medicine, Houston, TX, USA. Hanania@bcm.tmc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17052901

Citation

Hanania, Nicola A., et al. "The Role of Intrinsic Efficacy in Determining Response to a Beta2-agonist in Acute Severe Asthma." Respiratory Medicine, vol. 101, no. 5, 2007, pp. 1007-14.
Hanania NA, Moore RH, Zimmerman JL, et al. The role of intrinsic efficacy in determining response to a beta2-agonist in acute severe asthma. Respir Med. 2007;101(5):1007-14.
Hanania, N. A., Moore, R. H., Zimmerman, J. L., Miller, C. T., Bag, R., Sharafkhaneh, A., & Dickey, B. F. (2007). The role of intrinsic efficacy in determining response to a beta2-agonist in acute severe asthma. Respiratory Medicine, 101(5), 1007-14.
Hanania NA, et al. The Role of Intrinsic Efficacy in Determining Response to a Beta2-agonist in Acute Severe Asthma. Respir Med. 2007;101(5):1007-14. PubMed PMID: 17052901.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The role of intrinsic efficacy in determining response to a beta2-agonist in acute severe asthma. AU - Hanania,Nicola A, AU - Moore,Robert H, AU - Zimmerman,Janice L, AU - Miller,Charles T, AU - Bag,Remzi, AU - Sharafkhaneh,Amir, AU - Dickey,Burton F, Y1 - 2006/10/17/ PY - 2006/04/21/received PY - 2006/08/29/revised PY - 2006/08/30/accepted PY - 2006/10/21/pubmed PY - 2007/6/6/medline PY - 2006/10/21/entrez SP - 1007 EP - 14 JF - Respiratory medicine JO - Respir Med VL - 101 IS - 5 N2 - BACKGROUND: Current guidelines recommend repeated doses of albuterol for the emergency treatment of acute asthma. However, approximately one-third of patients show little or no initial response to this partial beta(2)-agonist. METHODS: We conducted a randomized, double-blind, proof-of-concept study to investigate whether a full beta(2)-agonist, isoproterenol, offers a therapeutic advantage in adults presenting with acute severe asthma (FEV(1)<50%) who fail to respond to an initial treatment of the partial beta(2)-agonist, albuterol. Study subjects were randomized to receive a 2-h continuous nebulization of either albuterol (7.5mg/h) (n=10, mean FEV(1)=37% predicted) or isoproterenol (7.5mg/h) (n=9, mean FEV(1)=33% predicted). Respiratory symptoms, vital signs and pulmonary function measures were collected. RESULTS: Subjects from both treatment groups had similar baseline characteristics. The percent improvements from baseline FEV(1) at 60 and 120min were significantly higher in subjects receiving isoproterenol than those receiving albuterol (44 vs. 17% and 63 vs. 24%, respectively, P<0.05). The change in symptoms measured by the modified Borg score was also significantly greater in subjects receiving isoproterenol (P<0.01). Both treatments were well tolerated, though the mean increase in pulse rate at 60 and 120min (21 vs. 1 and 23 vs. 6beats/min, respectively, P<0.05) and the mean change in serum potassium at 120min (-0.52 vs. -0.07meq/L, P<0.05) from baseline were significantly greater in the isoproterenol group. CONCLUSIONS: Our data suggest that in subjects presenting with acute severe asthma who fail to show an initial response to albuterol, the use of a beta(2)-agonist of higher intrinsic efficacy can be more effective in improving lung function and symptoms. SN - 0954-6111 UR - https://www.unboundmedicine.com/medline/citation/17052901/The_role_of_intrinsic_efficacy_in_determining_response_to_a_beta2_agonist_in_acute_severe_asthma_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0954-6111(06)00440-9 DB - PRIME DP - Unbound Medicine ER -