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Rebound airway obstruction and responsiveness after cessation of terbutaline: effects of budesonide.
Am J Respir Crit Care Med. 1996 Jan; 153(1):70-5.AJ

Abstract

Regular monotherapy with inhaled beta 2-agonists may lead to a temporary increase of airway obstruction and increase of airway responsiveness after cessation of treatment. We investigated whether anti-inflammatory therapy may affect these rebound phenomena. In a double-blind, placebo-controlled study, we assessed lung function (FEV1) and airway responsiveness (PC20 methacholine [PC20]) during and after cessation of 2 wk of regular treatment with placebo and low-dose (250 micrograms) and high-dose (1,000 micrograms) inhaled terbutaline three times daily. Patients with mild allergic asthma (means [+/- SD] age of 28.2 +/- 6.6 yr, mean FEV1% of 91.9 +/- 14.6%, and geometric mean PC20 of 0.25 mg/ml) were studied. One group (n = 16) was randomized to budesonide treatment, 400 micrograms three times daily; the other group (n = 14) to placebo. PC20 and FEV1 were measured 10, 14, 34, and 82 h after the last terbutaline or placebo inhalation. A different method of statistical analysis was used, in that measurements performed at 10, 14, and 34 h were expressed relative to 82 h values in each period as an area-under-the-curve (AUC) value. FEV1 did not significantly change during placebo and budesonide treatment. Mean PC20 and morning and evening peak expiratory flow were significantly higher during budesonide treatment (p < 0.01). PC20 did not significantly change after cessation of terbutaline treatment in both placebo and budesonide treatment groups. AUC-FEV1 values after cessation of treatment with both doses of terbutaline were significantly different from the 82 h values (p < 0.05). The decrease in FEV1 was significantly greater after the last terbutaline and placebo inhalation in the placebo group compared with the budesonide treatment group (p = 0.02). We conclude that cessation of regular treatment after 2 wk with both low-dose and high-dose inhaled terbutaline does not result in a significant rebound airway responsiveness in patients with mild asthma. However, the results suggest a small rebound bronchoconstriction that does not occur when asthmatic patients are also treated with budesonide.

Authors+Show Affiliations

Department of Pulmonology, University Hospital Groningen, The Netherlands.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Comparative Study
Controlled Clinical Trial
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

8542165

Citation

de Jong, J W., et al. "Rebound Airway Obstruction and Responsiveness After Cessation of Terbutaline: Effects of Budesonide." American Journal of Respiratory and Critical Care Medicine, vol. 153, no. 1, 1996, pp. 70-5.
de Jong JW, van der Mark TW, Koëter GH, et al. Rebound airway obstruction and responsiveness after cessation of terbutaline: effects of budesonide. Am J Respir Crit Care Med. 1996;153(1):70-5.
de Jong, J. W., van der Mark, T. W., Koëter, G. H., & Postma, D. S. (1996). Rebound airway obstruction and responsiveness after cessation of terbutaline: effects of budesonide. American Journal of Respiratory and Critical Care Medicine, 153(1), 70-5.
de Jong JW, et al. Rebound Airway Obstruction and Responsiveness After Cessation of Terbutaline: Effects of Budesonide. Am J Respir Crit Care Med. 1996;153(1):70-5. PubMed PMID: 8542165.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rebound airway obstruction and responsiveness after cessation of terbutaline: effects of budesonide. AU - de Jong,J W, AU - van der Mark,T W, AU - Koëter,G H, AU - Postma,D S, PY - 1996/1/1/pubmed PY - 1996/1/1/medline PY - 1996/1/1/entrez SP - 70 EP - 5 JF - American journal of respiratory and critical care medicine JO - Am. J. Respir. Crit. Care Med. VL - 153 IS - 1 N2 - Regular monotherapy with inhaled beta 2-agonists may lead to a temporary increase of airway obstruction and increase of airway responsiveness after cessation of treatment. We investigated whether anti-inflammatory therapy may affect these rebound phenomena. In a double-blind, placebo-controlled study, we assessed lung function (FEV1) and airway responsiveness (PC20 methacholine [PC20]) during and after cessation of 2 wk of regular treatment with placebo and low-dose (250 micrograms) and high-dose (1,000 micrograms) inhaled terbutaline three times daily. Patients with mild allergic asthma (means [+/- SD] age of 28.2 +/- 6.6 yr, mean FEV1% of 91.9 +/- 14.6%, and geometric mean PC20 of 0.25 mg/ml) were studied. One group (n = 16) was randomized to budesonide treatment, 400 micrograms three times daily; the other group (n = 14) to placebo. PC20 and FEV1 were measured 10, 14, 34, and 82 h after the last terbutaline or placebo inhalation. A different method of statistical analysis was used, in that measurements performed at 10, 14, and 34 h were expressed relative to 82 h values in each period as an area-under-the-curve (AUC) value. FEV1 did not significantly change during placebo and budesonide treatment. Mean PC20 and morning and evening peak expiratory flow were significantly higher during budesonide treatment (p < 0.01). PC20 did not significantly change after cessation of terbutaline treatment in both placebo and budesonide treatment groups. AUC-FEV1 values after cessation of treatment with both doses of terbutaline were significantly different from the 82 h values (p < 0.05). The decrease in FEV1 was significantly greater after the last terbutaline and placebo inhalation in the placebo group compared with the budesonide treatment group (p = 0.02). We conclude that cessation of regular treatment after 2 wk with both low-dose and high-dose inhaled terbutaline does not result in a significant rebound airway responsiveness in patients with mild asthma. However, the results suggest a small rebound bronchoconstriction that does not occur when asthmatic patients are also treated with budesonide. SN - 1073-449X UR - https://www.unboundmedicine.com/medline/citation/8542165/Rebound_airway_obstruction_and_responsiveness_after_cessation_of_terbutaline:_effects_of_budesonide_ L2 - http://www.atsjournals.org/doi/full/10.1164/ajrccm.153.1.8542165?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -