Salbutamol metered dose inhaler

Albuterol (salbutamol) metered-dose inhaler as needed Ortho-Tri-Cyclen Lo by mouth daily Echinacea 1 to 2 tablets by mouth daily as needed Multivitamin 1 tablet by mouth daily... 

He is started on salbutamol metered dose inhaler (MDI) two puffs when required and beclometasone (Qvar) 50 micrograms twice daily. 

Everard ML, Devadason SG, Summers QA, LeSouef PN. Factors affecting total and respirable dose delivered by a salbutamol metered dose inhaler. Thorax 1995 50 746-749. 

Chenge JK, Chrystyn H. Volumatic usage some generic salbutamol metered dose inhalers can be used. Thorax 1994 49 1162-1163. 

Clark DJ, Gordon-Smith J, McPhate G, Clark G, Lipworth BJ. Lung bioavailability of generic and innovator salbutamol metered dose inhalers. Thorax 1996 51 325-326. 

Chhabra SK. A compai ison of closed and open mouthed techniques of inhalation of salbutamol metered dose inhaler. J Asthma 1994 31 123-125. 

Finlay WH, Zuberbuhler P. In vitro comparison of beclomethasone and salbutamol metered-dose inhaler aerosols inhaled during pediatric tidal breathing from four valved holding chambers. Chest 1998 114 1676-1680. 

Airway clearance therapy is usually accompanied by bron-chodilator treatment [albuterol (also known as salbutamol outside the United States) by nebulizer or metered-dose inhaler] to stimulate mucociliary clearance and prevent bronchospasm associated with other inhaled agents. A mucolytic agent may be administered to reduce sputum viscosity and enhance clearance. 

M Vidgren, J Arppe, P Vidgren, P Vainio, M Silvasti, H Tukiainen. Pulmonary deposition of 99mTc-labelled salbutamol particles in healthy volunteers after inhalation from a metered-dose inhaler and from a novel multiple-dose powder inhaler. S.T.P. Pharm Sci 4 29-32, 1994. 

Nogami-Itoh, M., I.Yakuo, D.M.Hammerbeck, R.I.Miller, and K.Takeyama. 1997. The equivalent bronchodilator effects of salbutamol formulated in chlorofluorocarbon and hydrofluoroalkane-134a metered dose inhalers on the histamine-induced pulmonary response in dogs. Pharmaceut. Res. 14 208-212. 

Taggart, S.C.O., A.Custovic, D.H.Richards, and A.Woodcock 1994. An alternative metered dose inhaler propellant GR106642X comparison to chlorofluorocarbon 11 and 12 in the attenuation of histamine-induced bronchoconstriction by salbutamol. Eur. Resp. J. (Suppl. 18) 400s. 

Zainudin, B.M.Z., Biddiscombe. M., Tolfree, S.E.J., Short, M., and Spiro, S.G., Comparison of bronchodilator responses and deposition patterns of salbutamol inhaled from a pressurized metered dose inhaler, as a dry powder, and as a nebulized solution, Thorax, 45 469-473 (1990). 

Table 8.2 30-min post-inhalation urinary salbutamol excretion (% inhaled dose) in nine subjects following inhalation of 4 X 100 mg salbutamol using a metered-dose inhaler (MDI) and a dry powder inhaler (DISK) ... 

The data in Table 8.2 are taken from a study reported by Hindle et the purpose of which was to determine whether a new dry powder inhaler (DISK) was equivalent to a traditional metered-dose inhaler (MDI) in its ability to deliver doses of a bronchodilator to the lungs of volunteers. The data are the percentages of an inhaled dose of salbutamol recovered in a urine sample taken 30 min post-inhalation for each method of delivery in nine volunteers. Ameasure of treatment effect is the difference in percentages within volunteers, shown in the fourth column. Of these differences seven are negative and two are positive (fifth column) and the question we need to answer is how likely is it that if there is no difference between the inhalers, we would see this degree of imbalance between negatives and positives ... 

Pulmonary deposition efficiency depends on physicochemical characteristics, such as density of the aerosol or dry powder particles [33-35], Generally, particle diameters less than than 5 pm are required for efficient pulmonary delivery [36, 37], Pulmonary deposition also depends on the nature of the delivery device and differs between metered dose inhalers (MDIs). For example, pulmonary deposition expressed as the ratio of pulmonary versus total (pulmonary + oral) absorbed drug, ranged from 15-55% for a number of salbutamol devices and from 66-85% for drugs with lower oral bioavailabilities such as budesonide. 

Hindle, M., and Chrystyn, H. (1994), Relative bioavailability of salbutamol to the lung following inhalation using metered dose inhalation methods and spacer devices, Thorax, 49,549-553. 

Lipworth, B. J., Sims, E. J., Taylor, K., Cockburn, W., and Fishman, R. (2005), Dose-response to salbutamol via a novel palm sized nebuliser (aerodose inhaler), conventional nebuliser (pari LC plus) and metered dose inhaler (ventolin evohaler) in moderate to severe asthmatics, Br. J. Clin. Pharmacol, 59, 5-13. 

A 35-year old Caucasian man with AIDS and multiple opportunistic infections, including Mycobacterium kansasii and Mycobacterium avium complex (MAC) disease developed moderate to severe primary sensorineural hearing loss after 4—5 months of therapy with oral azithromycin 500 mg/day. Other medications included ethambutol, isoniazid, rifabutin, ciprofloxacin, co-trimoxazole, fluconazole, zidovudine (later switched to stavudine), lamivudine, indinavir, methadone, mod-ified-release oral morphine, pseudoephedrine, diphenhydramine, megestrol acetate, trazodone, sorbitol, salbutamol by metered-dose inhaler and nebulizer, ipratropium, and oral morphine solution as needed. Significant improvement of the hearing impairment was documented 3 weeks after drug withdrawal. 

In one case, paradoxical bronchoconstriction and laryngospasm necessitated emergency admission after the use of salbutamol in a metered-dose inhaler, which also contained edetate disodium as a preservative (15). Although there was prompt relapse on re-exposure, there were no positive findings demonstrating the role of edetate disodium. 

The efficacy and safety of salbutamol inhaled using a dry powder inhaler has been compared with salbutamol inhaled using a pressurized metered-dose inhaler (pMDI) in a randomized, open, crossover study in 12 patients with moderate to severe asthma. A total of 1600 micrograms of salbutamol was given on two separate days in a cumulative dose fashion in increments of 100,100,200, 400, and 800 micrograms at 3-minute intervals. FEVi rose progressively with each increment. The dose-response curves showed that powdered salbutamol was 3.0 times as potent (Cl = 1.8,5.8) as salbutamol from... 

Fok TF, al Essa M, Monkman S, Dolovich M, Girard L, Coates G, et al. Pulmonary deposition of salbutamol aerosol delivered by metered-dose inhaler, jet nebulizer, and ultrasonic nebulizer in mechanically ventilated rabbits. Pediatr Res 1997 42(5) 721-727. 

As with the metered-dose inhalers, some old drugs have been repackaged in new devices. For dry powder inhalers these are not true generics but have a similar impact on the marketplace. Most notable of these in the Clickhaler (Innovata Biomed), which is marketed in Europe, for the delivery of albuterol (salbutamol) and beclomethasone. 

H. Leon-Molina, F. Flores-Murrieta, and R. Chapela, Assessment of comparative bioequivalence of two metered-dose inhaler formulations of salbutamol— measuring bron-chodilatory effect in patients with asthma. Clin Drug Invest 22(7) 435-441 (2002). 

Ikeda A, Nishimura K, Koyama H, et al. Comparison of the bronchodilator effects of salbutamol delivered via a metered-dose inhaler with spacer, a dry-powder inhaler, and a jet nebulizer in patients with chronic obstructive pulmonary disease. Respiration 1999 66 119-123. 

Salbutamol 100 tig metered dose inhalator four times daily... 

Combination bronchodilator therapy - This topic has been recently reviewed In chronic asthma, the combination of IB and fenoterol was more effective administered by a metered dose inhaler than salbutamol. Aerosol IB when administered concurrently with Inhaled fenoterol and oral oxtriphylline increased bronchodllation with no detectable additional side effects. Inhalation of IB followed by metaproterenol resulted in additive bronchodllation that was greater and longer lasting than IB alone, metaproterenol alone or metaproterenol followed by IB. ° Neither Inhaled terbutallne nor DSCG were very effective in cold air-induced bronchoconstriction whereas both drugs in combination were much more effective. The interaction of methylxanthlnes and B-agonists continues to be a subject of interest. An Increased Incidence of... 

Acute angle-closure glaucoma developed rapidly in eight patients given nebulised ipratropium and salbutamol. Increased intra-ocular pressure has been reported in others, including one patient using an ipratropium metered-dose inhaler with nebulised salbutamol. 

Lofdahl CG, Andersson L, Bondesson E, Carlsson LG, Friberg K, Hedner J. Differences in bronchodUating potency of salbutamol in Turbuhaler as compared with a pressurized metered-dose inhaler formulation in patients with reversible airway obstruction. EurRespir J 1997 10 2474—2478. 

Tal A, Golan H, Aviram M. Deposition pattern of radiolabeled salbutamol inhaled from a metered-dose inhaler by means of a spacer with mask in young children with airway obstruction. J Pediatr 1996 128 479-484. 

Hindle M, Newton DAG, Chrystyn H. Dry powder inhalers are bioequivalent to metered-dose inhalers a study using a new urinary albuterol (Salbutamol) assay technique. Chest 1995 107 629-633. 

Newnham DM, McDevitt DG, Lipworth BJ. Comparison of the extrapuhnonary P -adrenorecptor responses and pharmacokinetics of salbutamol given by standard metered dose inhaler and modified actuator device. Br J Clin Pharmacol 1993 36 445 50. 

Schulze MD, Riebe MT, Martin NB, Ryder SM, Shurkus DD, Ashurst IC. Development and performance of a new HFA-based metered dose inhaler (MDl) system for salbutamol sulphate. Eur Resph J 1997 10(suppl 25) 38S. 

Conner WT, Dolovich MB, Frame RA, Newhouse MT. Rehahle salbutamol administration in 6- to 36-month-old children by means of a metered dose inhaler and Aerochamber with mask. Pediatr Pulmonol 1989 6 263-267. 

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