Safety and efficacy of oral nifedipine versus terbutaline injection in preterm labor.

OBJECTIVE: To compare the safety and tocolytic efficacy of oral nifedipine with intravenous terbutaline for the management of threatened preterm labor. MATERIAL AND METHOD: Pregnant women between 24 and 36 completed weeks of single gestation with preterm labor were randomized to either oral nifedipine (n=20) or intravenous terbutaline (n=20) treatment. Nifedipine (immediate released capsule) 10 mg was crushed and swallowed, 10 mg every 20 minutes was allowed if necessary with a maximum 40 mg in the first hour. After that 20 mg nifedipine every 4 hours was given, up to 72 hours. Terbutaline was initially infused with the rate 10 g/min with an increment 5 microg/min every 10 minutes if required, until 25 microg/min was reached. Once the contractions had stopped for 2-6 hours, the patients were switched to subcutaneous injection with 0.25 mg terbutaline every 4 hours for 24 hours. The main safety outcome was the changes in maternal diastolic blood pressure from baseline and 1 hour after starting the treatment (deltaDBP(1hr)). Secondary outcomes were the efficacy to delay delivery > or =48 hours and 7 days, the adverse events and the birth outcomes. RESULTS: deltaDBP(1hr) was greater in the terbutaline group than that in the nifedipine group with no statistically significant difference. Hypotension (defined as BP < or = 90/60 mmHg) was found in one patient of the nifedipine group and two patients of the terbutaline group. Seventeen and 14 patients in the nifedipine group and 15 and 12 patients in the terbutaline group had delayed delivery > or =48 hours and 7 days, respectively. Mothers in the nifedipine group experienced fewer side effects than those in the terbutaline group. Maternal heart rate, at I hour after starting the treatment, increased significantly higher in the terbutaline group than in the nifedipine group. Birth outcomes were measured in all nifedipine group patients, but in only 16 of the terbutaline group patients. Six mothers in each group delivered after 37 weeks. Intraventricular hemorrhage (IVH) occurred in three babies (gestational aged 25, 29 and 37 weeks) born to mothers treated with terbutaline. In one baby, IVH related to trauma resulted from the delivery procedure. CONCLUSION: The safety and efficacy of nifedipine compares with that of terbutaline for treatment of preterm labor.

Comparison of terbutaline and salbutamol inhalation in children with mild or moderate acute exacerbation of asthma.

OBJECTIVE: To compare the clinical efficacy and side effects of terbutaline and salbutamol administered by metered dose inhaler and holding chamber in the mild to moderate acute exacerbations of asthma in children. METHODS: The study subjects were children in the age group of 5- 15 years who presented with a mild or moderate acute exacerbation of asthma. Baseline assessment included clinical parameters and spirometry. The children were then randomized to receive salbutamol or terbutaline. Three puffs each of either 100 mcg salbutamol or 250 mcg of terbutaline were administered using 750 ml holding chamber with valve. Thirty minutes after drug administration, the children were reevaluated for clinical parameters and spirometry. RESULTS: Of the total 60 subjects studied, 31 were administered terbutaline and 29 salbutamol. The baseline spirometric parameters were comparable. After drug administration, all the studied variables showed significant improvement within each group. However, there were no statistically significant differences when the two groups were compared with each other. There was no significant difference in the side effects between two groups. CONCLUSION: Terbutaline and salbutamol, when administered by MDI with holding chamber, are equally efficacious in children with mild or moderate acute exacerbation of asthma.

The efficacy of terbutaline and magnesium sulfate in the management of preterm labor.

Ninety-six patients with preterm labor at 28 weeks to 35 weeks gestation were randomized to terbutaline or magnesium sulfate untill 36 weeks gestation, 25 patients were excluded from the study. Of the remaining 71 patients, 35 patients received terbutaline and 36 patients received magnesium sulfate. The result of the study showed that, there were no significant differences (P > 0.05) regarding time to stop, mean gestational age at delivery, time gained, failure rate, time to recurrent labor and readmission for recurrent labor, birth weight, apgar score and fetal survival. Serious maternal side effects were not observed with terbutaline or magnesium sulfate, although the majority of women also received dexamethasone. Neither drug caused serious adverse neonatal effects.

Liposomes of terbutaline sulphate: in vitro and in vivo studies.

In vitro studies were conducted to understand the comparative drug diffusion pattern, across artificial membrane, of the drug and of the prepared liposomes of different liposomal membrane composition. In vivo studies were carried out to determine the extent and time-course of pulmonary tissue uptake of administered liposomes containing terbutaline sulphate(TER) on rat lungs. In vitro studies revealed that the drug released from the prepared liposomes obeys Higuchi's diffusion controlled model. Different loading doses and release patterns of drug from the liposomes can be obtained by altering the PC:CHOL ratio and incorporation of cholesterol was found to reduce permeability of the membrane. Similarly drug absorption in vivo in rat's lung following intratracheal instillation, prolonged over 12 hr by liposomal entrapment of TER. The findings of present investigation indicated that liposomally encapsulated TER can be used for pulmonary delivery for maximizing the therapeutic efficacy and reducing undesirable side effects.

Cost-effectiveness of inhaled beta-agonists v. oral salbutamol in asthma: a randomized double-blind cross-over study.

BACKGROUND: Oral beta-stimulants are widely used in the management of chronic asthma in India, in spite of evidence suggesting the superiority of inhaled medication in achieving maximum bronchodilatation. An economic evaluation was performed in a randomized double-blind cross-over trial to evaluate the role of adjuvant oral beta-stimulants in the treatment of asthma. METHODS: Patients who had seasonal or perennial asthma and were using metered dose inhalers for control of symptoms were randomly selected for the study. They received either 4 mg of oral salbutamol or placebo as adjuvant treatment. During the study they controlled their symptoms by adjusting the dose of the inhaler medication. A cost minimization technique was used to assess the economic impact of this intervention in the treatment and control periods. A sensitivity analysis was performed to assess the robustness of the conclusions. RESULTS: The mean cost was significantly greater in the treatment period and a patient lost approximately Rs 20 per month (CI: 13 to 27; p = 0.001) as a result of the adjuvant treatment. There was no significant difference in the quality of life or peak expiratory flow rate during the two periods. The patients also noted mild but significantly increased tremors (p = 0.01) and palpitations (p = 0.001) during the treatment period. There was no treatment-to-period interaction. CONCLUSION: Adjuvant oral beta-agonists do not improve the quality of life or bronchodilatation in asthmatics using an inhaled beta-agonist for control of symptoms.

Prevención del asma inducido por ejercicio por terbutalina via turbuhaler / The protective effect of terbutaline inhaled via turbuhaler in excercise-induced asthma

El objetivo fue examinar el efecto preventivo de la terbutalina vía turbahaler en niños con asma inducido por ejercicio (AIE). Se estudiaron 20 casos (7-13 años), 12 varones y 8 mujeres, a quienes se les efectuó: una espirometría basal usando un espirómetro Flowmate 2500, test de provocación en cinta ergométrica Zuccolo Mod 315 llegando al 85 por ciento de su capacidad cardíaca durante 6', espirometria a los 7' y 30' post ejercicio. Durante la misma semana fue realizado el mismo estudio 15' posterior a la inhalación de 0,5 mg de terbutalina vía turbuhaler y el test con placebo a 12 pacientes. Fueron comparados los valores originales post ejercicio, y los encontrados posterior al uso de la terbutalina. Se encontraron 19 casos (95 por ciento) con Protección total (disminución < 5 por ciento del FEV1), 1 caso (5 por ciento) Protección parcial (disminución < del 10 por ciento FEV1) y sin encontrarse efectos significativos con placebos. La severidad del broncoespasmo en AIE fue significativamente reducida mediante el uso de terbutalina 15' previo al ejercicio y no observándose efectos adversos. La terbutalina vía turbuhaler es una droga B2 potente, y quizás su efecto mayor radica en el mejor depósito de la droga a nivel pulmonar, muy útil y práctico para casos de asma inducido por ejercicio, puesto que puede mejorar la calidad de vida de los asmáticos.

The protective effect of inhaled terbutaline, sodium cromoglycate and budesonide on exercise-induced asthma in children.

The effect of single-dose inhaled terbutaline, sodium cromo-glycate and budesonide were compared with control in 11 exercise-induced asthma (EIA) patients, aged 9-14 years. Patients exercise for 6 minutes, 15 minutes after inhaling drugs. The FVC, FEV1, PEFR and MMEF were recorded before exercise and after exercise at 5 minutes interval up to 25 minutes. After exercise, the mean (SEM) maximal percentage fall in FEV1 after placebo, 200 micrograms of terbutaline, 10 mg of sodium cromoglycate, and 100 micrograms of budesonide were 22.81 (3.45), 4.05 (2.11), 11.29 (1.18), and 20.36 (2.33) respectively. It was concluded that single-dose inhaled terbutaline and sodium cromoglycate resulted in a significant protective effect on exerxide-induced asthma whereas budesonide did not.

Furosemida vs terbutalina en la crisis asmática

En los últimos 7 años algunos estudios han establecido que la Furosemida nebulizada inhibe la broncoconstricción inducida por metabisulfito, ejercicio, aguda destilada y alergenos. Hay poca información sobre la utilidad clínica de la Furosemida y no hay experiencia en Crisis Asmática (CA). Para resolver tales interrogantes se realizó el presente estudio. Los pacientes con CA que consultaron al servicio de urgencia del Hospital Universitario de Cartagena desde noviembre de 1993 hasta mayo de 1994 ingresaron en el presente estudio, previo consentimiento informado. A todos los pacientes se les realizó historia clínica y cada hora se monitorizaron: signos vitales, pulso paradójico, cianosis, estado de conciencia, sibilancias, tirajes y Flujo Espiratorio Pico (FEP). Los pacientes con CA severa o Asma Potencialmente Fatal fueron excluidos. Al ingreso, al azar y doble ciego, los pacientes pasaron a un grupo terapéutico de Terbutalina ( 2 gotas por cada 10 Kg de peso Solución nebulizadora de 1cc=10mg) o de Furosemida (40 mg nebulizados). En ambos grupos la nebulización se realizó cada 20 minutos por 3 ocasiones, la primera hora, y luego cada 4 horas durante un máximo de 24 horas. En CA moderada se asoció aminofilina IV en ambos grupos. Cada hora se analizaron los parámetros anotados y según ellos se decidió hospitalizar, continuar manejo en el servicio de urgencia o dar de alta. Para el análisis estadístico se registraron los datos en una tabla maestra, se tomaron medidas de tendencia central (media), porcentajes, desviación estándar. Los parámetros clínicos y funcionales evaluados fueron analizados mediante prueba T de student (p menor 0.05).

Respuesta a la aerosolterapia con terbutalina y bromuro de ipatropio más fenoterol en pacientes con crisis asmática / Crisis asthmatic treatment under treatment of a terbuline and bromide plus fenoterol mix inhalation

Se estudio el efecto de inhalación de Terbutalina y Bromuro de Ipatropio, más Fenoterol, en el tratamiento de la Crisis Asmática, mediante la determinación del volúmen aspiratorio forzado en un (1) segundo pre y post-tratamiento en treinta (30) pacientes, con edades comprendidas entre 12 y 62 años. Se observó una respuesta favorable en el 83.3 por ciento, con una mejoría del 20 por ciento sobre el pico flujo de base. Solamente el 16.7 por ciento (5), no tuvo respuesta mayor del 15 por ciento, de los cuales dos (40 por ciento de estos últimos cinco pacientes) tuvieron efecto paradójico. La respuesta al tratamiento fue independiente de la edad, sexo, antecedentes previos, número de hospitalizaciones anteriores, así como de la clasificación clínica al momento de su ingreso. Concluimos que el uso de estos fármacos por vía inhalatoria, debe ser de elección en el tratamiento de pacientes con Crisis Asmatica.

Ventiloterapia con terbutalina y budesonide en pacientes con enfermedad pulmonar obstructiva crónica / Ventilotherapy with terbutaline and budesonide in patients with obstructive pulmonary disease

La ventiloterapia en los últimos años ha logrado ser un arma efectiva y económica que permite el uso de ciertas drogas nebulizadas para el tratamiento de la mayoría de los pacientes con enfermedad obstructiva pulmonar. En este estudio tratamos de demostrar la eficacia de dos líneas de tratamiento por vía inhalatoria (Terbutalina y Budesonide). Se estudiaron 36 pacientes, elegidos al azar de la consulta de Neumología del H.C.M.: 25 del sexo femenino y 11 masculinos, en las edades comprendidas de 30 a 80 años con una media de 56 años. Previo al estudio se les realizó espirometría y gases arteriales. Recibieron Terbutalina a dosis de 1.000 mcgrs/día (n=18) y Budesonide de 400 mcgrs/día (n=18) por 3 semanas. Posterior a lo cual se repiten la espirometria y los gases arteriales. Encontrándose como resultado que ambos medicamentos produjeron mejoria clínica, espirométrica y gases arteriales (p:0.05) y sólo se encontró diferencia estadística significativa en cuanto al FEV e Indice de Tifeneau (p:0.05) comparando ambas líneas terapéuticas a favor del Budesonide. El resto de los parámetros mwjoraron igual para ambos grupos. Por lo que se concluye que ambas drogas representan una alternativa importante en el manejo del EPOC

Métodos complementares para o diagnóstico e tratamento da amniorrexe prematura no Hospital Universitário Lauro Wanderley / Complementary methods for treatment and diagnosis of premature rupture of the membranes in Lauro Wanderley Hospital

Os autores fizeram um estudo retrospectivo nos prontuários de 90 pacientes portadoras de amniorrexe prematura que foram admitidas na Maternidade do Hospital Universitário Lauro Wanderley, no período de 1991 a março de 1993. A idade das pacientes variou de 15 a 39 anos, com idade média de 22,5 anos, sendo que 48,9 por cento eram primigestas, e 59 por cento tinham idade gestacional acima de 36 semanas. O estudo evidenciou que o método clínico foi o mais utilizado para feitura do diagnóstico, tendo o trabalho de parto sido induzido em 24,5 por cento dos pacientes, com maior frequência entre 34 e 36 semanas, atingindo 66,7 por cento. Foram administrados antibióticos em 67, 8 por cento das pacientes, tendo-se observado ocorrência de infecçöes em 8,8 por cento das pacientes com amniorrexe prematura

Ease of handling and efficacy of Bricanyl Turbuhaler in Asian asthmatic children.

Ease of handling as well as efficacy of a new terbutaline inhalation device--Bricanyl Turbuhaler--were evaluated among eighty-six Asian children with mild to moderate asthma with a mean age of 8.7 years (range 5 to 14 years) in an open, non-comparative trial. Clinical evaluations were performed on four occasions, ie at the beginning of the run-in period, at the start of the study medication, after 2 weeks of treatment and after a total of 4 weeks of treatment. Appraisal of handling technique was performed by the investigator at the start and end of treatment. Peak expiratory flow rate (PEF) was determined at each visit. Diaries were also kept throughout this time; PEF and asthma symptom scores were recorded every morning and evening. Maximum scores for inhalation technique were achieved by 73% of patients after combined written and verbal instructions at the start of the study and 99% of patients achieved this score at the end of the 4 week treatment period with Bricanyl Turbuhaler. Assessment revealed that approximately 90% of the patients considered loading, inhalation and handling of the Turbuhaler device to be easy, and 90% considered it to be effective in affording symptom relief. Improvements in PEF and reductions in asthma symptoms were observed during the Bricanyl Turbuhaler treatment, as compared to baseline values. All patients tolerated the study medication well without any serious adverse events. We concluded that this group of Asian children were able to use this new "Turbuhaler" device of terbutaline without any difficulty.(ABSTRACT TRUNCATED AT 250 WORDS)

Estudo duplo-cego, randomizado, comparativo entre a eficacia e a tolerabilidade de terbutalina e fenoterol em nebulizacao, em pacientes pediatricos com asma / Double-blind, randomized, comparative study on the efficacy and tolerability of terbutaline versus fenoterol in nebulization, in pediatric asthmatic patients

Num estudo duplo-cego randomizado comparativo entre a terbutalina e fenoterol em nebulizacao, foram avaliados 52 pacientes asmaticos estaveis atraves de testes de espirometria (CV,VEF1,FEF 25-75 por cento e PFE), pre e pos-brocodilatador. Nao se demosntraram diferencas significativas no efeito broncoldilatador, nas doses utilizadas, e nao houve efeitos colaterais de significancia clinica.

Efeito do agonismo e antagonismo betadrenérgico sobre a homeostase extra-renal de potássio na insuficiência renal crônica terminal / Effect of beta adrenergic agonism and antagonism on potassium extrarenal potassium homeostasis in terminal chronic renal failure

O efeito da estimulaçäo beta-2 adrenérgica com terbutalina sobre a homeostase do potássio foi examinado em seis pacientes com insuficiência renal crônica mantidos em hemodiálise. Os pacientes foram estudados em três situaçöes diferentes: infusäo de terbutalina isoladamente, infusäo de terbutalina precedida de propranolol e infusäo de terbutalina precedida de metoprolol. A concentraçäo inicial de potássio sérico foi significativamente menor no primeiro estudo, quando comparada ao segundo (4,7 ñ 0,7 vs 5,6 ñ 0,6 mmol/l, p < 0,05). Durante o primeiro estudo, a concentraçäo sérica do potássio reduziu-se de 4,7 ñ 0,7 para 3,3 ñ 0,7 mmol/l (p < 0,01). No segundo estudo, a concentraçäo de potássio näo variou. Em contraste, no terceiro estudo, ela reduziu-se de 5,3 ñ 0,7 para 4,2 ñ 0,8 mmol/l (p < 0,01), sendo essa reduçäo significativamente menor que aquela observada no primeiro estudo (29,9 ñ 7,1 vs 21 ñ 6,4 por cento, p < 0,05). Esses resultados sugerem que o manejo extra-renal do potássio é mediado por receptores beta-2. Desde que houve elevaçäo do potássio sérico quando os pacientes receberam propranolol, os autores sugerem que pacientes com insuficiência renal crônica candidatos ao uso de betabloqueadores devam receber preferencialmente um betabloqueador beta-I específico. Os autores concluem ainda que a estimulaçäo betadrenérgica com terbutalina é um método rápido, seguro e eficaz na reduçäo do potássio sérico, desde que os pacientes näo estejam recebendo droga betabloqueadora näo específica

Effect of inhaled terbutaline on platelet activity in bronchial asthma.

Thirty five young subjects with long standing bronchial asthma were studied for the effects of terbutaline misthaler (500 micrograms) during acute asthma. Bronchodilators were omitted for a day before the test. Ten matched controls were also studied. In all subjects, basal IgE level (ELISA), pulmonary parameters (FVC, FEV, PEFR, FEF 25-75 and FEF 75-85) and platelet activity, (platelet clumping/150 WBC on smear, platelet adhesiveness, blood recalcification time and kaolin clotting time for platelet factor3) were compared. During acute asthma, the subjects displayed IgE levels > or = 500 IU/ml (n = 33), activation of clotting (n = 30) and eosinophilia > or = 450/cmm (n = 28). These changes were not seen in normal controls. Terbutaline resulted in a reversal of airway obstruction, mainly of small airways, while the platelet hyperactivity and blood hypercoagulability were rectified (P < 0.001). It is concluded that platelet activity increases in acute asthma and is corrected by inhaled terbutaline concomittant with the relief of bronchospasm.

Improvement of inhaler efficacy by home-made spacer.

The delivery of aerosol from a metered dose inhaler (MDI) was reported to be more efficient with a spacer. Hence, a home-made spacer modified from a 950 ml low cost plastic bottle, was compared with a MDI and with a 750 ml imported spacer (Nebuhaler). On three consecutive days, at the same time of day, 20 adult patients with chronic asthma inhaled two puffs of terbutaline sulphate (0.5 mg), delivered from MDI alone, MDI with a 750 ml Nebuhlaer and MDI with a home-made spacer. The following measurements were made: forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and pulse rate. These measurements were carried out immediately before and at 5, 20, 60 min after inhalation of terbutaline. FEV1 was significantly increased (P < 0.05) at 5, 20 and 60 min after administration of terbutaline with MDI via either spacers than with MDI alone but no significant difference was observed between Nebuhaler and the home-made spacer. FVC and pulse rate showed no significant change with each method of administration. In conclusion, terbutaline delivered by MDI and home-made spacer was more effective in bronchodilatation than by MDI alone and was just as effective as MDI and Nebuhaler. The home-made spacer therefore offers a simple, inexpensive and more effective method for delivering aerosol drug.

Control of uterine hyperactivity caused by prostaglandin with intravenous terbutaline: a case report.

Prostaglandin E2 is beginning to be used more widely for the induction of labor in this country. The main concern with vaginal administration is the difficulty in stopping uterine hyperactivity. This report is a case where intravenous terbutaline was given as soon as hyperactivity and fetal heart rate deceleration were detected. Using this treatment, hyperactivity was controlled and the fetal heart rate returned to normal. Unfortunately, cesarean section was necessary for fetal distress which developed two and a half hours later when syntocinon was started intravenously to augment the labor.

Terbutalina inhalada vs. Terbutalina subcutánea para el tratamiento de la crisis de asma bronquial en niños mayores de 5 años / Inhalated terbutalina vs. subcutaneous terbutaline for the treatment asthma crisis un children over 5 years

39 niños, entre 5 y 12 años con crisis de asma bronquial fueron tratados con terbutalina, 15 por la vía inhalatoria y 15 por vía subcutánea. al comparar los resultados obtenidos la mejoría clínica y espirométrica resultó ser semejante para los dos grupos estudiados