Terbutaline inhalations by the Turbuhaler as replacement for domiciliary nebulizer therapy in severe chronic obstructive pulmonary disease.

Patients with chronic obstructive pulmonary disease (COPD) are often treated with high dose inhalations of beta 2-agonists. We compared domiciliary therapy with terbutaline administered by the Turbuhaler and by a jet nebulizer. Forty nebulizer users with severe COPD were included in the randomized, double-blind, cross-over study. Terbutaline was inhaled t.i.d. for 2 weeks as dry powder (5 doses = 2.5 mg) by Turbuhaler or as solution (2 ml = 5 mg) by jet nebulizer (Pari Inhalierboy). The mean age of the 25 completing patients was 66 years (range: 54-81), the mean FEV1 was 0.73 l or 29% of predicted (range: 11-55%). The period where the Turbuhaler delivered the active drug was preferred by 16 patients, the nebulizer period by seven (P = 0.09). The median score concerning feeling of control over the disease--according to the Chronic Respiratory Disease Questionnaire--was better after the Turbuhaler period (P = 0.01). Other scores concerning disease related quality of life, the daily peak expiratory flow rates, the additional use of a metered dose inhaler were not significantly different for the two types of treatment. It is concluded that high dose domiciliary terbutaline treatment by Turbuhaler can replace nebulizer treatment in most patients with severe COPD.

Bronchodilating effect of terbutaline powder in acute severe bronchial obstruction.

The bronchodilating effect of terbutaline dry powder inhaled via Turbuhaler was compared with terbutaline inhaled via a conventional, chlorofluorocarbon (CFC) inhaler and Nebuhaler (750 ml spacer) in 68 consecutive patients attending the emergency department with acute severe bronchial obstruction. The study was of an open, randomized, parallel group design with one study day. Patients were treated with 2.5 mg of terbutaline 15 min apart, either as dry powder via Turbuhaler or with a CFC inhaler in conjunction with Nebuhaler. Data from 62 patients were analyzed. The mean baseline FEV1 values were 0.81 L (SD, 0.64; range, 0.14 to 2.74 L) in the Turbuhaler group (n = 33), and 0.90 L (SD, 0.90; range, 0.27 to 2.60 L) in the Nebuhaler group (n = 29). The mean increases in FEV1 from baseline were 0.40 L (SD, 0.40; range, 0.06 to 2.36 L) and 0.21 L (SD, 0.25; range, -0.05 to 0.95 L) 10 min after the last inhalation via Turbuhaler and Nebuhaler, respectively. The difference between mean values of the increase in FEV1 after terbutaline treatment with Turbuhaler and the CFC inhaler and Nebuhaler was statistically significant (p = 0.0004, ANOVA). This study showed that inhalation of terbutaline via Turbuhaler produced a significantly greater increase in FEV1 compared with the same dose of terbutaline administered via the CFC inhaler and Nebuhaler in patients attending the emergency department with acute severe bronchial obstruction.

[Occurrence of asthma in schoolchildren. Is the disease underdiagnosed?]. / Hyppighed af astma hos skolebørn. Er sygdommen underdiagnosticeret?

A cross sectional study of 1064 unselected school children aged 6-17 years obtained the following for 851 of them (80%): complete data from a questionnaire on current asthma diagnosed by a physician, information on previous recurrent wheezing and present exposure to tobacco smoking combined with measurement of peak expiratory flow rate (PEFR) before and after six minutes running. Seventy-five (8.8%) had had previous periods of recurrent wheezing, and 535 (62.7%) were exposed to tobacco smoking at home. A correlation was found between passive smoking and previous recurrent wheezing. Thirty-four (4.0%) suffered from current asthma. Thirty-one children (3.6%) without an earlier diagnosis of asthma showed a significant exercise-induced fall in PEFR) (at least 15%). Thirty of these 31 children were followed up, and at reinvestigation, 27 (95%) were confirmed to suffer from hyperreactive airways based on significant exercise-induced fall in PEFR and/or a significantly increased variability of PEFR of at least 15% as measured by home recordings of PEFR. In conclusion the point prevalence of asthma diagnosed by a physician was 4.0%. In addition at least 3.2% had reproducible significant bronchial hyperreactivity indicating a point prevalence of asthma/clinically significant bronchial hyperreactivity of at least 7.2%. Asthma seems to be underdiagnosed in school children. Furthermore, our results indicate an association between passive smoking and recurrent wheezing.

Therapeutic equivalence between bambuterol, 10 mg once daily, and terbutaline controlled release, 5 mg twice daily, in mild to moderate asthma.

Bambuterol is the first long-acting oral beta 2-agonist with a 24 h effective duration. In order to investigate the possibility of replacing established treatment modalities with bambuterol once daily, we wanted to compare the bronchodilating and tremorogenic effects of bambuterol, 10 mg once daily, and terbutaline, 5 mg controlled-release (CR) tablets twice daily. The study was of a double-blind, double-dummy, randomized, cross-over design and involved two, two week treatment periods, separated by a one week wash-out period. Peak expiratory flow (PEF) recorded in patients' diaries was the primary efficacy variable. Seventy adult, asthmatic out-patients with mild to moderate asthma were included (forced expiratory volume in one second (FEV1) > or = 50% predicted). After treatment with bambuterol, mean morning and evening PEF (SD) were 347 (122) and 365 (121) l.min-1, respectively and 346 (121) and 365 (122) l.min-1, respectively, after treatment with terbutaline. FEV1 (SD) was 2.21 (0.91) l and 2.27 (0.93) l after bambuterol and terbutaline treatments, respectively. Tremor scores tended to be lower during treatment with bambuterol, although not significantly so. Tremor scores were low, in general. In conclusion, no difference in the bronchodilating effect was demonstrated between bambuterol, 10 mg once daily, and controlled release terbutaline, 5 mg twice daily. A tendency towards less tremor was seen with bambuterol.

[The significance of incorrect spray technic on the consumption of terbutaline in patients with chronic obstructive lung disease]. / Betydningen af fejlagtig sprayteknik på terbutalinforbruget hos patienter med kronisk obstruktiv lungesygdom.

A total of 140 patients with chronic obstructive pulmonary disease was included in this multicentre parallel group investigation with the object of assessing whether poor inhalation technique results in increased consumption of beta 2-agonist. On the basis of measurements of pulmonary function, the patients were stratified into two groups with good and poor inhalation techniques, respectively, and these were subdivided at random to inhalation of terbutaline via either a freon spray (aerosol) or Turbohaler (powder). During a period of four weeks the daily terbutaline consumption, the symptoms and pulmonary function were noted. Patients with poor inhalation technique did not have significantly increased terbutaline consumption. The consumption of terbutaline was independent of the method of administration. The Turbohaler was just as effective as the spray and the patients preferred this method, (p less than 0.05).

[Measurement of the quality of life or general health status in chronic obstructive lung diseases]. / Måling af livskvalitet eller generel helbredstilstand ved kronisk obstruktive lungesygdomme.

During recent years, in assessment of the therapeutic effect of medicinal treatment, measurement of the general condition of health or quality of life has been extensively employed. This holds true particularly in patients with chronic disease, including patients with chronic obstructive pulmonary disease. In this patient category, several controlled investigations have been carried out in which one or more questionnaires concerning general health have been employed. The questionnaires employed and reviewed are the Sickness impact profile (SIP), Mcmaster's chronic respiratory disease questionnaire (CRQ), Quality of well-being scale (QWB), General health questionnaire (GHQ), Minnesota multiphasic personality inventory (MMPI) and Profile of mood states (POMS). The questionnaires contain questions regarding many aspects of the existence of the patients and have been tested to varying extents for reproducibility, sensitivity and validity. No patent method exists for measurement of quality of life. It is therefore important for interpretation of investigations that the aspects of quality of life which have been measured are clearly defined and that the questionnaire method employed is quoted.

Operative treatment of recurrent cancer of the uterine cervix after radiotherapy.

During the period 1976-83, 47 women were operated on for recurrent or persistent cancer of the uterine cervix following initial radiation therapy. The operations performed were Wertheim's operation combined with dissection of the pelvic nodes, or some type of pelvic exenteration. With a 5-year survival of 31% in our material, surgical treatment of centrally located recurrences is a realistic possibility. We recommend an exenterative procedure as the operation is technically easier and the complications require less radical surgical treatment. The operation should only be done on narrow indications in the hope of achieving a cure, and the selection of patients must thus be stringent.