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CMAJ : Canadian Medical Association Journal logoLink to CMAJ : Canadian Medical Association Journal
. 1991 Jan 1;144(1):35–39.

Mechanism of bronchodilator effect in chronic airflow limitation.

R Jaeschke 1, G H Guyatt 1, J Singer 1, J Keller 1, M T Newhouse 1
PMCID: PMC1452523  PMID: 1984814

Abstract

OBJECTIVE: To examine the mechanisms through which two bronchodilators (theophylline and salbutamol) influence dyspnea during daily activities. METHODS: Twenty-four patients with chronic airflow limitation participated in a multiple crossover, randomized, placebo-controlled trial. The effect of theophylline and salbutamol, alone or combined, on pulmonary function and dyspnea during daily activities was examined. Correlations of changes in forced expiratory volume in 1 second (FEV1) and maximum expiratory pressures (MIPs) (independent variables) and changes in dyspnea score during daily activities (dependent variable) were also examined. RESULTS: The two drugs proved to be beneficial the effects in general were additive rather than synergistic. The drugs improved the FEV1; theophylline significantly improved the MIPs. The correlation between the changes in FEV1 and those in dyspnea score, after adjustment for the changes in MIPs, was 0.55 (p less than 0.001). The correlation between the changes in MIPs and those in dyspnea score, after adjustment for the changes in FEV1, was 0.39 (p less than 0.001). CONCLUSIONS: Changes in airway calibre and in respiratory muscle strength play an independent and important role in dyspnea during daily activities in patients with chronic airflow limitation. Changes in airway calibre may be of greater importance.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Corris P. A., Neville E., Nariman S., Gibson G. J. Dose-response study of inhaled salbutamol powder in chronic airflow obstruction. Thorax. 1983 Apr;38(4):292–296. doi: 10.1136/thx.38.4.292. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Feldman H. A. Families of lines: random effects in linear regression analysis. J Appl Physiol (1985) 1988 Apr;64(4):1721–1732. doi: 10.1152/jappl.1988.64.4.1721. [DOI] [PubMed] [Google Scholar]
  3. Foxworth J. W., Reisz G. R., Knudson S. M., Cuddy P. G., Pyszczynski D. R., Emory C. E. Theophylline and diaphragmatic contractility. Investigation of a dose-response relationship. Am Rev Respir Dis. 1988 Dec;138(6):1532–1534. doi: 10.1164/ajrccm/138.6.1532. [DOI] [PubMed] [Google Scholar]
  4. Guyatt G. H., Berman L. B., Townsend M., Pugsley S. O., Chambers L. W. A measure of quality of life for clinical trials in chronic lung disease. Thorax. 1987 Oct;42(10):773–778. doi: 10.1136/thx.42.10.773. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Guyatt G. H., Townsend M., Keller J., Singer J., Nogradi S. Measuring functional status in chronic lung disease: conclusions from a randomized control trial. Respir Med. 1989 Jul;83(4):293–297. doi: 10.1016/s0954-6111(89)80199-4. [DOI] [PubMed] [Google Scholar]
  6. Guyatt G. H., Townsend M., Nogradi S., Pugsley S. O., Keller J. L., Newhouse M. T. Acute response to bronchodilator. An imperfect guide for bronchodilator therapy in chronic airflow limitation. Arch Intern Med. 1988 Sep;148(9):1949–1952. doi: 10.1001/archinte.148.9.1949. [DOI] [PubMed] [Google Scholar]
  7. Guyatt G. H., Townsend M., Pugsley S. O., Keller J. L., Short H. D., Taylor D. W., Newhouse M. T. Bronchodilators in chronic air-flow limitation. Effects on airway function, exercise capacity, and quality of life. Am Rev Respir Dis. 1987 May;135(5):1069–1074. doi: 10.1164/arrd.1987.135.5.1069. [DOI] [PubMed] [Google Scholar]
  8. Jaeschke R., Singer J., Guyatt G. H. Measurement of health status. Ascertaining the minimal clinically important difference. Control Clin Trials. 1989 Dec;10(4):407–415. doi: 10.1016/0197-2456(89)90005-6. [DOI] [PubMed] [Google Scholar]
  9. Jenkins S. C., Moxham J. High dose salbutamol in chronic bronchitis: comparison of 400 micrograms, 1 mg, 1.6 mg, 2 mg and placebo delivered by Rotahaler. Br J Dis Chest. 1987 Jul;81(3):242–247. doi: 10.1016/0007-0971(87)90156-2. [DOI] [PubMed] [Google Scholar]
  10. Leech J. A., Ghezzo H., Stevens D., Becklake M. R. Respiratory pressures and function in young adults. Am Rev Respir Dis. 1983 Jul;128(1):17–23. doi: 10.1164/arrd.1983.128.1.17. [DOI] [PubMed] [Google Scholar]
  11. Mahler D. A., Matthay R. A., Snyder P. E., Wells C. K., Loke J. Sustained-release theophylline reduces dyspnea in nonreversible obstructive airway disease. Am Rev Respir Dis. 1985 Jan;131(1):22–25. doi: 10.1164/arrd.1985.131.1.22. [DOI] [PubMed] [Google Scholar]
  12. Murciano D., Aubier M., Lecocguic Y., Pariente R. Effects of theophylline on diaphragmatic strength and fatigue in patients with chronic obstructive pulmonary disease. N Engl J Med. 1984 Aug 9;311(6):349–353. doi: 10.1056/NEJM198408093110601. [DOI] [PubMed] [Google Scholar]
  13. Murciano D., Auclair M. H., Pariente R., Aubier M. A randomized, controlled trial of theophylline in patients with severe chronic obstructive pulmonary disease. N Engl J Med. 1989 Jun 8;320(23):1521–1525. doi: 10.1056/NEJM198906083202304. [DOI] [PubMed] [Google Scholar]

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