Response to inhaled albuterol during nocturnal asthma

During conventional daytime studies of β 2-agonists, 1 puff of a metered-dose inhaler often produces a near maximum bronchodilator response. Consequently, the US Food and Drug Administration–approved dose of albuterol is only 1 to 2 puffs every 4 to 6 hours. To determine whether a higher dose of alb...

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Bibliographic Details
Published in:Journal of allergy and clinical immunology 2004-06, Vol.113 (6), p.1058-1062
Main Authors: Hendeles, Leslie, Beaty, Russell, Ahrens, Richard, Stevens, Gary, Harman, Eloise M.
Format: Article
Language:English
Subjects:
Administration, Inhalation
Adolescent
adrenergic β-agonists
Adult
Airway management
Albuterol - administration & dosage
Asthma
Asthma - drug therapy
Asthma - physiopathology
Biological and medical sciences
Bronchodilator agents
Bronchodilator Agents - therapeutic use
bronchospasm
Cross-Over Studies
dose-response
Dose-Response Relationship, Drug
Drug dosages
Female
Forced Expiratory Volume
Fundamental and applied biological sciences. Psychology
Fundamental immunology
Heart rate
Humans
Hypotheses
Immunopathology
Male
Medical sciences
Medical treatment
Muscular system
Smooth muscle
Statistical methods
Studies
Time Factors
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Summary:During conventional daytime studies of β 2-agonists, 1 puff of a metered-dose inhaler often produces a near maximum bronchodilator response. Consequently, the US Food and Drug Administration–approved dose of albuterol is only 1 to 2 puffs every 4 to 6 hours. To determine whether a higher dose of albuterol is required to normalize lung function during nocturnal asthma. Fifteen subjects (age, 18-37 years) were treated with albuterol metered-dose inhalers in a randomized crossover manner at the onset of nocturnal symptoms while sleeping in the Clinical Research Center and during the day when they were asymptomatic. The dose was doubled at 15-minute intervals to 16 cumulative puffs. The mean ± SD predose FEV 1 was lower at night than during the day (44% ± 12% vs 68% ± 9% predicted; P = .0001). The maximum FEV 1 achieved was also lower at night (84% ± 15% vs 90% ± 12%; P = .02). The nocturnal dose-response curve was shifted to the right. The median (25th, 75th percentiles) dose required to achieve 80% of the subject's personal best FEV 1 was substantially higher at night (5 [1, 19] vs 0.4 [
ISSN:0091-6749
1097-6825
DOI:10.1016/j.jaci.2004.03.046