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GUEST EDITORIAL
Year : 1979  |  Volume : 25  |  Issue : 1  |  Page : 1-3

Evaluation of bronchodilators and mucolytic agents


Department of Chest Medicine, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012, India

Correspondence Address:
S R Kamat
Department of Chest Medicine, Seth G.S. Medical College and K.E.M. Hospital, Parel, Bombay-400 012
India
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Source of Support: None, Conflict of Interest: None


PMID: 458736

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How to cite this article:
Kamat S R. Evaluation of bronchodilators and mucolytic agents. J Postgrad Med 1979;25:1-3

How to cite this URL:
Kamat S R. Evaluation of bronchodilators and mucolytic agents. J Postgrad Med [serial online] 1979 [cited 2019 Nov 21];25:1-3. Available from: http://www.jpgmonline.com/text.asp?1979/25/1/1/42096


Relief of dyspnoea or expiratory obstruction has been an important step in the management of chronic lung diseases. When there are other factors like ineffective cough, undernutrition, dehydration, infective exacerbations, these need specific measures. For the treatment of bronchospasm, bronchodila­tors have been very much in common use. A common way of judging their efficacy is to clinically monitor the fre­quency and severity of attacks to record changes in the clinical status and also to detect the degree of prolongation of ex­piration or wheezing. [4]

One way of objective evaluation has been to record the need of additional medications required. These can be suitably scored and can serve as an index of the efficacy of a drug. [4],[8] So with effective drug the need for other medi­cines is minimised. A more objective way is to record changes in pulmonary function before and after the drug for a short study [9] and over a long period intermittently (say once weekly) for the long term effects. [1],[6] The functional parameters measured may be FVC, FEV,, MEFR, PEF, DMBC and sometimes air­way resistance, flow volume curves or blood gases.

The former are measured by a spiro­meter, peak flow meter and a weather balloon. The latter are recorded on a multichannel recorder with instantane­ous monitoring of flow, volume and pres­sure curves. The patients chosen are those with regular attacks, evidence of obstruction on lung function and absence of infection. These methods can be ap­plied to various old and new drugs and comparative efficacy worked out.

We did several comparisons of ephe­drine-theophylline combinations. The long acting preparations gave a more sustained functional improvement . [4] Over 3 weeks there was little difference bet­ween the short and the long acting pre­parations for clinical improvement, the former being somewhat better. The com­binations with prednisolone (6 mg.) and standard dose theophylline were more useful in maintaining the clinical and functional status. [2] However, low dose ephedrine-theophylline was not useful except for its prednisolone content. [2]

There was some evidence to show that prednisolone in small doses also increases gastric distress [2] and phenobarbitone does not seem to contribute usefully. [4] From our results there may be a case for omitting phenobarbitone totally from the bronchodilator preparations.

Parenteral steroids in a long acting preparation produce a sustained (upto 6 days) improvement in lung function an-4 clinical status, more so in asthmatic cases. [8] The peak effect was seen around the 3rd day and it did not change the incidence of lung infection,

When an intravenous preparation was given for acute study, the improvement in function was seen maximally at 4 to 6 hours. [7] Even theophylline alone show­ed bronchodilator effect only at 6 hours thus suggesting that its other effects are useful in giving relief in status asthma­ticus.

In a crossover comparison of oral sal­butamol (4 mg.) with ephedrine (30 mg.) given 4 times daily for 3 weeks it was shown that two drugs were comparable but there was a slight tolerance to ephe­drine at 3 weeks. [3] A comparison of ephedrine-theophylline combination with salbutamol showed some superiority of the former. There was no evidence of residual long term benefit for lung func­tion with either of the preparations. The relief with salbutamol thus was compar­able with the traditional combination in a 3 months trial. [5]

The new beta stimulator drugs gave good improvement as aerosols. The latter when given by gas flow method are more effective than when given as the freon powered inhaler. [9] Salbutamol or isopre­naline were similar but the effect of the former was more sustained (for 4-6 hours).

Over a long term aerosol trial in (bys­sinotic) cotton mill workers, orciprena­line and salbutamol aerosols gave great­er improvement as compared to placebo or isoprenaline. [6]

Further studies with salbutamol aero­sol showed it to give improvement only during the few hours of administra­tion [1],[6] . Similarly many newer drugs can be evaluated by using these methods.

In a long term study of aerosolised sodium chromoglycate we found that only a proportion of asthmatic patients improved. (unpublished data). In a study of mucolytic drugs, we gave the drug as aerosol and showed in a study over 10 days that the drug reduced the viscosity of sputum but did not give much im­provement of lung function. In fact, in some there was a decline in lung func­tion after the drug. The functions were studied every hour for 8 hours for 8-10 days. There was a significant improve­ment clinically over saline aerosol in some cases. (under publication).

Thus new methods of assessment of bronchodilator drugs have changed our ideas about their role.

 
 :: References Top

1.Kamat, G. R., Kamat, S. R., Singh, H., D'sa, E., Karandikar, K. N., Chakravarty, M. A., Store, S. D. and Sheth, U. K.: Pressurised bronchodilator aerosol in byssinosis. Ind. J. Med. Sc., 29: 208-213, 1975.  Back to cited text no. 1    
2.Kamat, S. R., Hoskote, V. R., Jagasia, R. S., Shah, D. C'. and Tyagi, N. K.: Study of the effect of small dose of steroid to ephedrine-theophylline combination in chronic obstructive pulmonary disease. Submitted to J. Ass. Phys. India (In press).  Back to cited text no. 2    
3.Kamat. S. R., Hoskote, V. R., Store, S. D., Sanghavi, B. and Sheth, U. K.: Compari­son of oral salbutamol and ephedrine in chronic obstructive pulmonary disease. Ind. J. Chest Dis., 20: 54-62, 1978.  Back to cited text no. 3    
4.Kamat, S. R., Panandikar, S. G., Purohit, S. D., Jagasia, R. S. and Kulkarni, S. T.: Experience with various preparations of ephedrine-theophylline combination in chronic obstructive pulmonary disease, Ind. J. Chest Dis., 18: 25-35, 1976.  Back to cited text no. 4    
5.Kamat. S. R., Salpekar, V. Y., D'sa, E., Sanghavi, B. and Kamat, G. R.: Prolonged comparison of oral salbutamol and ephedrine-theophylline combination in byssinosis. Ind. J. Chest Dis., 20: 63-72, 1978.  Back to cited text no. 5    
6.Kamat, S. R., Store, S. D., D'sa, E., Karandikar, K N., Kamat, G. R., Singh, H., Phadnis, S. V. and Gaonkar. P. K.: Bronchodilator trials in byssinosis. Ind. J. Chest Dis., 17: 151-157, 1975.  Back to cited text no. 6    
7.Kamat, S. R., Warrier, N. V. U., Store, S. D., Sanghavi, B. and Sheth, U. K.: Parenteral hydroxypropyl theophylline with corticosteroid in obstructive airway disease. J. Postgrad. Med., 20: 188-192, 1974.  Back to cited text no. 7    
8.Store, S. D., Kamat, S. R. Fakay, Y. C., Sanghavi, B. and Sheth, U. K.: A long act­ing corticosteroid in obstructive airway disease. Ind. J. Chest Dis., 16: 374-380, 1974.Store, S. D., Kamat, S. R., Purohit, S. D. and Rane, M. A.: Bronchodilatation by metered inhaler (prenomiser) in obstruc­tive airway disease. J. Ass. Phys. Ind., 22: 515-520, 1974.  Back to cited text no. 8    
9.Store, S. D., Kamat, S. R., Warrier, N. V. U., Sanghavi, B., Kulkarni, P. S. and Sheth, U. K.: Oral salbutamol in obstruc­tive airway disease. Ind. J. Chest Dis., 16:144-152, 1974.  Back to cited text no. 9    




 

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