Chest
Original Research: Airway SecretionsAssessing the Effects of Racemic and Single-Enantiomer Albuterol on Airway Secretions in Long-term Intubated Patients
Section snippets
Study Design
This is a placebo-controlled crossover study. During a 2-week washout period, regularly scheduled β2-agonists were discontinued. Patients then underwent daily measurements of secretion volume for 1 week with no aerosolized medications. The patients then received a series of three nebulized treatments in random order during consecutive weeks: normal saline solution, generic racemic albuterol, and R-albuterol. The racemic albuterol and R-albuterol were supplied by the manufacturers as premixed
Results
In Figure 2, the data from individual subjects are illustrated with each set of four bar graphs representing the sum of 5 days of aspirate volumes for the control period and each of the three treatment periods. Each data point in Figure 2, top, a, and bottom, b, represents the sum of five individual timed daily volume measurements. Figure 2, top, a, presents data for the 5-day aggregate of first-hour volumes, while Figure 2, bottom, b, presents the 5-day aggregate volumes at 4 h. Table 2 shows
Discussion
This is the first clinical study to compare the effects of a racemic and a single-enantiomer formulation on airway secretion in any population, and the first study to objectively evaluate the impact of β2-sympathomimetic agonists on secretory function in tracheostomized patients receiving mechanical ventilation, and only the second study of the effects of these agents on secretion volume. We report that all treatments, including saline solution, were associated with a transient increase in
Acknowledgment
We thank the Respiratory Care Department staff and the nursing staff of Floor Four East, Gurwin Jewish Geriatric Center, Commack, NY, for their cooperation with the study. We thank Teresa Kramer, RN, ANP, April Plank, RN, ANP, and Barbara Starke, RN, ANP, for the specimen collection. We thank Mohammed Amin, MD, and Akbar Shah, MD, for performing the ventilator bench testing, and Mr. Robert Perry for performing the cytokine assays.
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Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (www.chestjournal.org/misc/reprints.shtml).
This study was supported by a grant from Sepracor Inc., Marlborough, MA.