At our SCM meet this past weekend we had an out-of-state visitor swimming. She was a very serious swimmer, arrived a week early to acclimate, came with a bit of an entourage, and did some pretty amazing times (45-49). We also saw her taking frequent hits from a very large inhaler always just before her races as she was warming up and behind the blocks. Any thoughts?.
Please see extensive reference list from this review:
Expert Rev Respir Med. 2008 Apr;2(2):149-59.
Albuterol HFA for the management of obstructive airway disease.
Colice GL.
Clinical efficacy
From the preclinical formulation work, it was expected that albuterol HFA MDI would be as effective a bronchodilator, on a puff-per-puff basis, as albuterol CFC MDI. This expectation was confirmed in dose-response studies in patients with asthma . One puff of albuterol HFA MDI improved FEV1 significantly more than placebo, but the bronchodilator effect was less than with two puffs. The bronchodilator effects of two puffs from an albuterol HFA MDI were comparable to those of two puffs from an albuterol CFC MDI. In a pivotal Phase III study, adult patients with asthma were randomized in a blinded fashion to self-administer two puffs of either albuterol HFA MDI, albuterol CFC MDI or an HFA placebo MDI four-times per day for 12 weeks. At week 12, the bronchodilator effects of albuterol HFA MDI were significantly greater than placebo and comparable to the group randomized to treatment with albuterol CFC MDI . The bronchodilator effects from both albuterol products decreased from baseline after 4 weeks of dosing (i.e., tachyphylaxis), with repetitive albuterol exposure occurring. Studies in children with asthma confirmed that the bronchodilator effects of two puffs of albuterol HFA MDI were comparable to those achieved with two puffs of albuterol CFC MDI after regular dosing for 2-4 weeks .
Asthma patients who had been stabilized on regular treatment with albuterol CFC MDI were studied after being switched to regular treatment with albuterol HFA MDI . No evidence of loss of asthma control was found and serial spirometry confirmed that albuterol HFA MDI provided comparable improvements in FEV 1 as were previously seen with albuterol CFC MDI. Two large postapproval studies, using diary card-recorded measures of peak expiratory flow and asthma symptoms, showed that patients randomized to albuterol HFA MDI treatment had comparable asthma control as those receiving albuterol CFC MDI . In adults and children with asthma and exercise-induced bronchospasm, treatment with albuterol HFA MDI prior to exercise was significantly better than placebo and comparable to albuterol CFC MDI in preventing postexercise falls in FEV1 .
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(excerpted below):
73 Dockhorn R, Vanden Burgt J, Ekholm BP et al. Clinical equivalence of a novel non-chlorofluorocarbon-containing salbutamol sulfate metered-dose inhaler and a conventional chlorofluorocarbon inhaler in patients with asthma. J. Allergy Clin. Immunol. 96, 50-56 (1995).
74 Langley SJ, Sykes AP, Batty EP et al. A comparison of the efficacy and tolerability of single doses of HFA 134a albuterol and CFC albuterol in mild-to-moderate asthmatic patients. Ann. Allergy Asthma Immunol. 88, 488-493 (2002).
75 Bleecker ER, Tinkelman DG, Ramsdell J et al. Proventil HFA provides bronchodilation comparable to ventolin over 12 weeks of regular use in asthmatics. Chest 113, 283-289 (1998).
* Pivotal Phase III study comparing regular use of albuterol HFA MDIs with albuterol CFC MDIs over 12 weeks.
76 Shapiro GS, Klinger NM, Ekholm BP, Colice GL. Comparable bronchodilation with hydrofluoroalkane-134a (HFA) albuterol and chlorofluorcarbons-11/12 (CFC) albuterol in children with asthma. J. Asthma 37, 667-675 (2000).
77 Shapiro G, Bronsky E, Murray A et al. Clinical comparability of ventolin formulated with hydrofluoroalkane or conventional chlorofluorocarbon propellants in children with asthma. Arch. Ped. Adolescent Med. 154, 1219-1225 (2000).
Please see extensive reference list from this review:
Expert Rev Respir Med. 2008 Apr;2(2):149-59.
Albuterol HFA for the management of obstructive airway disease.
Colice GL.
Clinical efficacy
From the preclinical formulation work, it was expected that albuterol HFA MDI would be as effective a bronchodilator, on a puff-per-puff basis, as albuterol CFC MDI. This expectation was confirmed in dose-response studies in patients with asthma . One puff of albuterol HFA MDI improved FEV1 significantly more than placebo, but the bronchodilator effect was less than with two puffs. The bronchodilator effects of two puffs from an albuterol HFA MDI were comparable to those of two puffs from an albuterol CFC MDI. In a pivotal Phase III study, adult patients with asthma were randomized in a blinded fashion to self-administer two puffs of either albuterol HFA MDI, albuterol CFC MDI or an HFA placebo MDI four-times per day for 12 weeks. At week 12, the bronchodilator effects of albuterol HFA MDI were significantly greater than placebo and comparable to the group randomized to treatment with albuterol CFC MDI . The bronchodilator effects from both albuterol products decreased from baseline after 4 weeks of dosing (i.e., tachyphylaxis), with repetitive albuterol exposure occurring. Studies in children with asthma confirmed that the bronchodilator effects of two puffs of albuterol HFA MDI were comparable to those achieved with two puffs of albuterol CFC MDI after regular dosing for 2-4 weeks .
Asthma patients who had been stabilized on regular treatment with albuterol CFC MDI were studied after being switched to regular treatment with albuterol HFA MDI . No evidence of loss of asthma control was found and serial spirometry confirmed that albuterol HFA MDI provided comparable improvements in FEV 1 as were previously seen with albuterol CFC MDI. Two large postapproval studies, using diary card-recorded measures of peak expiratory flow and asthma symptoms, showed that patients randomized to albuterol HFA MDI treatment had comparable asthma control as those receiving albuterol CFC MDI . In adults and children with asthma and exercise-induced bronchospasm, treatment with albuterol HFA MDI prior to exercise was significantly better than placebo and comparable to albuterol CFC MDI in preventing postexercise falls in FEV1 .
-----
(excerpted below):
73 Dockhorn R, Vanden Burgt J, Ekholm BP et al. Clinical equivalence of a novel non-chlorofluorocarbon-containing salbutamol sulfate metered-dose inhaler and a conventional chlorofluorocarbon inhaler in patients with asthma. J. Allergy Clin. Immunol. 96, 50-56 (1995).
74 Langley SJ, Sykes AP, Batty EP et al. A comparison of the efficacy and tolerability of single doses of HFA 134a albuterol and CFC albuterol in mild-to-moderate asthmatic patients. Ann. Allergy Asthma Immunol. 88, 488-493 (2002).
75 Bleecker ER, Tinkelman DG, Ramsdell J et al. Proventil HFA provides bronchodilation comparable to ventolin over 12 weeks of regular use in asthmatics. Chest 113, 283-289 (1998).
* Pivotal Phase III study comparing regular use of albuterol HFA MDIs with albuterol CFC MDIs over 12 weeks.
76 Shapiro GS, Klinger NM, Ekholm BP, Colice GL. Comparable bronchodilation with hydrofluoroalkane-134a (HFA) albuterol and chlorofluorcarbons-11/12 (CFC) albuterol in children with asthma. J. Asthma 37, 667-675 (2000).
77 Shapiro G, Bronsky E, Murray A et al. Clinical comparability of ventolin formulated with hydrofluoroalkane or conventional chlorofluorocarbon propellants in children with asthma. Arch. Ped. Adolescent Med. 154, 1219-1225 (2000).
