indacaterol and Acute-Disease

The administration of β2-agonists to patients with airways obstruction often results in transient decrease in PaO2 despite concomitant bronchodilation. This effect is potentially dangerous for patients suffering from acute exacerbation of COPD (AECOPD). In this study, we investigated the effect of indacaterol 150 μg and 300 μg on the arterial blood gas tensions of hospitalised patients with AECOPD.. We explored the acute effects on arterial blood gases and spirometry of two doses of indacaterol Breezhaler (150 and 300 μg) in 12 patients hospitalised because of an AECOPD in 2 non-consecutive days under open-label, randomized, crossover conditions, with blind evaluation. Blood specimens were taken just before the inhalation and at 15, 30, 60, 120, 240 and 360 min after inhalation of each treatment, and spirometry was performed at the same time points.. Both doses of indacaterol did not cause significant changes in blood gases, although some patients with relatively well-preserved PaO2 presented transient episodes of oxygen desaturation that normalize spontaneously in a very short time. Moreover, they induced a significant mean increase in FEV1 and FVC, although the improvement caused by indacaterol 300 μg was larger.. Indacaterol up to 300 μg is a potent bronchodilator that may induce small, transient decrease in PaO2 mainly in patients with relatively well-preserved PaO2. There appeared to be no clinical consequences of these PaO2 abnormalities in patients suffering from AECOPD.

Topics: Acute Disease; Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Aged; Aged, 80 and over; Blood Gas Analysis; Carbon Dioxide; Cross-Over Studies; Female; Forced Expiratory Volume; Humans; Indans; Male; Middle Aged; Oxygen; Partial Pressure; Pulmonary Disease, Chronic Obstructive; Quinolones; Vital Capacity

Some clinical trials have suggested that the inhaled long-acting β2-agonists (LABAs) may be effective in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Since indacaterol, the first once-daily LABA to be developed for the regular treatment of COPD, exhibits fast onset of action and 24-h duration of bronchodilation, we have investigated its effects in patients with AECOPD managed in the emergency department. In a randomised controlled pilot trial, we have enrolled 29 consecutive patients with a recent (i.e., within ≤ 4 d) history of AECOPD and requiring hospitalization. All patients received a standard protocol consisting of ipratropium bromide aerosol 500 μg three times a day, intravenous methylprednisolone 20 mg twice-daily and, if indicated, oral levofloxacin 500 mg once-daily. Moreover, they were randomly allocated to one of the two 5-day treatment groups (indacaterol maleate 300 μg once-daily or salbutamol nebulizer 1250 μg three times a day). The administration of indacaterol 300 μg to patients admitted to emergency department for an AECOPD resulted in a greater improvement of pulmonary function compared with traditional therapy, without cardiovascular side effects. Our results suggest that indacaterol could be a useful option in the treatment of AECOPD. However, further larger double-blinded randomized clinical trials are needed to validate the intriguing results obtained in this setting.

Topics: Acute Disease; Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Aged; Albuterol; Bronchodilator Agents; Drug Therapy, Combination; Hospitalization; Humans; Indans; Ipratropium; Levofloxacin; Male; Methylprednisolone; Nebulizers and Vaporizers; Pilot Projects; Pulmonary Disease, Chronic Obstructive; Quinolones; Treatment Outcome