Chest
Clinical InvestigationsSleepSalmeterol vs Theophylline: Sleep and Efficacy Outcomes in Patients With Nocturnal Asthma
Section snippets
Patient Population
Nonsmoking men and nonpregnant women who were ≥ 18 years of age and who had nocturnal asthma were selected for study participation. Nocturnal asthma was defined as asthma with symptoms of cough, wheezing, chest tightness, or shortness of breath causing awakenings at least two times a week on average in the 2 months prior to the initial screening visit, with the presence of a diurnal peak expiratory flow (PEF) variation of ≥ 15% on at least 3 of 10 days during the screening period. Entry
Patient Characteristics
Demographic data and characteristics of all randomized patients are summarized in Table 1. Of the 38 patients screened, 19 were randomized to study treatment after open-label theophylline titration. The 19 patients withdrawing prior to randomization did so due to failure to meet the enrollment criteria (8), theophylline titration failure (4), adverse events (2), patient decision (2), protocol violation (1), asthma exacerbation (1), and failure to return (1). One of these patients withdrew
Discussion
Clinical studies have shown salmeterol15 and theophylline18,19 to be safe and effective in treating nocturnal asthma. In a comparison of the two medications, salmeterol was superior to sustained-release theophylline in some objective measures of efficacy and was reported to be better tolerated by study patients.16 Similar results were seen in the current study, with salmeterol providing significantly greater improvements in lung function than theophylline or placebo while reducing the
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2011, Handbook of Clinical NeurologyCitation Excerpt :Salmeterol has been shown to be associated with sustained improvement in morning peak expiratory flow, protection from nighttime lung function deterioration, reduction in albuterol use, and improvement in patient sleep perceptions. No differences have been seen, however, in polysomnographic measures of sleep quality (Wiegand et al., 1999). It should be remembered that both corticoids and β2-agonists may disrupt sleep.
Alcohol, toxins, and medications as a cause of sleep dysfunction
2011, Handbook of Clinical NeurologyCitation Excerpt :These patients have disturbed sleep when compared to healthy controls even when they are clinically stable (Vir et al., 1997), which may reflect in part the sleep-disrupting effects of bronchodilators. Nevertheless, randomized double-blind trials suggest that the beta-2-adrenergic agonists improve the subjective sleep of patients with nocturnal asthma when compared to placebo, due to the reduction of breathing disturbances (Petrie et al., 1993; Kraft et al., 1997; Wiegand et al., 1999; Sears, 2001). In addition, they appear to have minimal effects on sleep architecture (Stewart et al., 1987; Veale et al., 1994; Man et al., 1996; Wiegand et al., 1999); one study reported beneficial effects, including decreased light sleep and increased S4 sleep when patients were treated with salmeterol versus placebo (Fitzpatrick et al., 1990).
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This research was supported by a grant from Glaxo Wellcome Inc.