Effects of aerosolized surfactant in patients with stable chronic bronchitis: a prospective randomized controlled trial
A. Anzueto, A. Jubran, J. A. Ohar, C. A. Piquette, S. I. Rennard, G. Colice, E. N. Pattishall, J. Barrett, M. Engle, K. A. Perret and B. K. Rubin
University of Texas Health Science Center at San Antonio, USA.
CONTEXT: Chronic bronchitis, estimated to affect more than 13 million
adults in the United States, is characterized in part by retention of
airway secretions, but no approved or effective therapy for airway mucus
retention in patients with chronic bronchitis has been established.
Surfactant reduces sputum adhesiveness, which contributes to difficulty in
clearing secretions, but surfactant has not been tested in patients with
chronic bronchitis. OBJECTIVE: To examine the effects of exogenous
surfactant on sputum clearance and pulmonary function in patients with
stable chronic bronchitis. DESIGN: A prospective, multicenter, randomized,
double-blind, parallel-group, placebo-controlled comparison of the effects
of 2 weeks of treatment with 3 doses of aerosolized surfactant
(palmitoylphosphadidylcholine [DPPC]) or saline (placebo). SETTING: Four US
teaching hospitals. PARTICIPANTS: A total of 87 adult patients with the
diagnosis of stable chronic bronchitis. MAIN OUTCOME MEASURES: Pulmonary
function, respiratory symptoms, and sputum properties before treatment (day
0), after 2 weeks of treatment (day 14), and 7 days after stopping
treatment (day 21). RESULTS: A total of 66 patients were randomized to
surfactant treatment and 21 to saline treatment. Patient demographic
characteristics between groups were similar at baseline. In patients who
received a DPPC dose of 607.5 mg/d for 2 weeks, prebronchodilator forced
expiratory volume in 1 second (FEV1) increased from 1.22 L (SEM, 0.08 L) at
day 0 to 1.33 L (SEM, 0.09 L) at day 21 (P=.05), an improvement of 11.4%;
postbronchodilator FEV1 improved 10.4% by days 14 and 21 (P=.02); and the
ratio of residual volume to total lung capacity, a measure of thoracic gas
trapping, decreased 6.2% by day 21 (P=.009). In the surfactant groups,
there was a dose-dependent increase in the ability of sputum to be
transported by cilia in vitro. CONCLUSION: Aerosolized surfactant improved
pulmonary function and resulted in a dose-related improvement in sputum
transport by cilia in patients with stable chronic bronchitis.
Restoration of Mucociliary Transport in the Fluid-DepletedTrachea by Surface-Active Instillates
Ballard et al.
Am. J. Respir. Cell Mol. Bio. 2006;34:500-504.
ABSTRACT
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Impaired recycling of surfactant-like liposomes in type II pneumocytes from injured lungs
Muller et al.
Thorax 2003;58:127-134.
ABSTRACT
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Alternative Mechanisms for Long-Acting {beta}2-Adrenergic Agonists in COPD
Johnson and Rennard
Chest 2001;120:258-270.
ABSTRACT
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Function and Composition of Pulmonary Surfactant and Surfactant-Derived Fatty Acid Profiles Are Altered in Young Adults With Cystic Fibrosis
Meyer et al.
Chest 2000;118:164-174.
ABSTRACT
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Exogenous Surfactant Therapy and Mucus Rheology in Chronic Obstructive Airway Diseases
Banerjee and Puniyani
J Biomater Appl 2000;14:243-272.
ABSTRACT
An In Vitro Comparison of the Mucoactive Properties of Guaifenesin, Iodinated Glycerol, Surfactant, and Albuterol
Rubin
Chest 1999;116:195-200.
ABSTRACT
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Emerging Therapies for Cystic Fibrosis Lung Disease
Rubin
Chest 1999;115:1120-1126.
FULL TEXT
'Clear-ability' and Clarity in Medical Writing
Kissoon and Rubin
JAMA 1998;279:582-583.
FULL TEXT
AEROSOLIZED SURFACTANT IMPROVES PULMONARY FUNCTION IN BRONCHITIS
JWatch General 1997;1997:3-3.
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