Tuesday February 7, 2006
Adrenergic Agonists in Acute Lung Injury - BALTI trial
ß2-Agonists remain the most important inhaled bronchodilators and provide rapid symptom relief for many patients. Short-acting, inhaled, selective ß2-agonists remain the mainstay bronchodilators for asthma, COPD, and airway obstruction of all etiologies. The use of B-adrenergic agonists as a potential therapy for acute lung injury has generated considerable interest. B-agonists have well-recognized antiinflammatory properties and treatment with a B-agonist have shown to enhances the rate of alveolar fluid clearance by increasing intracellular cAMP.
Perkins and colleagues report the results of a clinical trial of 40 patients with acute lung injury in which the effects of B-agonists were examined.1 Salbutamol (albuterol) was administered intravenously at a dose of 15 μg/kg/hour in a double-blind, randomized manner. Extravascular lung water on Day 7, the primary outcome variable, was lower in the salbutamol-treated patients compared with the placebo control subjects (9.2 vs. 13.2 ml/kg, p = 0.04). Post hoc analysis indicated that extravascular lung water was significantly lower in the treated group at earlier time points as well. Plateau airway pressure was also 6 cm H2O lower at Day 7 in the salbutamol-treated group (p = 0.049), and there was a trend toward lower acute lung injury scores in the salbutamol-treated patients.
The results indicate that a multicenter clinical trial may be warranted to test the possible therapeutic benefit of B-agonist therapy for acute lung injury.
References: Click to get article/abstract: (appears in popup window and second popup overwrites first popup).
1. Perkins GD, McAuley DF, Thickett DR, , Gao F The b-agonist lung injury trial (BALTI): a randomized placebo-controlled clinical trial. Am J Respir Crit Care Med 2006;173:281–287
2. Matthay MA, Folkesson HG, Clerici C. Lung epithelial fluid transport and the resolution of pulmonary edema. Physiol Rev 2002;82:569–600.
3. McAuley DF, Frank JA, Fang X, Matthay MA. Clinically relevant concentrations of beta2-adrenergic agonists stimulate maximal cyclic adenosine monophosphate-dependent airspace fluid clearance and decrease pulmonary edema in experimental acid-induced lung injury. Crit Care Med 2004;32:1470–1476.