Optimal pharmacologic treatment of the critically ill patient with obstructive airways disease

The American Journal of Medicine
A D Siefkin

Abstract

There are few experimental data evaluating the effect of inhaled bronchodilator treatment in the critically ill patient in the intensive care unit. Extrapolating from the data that are available in chronic and acute asthma and chronic obstructive pulmonary disease (COPD) studies, it appears that both agents may be beneficial. Beta-adrenergic receptor agonists are first-line agents in asthma. However, anticholinergics may be valuable as additive agents or as single agents if the patient is intolerant of beta-adrenergic side effects. This may be especially important in the critically ill patient with multiple organ failure in whom excessive tachycardia may reduce oxygen delivery. Anticholinergics and beta 2-adrenergic agonists both appear to be beneficial in smoking-related chronic bronchitis. Finally, because of the severity of illness in the critical care setting, both drugs should be titrated to maximal effect when possible, monitoring closely for adverse effects of the larger than normal doses that are used.

References

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Citations

Feb 24, 2001·Clinics in Chest Medicine·P A Sherk, R F Grossman
Oct 19, 2017·Current Opinion in Allergy and Clinical Immunology·Gustavo J Rodrigo
Jun 10, 2003·Emergency Medicine Clinics of North America·Kenneth H Palm, Wyatt W Decker

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