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Query: UMLS:C0040822 (tremor)
 18,428 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Physiologic postural skeletal muscle tremor is enhanced by beta 2 receptor agonist such as those used in the treatment of asthma. This is a peripheral response rather than one occurring at the central nervous system level. It is greatest when drugs are administered by the oral or parenteral routes, and is the most important dose-limiting factor for oral administration. Clinically important tremor is minimal after aerosolized administration of clinically recommended doses of aerosolized beta 2 receptor agonists, but can be significant when larger doses are administered. Sympathomimetic drugs which can selectively stimulate airway beta 2 receptors, as opposed to skeletal muscle beta 2 receptors, do not currently exist. Combining orally administered beta 2 agents with theophylline potentiates the effects on muscle tremor. There does not seem to be a clinical advantage, in terms of reduced side effects such as muscle tremor, to combining "small doses" of oral beta agonists and theophylline as opposed to using either agent alone in optimal doses. Tolerance to the tremoregenic effects of beta 2 agonists appears to occur when these agents are administered on a chronic basis. Thus, there may be some rationale for beginning oral beta agonists initially with lower doses and progressively increasing to full doses over a period of days to weeks.
J Asthma 1990
PMID:Skeletal muscle tremor and the influence of adrenergic drugs. 196 52

A double-blind crossover study was performed to evaluate the bronchodilating effect of different single doses of procaterol (less than 0.5 micrograms/kg, 1.5 micrograms/kg, and placebo) orally administered. Sixteen asthmatic children, age 6-12 years, participated in the trial. Pulmonary function, heart rate, blood pressure, and tremor were evaluated at 30, 60, 90, and 120 min and then hourly for 8 hours after administration. All three doses were therapeutically effective. The 1.5 micrograms/kg dose produced a more sustained bronchodilatation effect, but was also associated with an increase in the incidence of tremors. The 0.5 micrograms/kg dosage may, however, be a good starting dose because it assures a reasonable risk/benefit ratio.
J Asthma 1990
PMID:Efficacy and duration of action of oral procaterol in asthmatic children after single administration of different dosages. 213 15

Asthma is an airway obstruction which is reversible, either spontaneously or in response to treatment. Repeated peak expiratory flow rate (PEFR) measurements, up to six times daily, allows this characteristic reversibility to be recognised, to guide diagnosis and therapy. Chronic asthmatics may eventually become relatively irreversible, and then appear similar to chronic bronchitics - unless an adequate history is taken. The commonest world-wide allergen is the fecal pellet of the house mite. Modern therapy of asthma starts with inhaled beta 2 agonists, but difficulty in using metered dose inhalers is helped by the 'spacer', or reservoirs (e.g. 'Nebuhaler'). Interaction between slow-release oral theophyllines and beta 2 agonists by inhalation maximises bronchodilatation but minimises tremor. High-dose ipratropium inhalation, as isotonic wet nebulisation with a beta 2 agonist, is useful in acute severe asthma. High doses of inhaled topical steroid are valuable in the difficult asthmatic, but pituitary adrenal suppression occurs if dosage exceeds 1,500 micrograms/day. Cromoglycate and a beta 2 agonist by inhalation can prevent exercise-induced asthma. Long-term oral steroids (never over 10 mg/day) are only used if inhaled therapy (+/- oral slow-release theophyllines) fails. Acute severe asthma needs parenteral steroid, parenteral beta 2 agonist, high-dose beta 2 agonist by inhalation, oxygen and hospital admission. Ventilation is increased in the acute severe asthmatic with hypoxia and low PCO2. In 90 asthmatic deaths surveyed in Britain, half had failed to realise the severity.
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PMID:Reversible airway obstruction: neurohumoral mechanisms and treatment. Lecture on asthma: clinical overview. 288 69

In a double-blind crossover study, clenbuterol at a dose of 0.75 micrograms/kg, procaterol at a dose of 1.5 micrograms/kg, and placebo, all administered orally, were compared for bronchodilation efficacy. Twelve children aged from 6 to 13 years, with moderate to severe asthma, participated in the trial. Pulmonary function, heart rate, blood pressure, and tremor were evaluated at 30, 60, 90, and 120 minutes and then hourly for 8 hours after administration. Both clenbuterol and procaterol induced a significant change over their baseline values for all the pulmonary function parameters considered. For clenbuterol, the same was also observed in comparison with placebo, while for procaterol this was true only for FEV1 and FEF25-75, while no difference resulted from FVC and PEF. Mild and transient tremor was the only side effect observed. Oral clenbuterol and procaterol were both demonstrated to be safe and effective. However, at the doses studied, clenbuterol had a significantly higher bronchodilator activity lasting up to 8 hours.
J Asthma 1987
PMID:Oral clenbuterol and procaterol. A double-blind comparison of bronchodilator effects in children with chronic asthma. 296 40

The aim of the present study was to compare the duration of bronchodilation obtained with 12 micrograms formoterol and 24 micrograms formoterol with that of 200 micrograms salbutamol over 12 hr. Thirteen stable asthmatics (mean age 59 years, asthma duration 7 years, mean FEV1 56% predicted, and reversibility to beta-adrenoceptor stimulation 36%) were studied in a double-blind crossover study. Lung function test (FEV1 and FVC), heart rate, tremor, and subjective effects were recorded before and 30 min after the test doses and every hour up to 12 hr. The test doses were randomized and given double-blindly as two puffs using a spacer. The median duration of effect, defined as time when FEV1 fell below 20% the maximum bronchodilating capacity, was longer than 12 hr for both formoterol doses, whereas it was 7 hr for salbutamol (p < 0.01). No difference between the two doses of formoterol was seen. The median of the patients' subjective evaluation of the duration of effect was 12 hr, more than 12 hr for 12 and 24 micrograms formoterol, respectively, and 8 hr for salbutamol (p < 0.01). Only 1 patient needed rescue medication on the 2 formoterol days. However, 6 patients inhaled rescue medication during treatment with salbutamol. There were no differences with regard to heart rate, blood pressure, subjective tremor, or palpitations. Formoterol, 12 micrograms and 24 micrograms, was shown to produce at least 12 hr of bronchodilating effect in most patients. However, there was considerable individual variation in duration of effect.
J Asthma 1993
PMID:Objective and subjective bronchodilation over 12 hours after inhaled formoterol: individual responses. 824 16

Thirty-five separate episodes of acute bronchial asthma were studied in 21 asthmatic children. The bronchodilator, cardiovascular, and tremorogenic responses following three modes of administration of salbutamol were compared: open continuous nebulization (ON), closed-port intermittent nebulization (CN), and oral route (OR), for a period of 8 hours. Eleven acute attacks were treated by ON, 11 by CN, and 13 by OR. Pulmonary function was evaluated by clinical assessment and by the spirometric indices FEV1 and FEF25-75. Tremor was objectively measured, as well as heart rate (HR), respiratory rate (RR), and blood pressure (BP). Fastest onset of bronchodilator action, maximal response, and longest duration were seen when the drug was administered by the CN. Onset of tremorogenic effect was registered at 5 minutes when salbutamol was used by CN and ON and at 30 minutes when used by OR. During the first 30 minutes, tremor was significantly greater when salbutamol was used by CN than by OR. There were minor cardiovascular effects, except regarding HR after CN, which was significantly greater than after OR, at 5 and 30 minutes. Our findings indicate the inhaled route as the most effective route for administration of salbutamol to treat acute bronchospasm in children. The use of CN is a good alternative to jet nebulizers, but the greater dose of drug effectively administered by this system can briefly cause more tremor and heart acceleration.
J Asthma 1993
PMID:Efficacy and side effects of salbutamol in acute asthma in children: comparison of oral route and two different nebulizer systems. 842 59

Thirty-seven separate episodes of acute bronchial asthma were studied in 21 asthmatic children. The bronchodilator, cardiovascular, and tremorigenic responses following administration of salbutamol (SAL), terbutaline (TER) and fenoterol (FEN) by closed-port intermittent nebulization were compared for a period of 8 hr. SAL was used at the maximum dose recommended by the manufacturer and TER and FEN at the average doses commonly used in children. Eleven acute attacks were treated with SAL, 12 with TER, and 14 with FEN. Pulmonary function was evaluated by clinical assessment and by the spirometric indices FEV1 and FEF25-75. Tremor was objectively measured, as well as heart rate (HR), respiratory rate, and blood pressure. The onset of bronchodilating effect occurred at 5 min for all three drugs and there were no differences in intensity and duration of bronchodilation between drugs. All three drugs caused rapid onset of tremor (5 min) and this tended to be more intense with SAL. There was a slight decrease in HR in the TER group, whereas SAL and FEN caused increase in HR, with mean values significantly greater than in the TER group from 5 to 30 min after drug administration. Our results indicate that the three short-acting beta 2-agonists studied are equally effective in treatment of acute bronchospasm by the inhaled route in children, in the doses used. Our findings imply that a dose of SAL twice as great as that commonly used by nebulization in children is equipotent to those usually employed for TER and FEN, as far as therapeutic effect is concerned, but it could generate more intense tremorigenic and tachycardic side effects.
J Asthma 1996
PMID:Efficacy and side effects of beta 2-agonists by inhaled route in acute asthma in children: comparison of salbutamol, terbutaline, and fenoterol. 896 95

Bambuterol, a carbamate prodrug of terbutaline, is the first once-daily oral beta 2-agonist. The effect/side effect ratio of bambuterol oral solution was compared with terbutaline mixture in elderly patients with chronic reversible obstructive airways disease. The study was of a double-blind, crossover, randomized design and consisted of a 4-7-day run-in period followed by four consecutive treatment periods each of 2 weeks. The treatments were bambuterol solution 20 mg nocte (B20), 10 mg nocte (B10), terbutaline mixture 3 mg t.i.d., (T), and placebo solution (P). Patients measured daily peak expiratory flow rate (PEFR), asthma symptoms, use of inhaled beta 2-agonist, and tremor. Of 84 patients, 66 completed all periods. Mean age was 67 years (60-90), basal FEV1 1.49 L, and reversibility of FEV1 30%. Ninety-four percent of the patients used inhaled/oral steroids in constant dosage. All treatments were significantly more effective than placebo. B20 resulted in higher morning PEFR than T (306 +/- 2.9 L/min vs. 297 +/- 2.9 L/min), while B10 gave equivalent results to T. No differences were seen in the use of inhaled beta 2-agonist. Less shortness of breath was experienced during the night with B20 and during the day with B10 compared with placebo. Both B20 and T produced more tremor than B10 and P. In elderly patients with chronic reversible airways obstruction once-daily bambuterol (10-20 mg) has a better effect/side effect ratio than 3 mg terbutaline thrice daily.
J Asthma 1997
PMID:Comparison of oral bambuterol and terbutaline in elderly patients with chronic reversible airflow obstruction. 903 40

The effectiveness of antiasthmatic therapy with metered-dose inhalers (MDIs) is usually limited by defective inhalational technique. This study surveyed the MDI inhalation performance and knowledge of 100 physicians whose performance (demarcated into six stages) and knowledge scores correlated (r = 0.33, p < 0.001). Inhalation performance scores for shaking the canister, full expiration prior to using the MDI, breath holding thereafter, and positioning of the mouth-piece correlated with their corresponding knowledge scores (p < or = 0.02). Training of physicians entailing actual instruction and supervision of inhalational maneuvers may enhance the ability of doctors to use MDIs and facilitate better patient supervision.
J Asthma 1997
PMID:Inability of physicians to use metered-dose inhalers. 942 95

Asthma is one of the most common chronic medical conditions. The usual treatment includes quick relief bronchodilator medications of the sympathomimetic class and controller medications that may include the long-acting inhaled bronchodilator salmeterol. Mild adverse cardiac and central nervous system effects are common with these medications, requiring modifications in dose or occasionally switching to a different medication. Both asthma and thyroid disease are common disorders that occasionally occur together. Hyperthyroidism may exacerbate asthma. Many symptoms of hyperthyroidism are identical to the adverse effects of the commonly used inhaled bronchodilators and include tremor, nervousness, tachycardia, wide pulse pressure, palpitations, emotional lability, agitation, nightmares, aggressive behavior, and diarrhea. In this report we describe a patient with hyperthyroidism whose symptoms initially were thought to be adverse effects of the inhaled bronchodilator medications.
Allergy Asthma Proc
PMID:Hyperthyroidism complicating asthma treatment. 1079 Nov 6


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