THE EFFECTS OF ALBUTEROL ON THE LUNG-FUNCTION OF HOSPITAL ED PATIENTSWITH CYSTIC-FIBROSIS

Twenty-four hospitalized patients with cystic fibrosis were enrolled i nto a 2-d, double-blind, placebo-controlled, randomized crossover tria l comparing albuterol inhalation aerosol with a saline placebo. Aeroso ls were administered with the first three of four chest physiotherapy sessions given 4 h apart. Spirometry was measured before and 45 thin a fter 7:00 A.M. and 3:00 P.M. therapy and before therapy at 7:00 P.M. a nd 7:00 A.M. the next morning. The mean percent change in FVC, FEV(1), and FEF25-75% at 7:00 A.M. was 10.7, 14.8, and 19.6% with albuterol v ersus 2.4, 1.0, and -0.8% with placebo (p = 0.0012, < 0.0001, and = 0. 003, respectively). A greater than 8% change in FEV(1) separated chang es with albuterol versus placebo with 96% specificity and occurred in 75% of all patients with albuterol; 71% at 7:00 A.M. versus 24% at 3:0 0 P.M. The reduction in response at 3:00 P.M. (p < 0.01) was presumabl y due to prolonged effects of morning therapy (> 4 h). Individual chan ges in spirometry were significantly more positive and homogeneous wit h albuterol versus placebo at both 7:00 A.M. and 3:00 P.M.. The mean p ercent change for the FVC, FEV(1), and FEF25-75 across the day (7:00 A .M. pretherapy to 7:00 P.M. pretherapy) was 8.1, 10.1, and 9.7% with a lbuterol versus 3.9, 3.5, and 2.6% with placebo (p = 0.029, 0.036, and 0.232, respectively). The more positive and homogeneous changes in sp irometry with albuterol, along with greater changes in these measures across the day when compared with placebo, suggest that albuterol impr oves pulmonary function in a majority of hospitalized patients with cy stic fibrosis.