ABSTRACT
Objetivos: Valorar el efecto del empleo del fumarato de fesoterodina como rescate ante un tratamiento previo fallido con anticolinérgicos en pacientes con vejiga hiperactiva, por falta de efectividad terapéutica o por intolerancia a los efectos secundarios. Material y métodos: Revisión retrospectiva de 158 pacientes afectos de vejiga hiperactiva que se distribuyeron en 2 grupos, uno donde el fumarato de fesoterodina se empleó como rescate ante una inefectividad del anticolinérgico previo (n=56) y otro donde se empleó ante una intolerancia manifiesta al mismo (n = 102). Resultado: sEn el grupo en el que se empleó como rescate a una inefectividad, se apreció una mejoría en los componentes de urgencia miccional (p = 0,001), vaciado insuficiente (p = 0,001) e incontinencia de esfuerzo (p = 0,009), y en el número de compresas/día (p<0,001). En el grupo en el que se empleó como fármaco de segunda línea ante efectos secundarios a otros anticolinérgicos se apreció una reducción en la incidencia de sequedad de boca (p<0,001) y de estreñimiento (p = 0,015), además de una mejora clínica significativa. Conclusiones: El fumarato de fesoterodina es una alternativa de tratamiento válida si los resultados con otros anticolinérgicos previamente no han sido satisfactorios, bien sea por falta de efecto terapéutico esperado, bien por intolerancia a los efectos secundarios, sobre todo cuando el tratamiento se plantea prolongado (AU)
Objective: Evaluate the effect of the treatment with fesoterodine fumarate in patients with overactive bladder, as an alternative in case of failure of the usual anticholinergic treatment, due to either lack of therapeutic efficacy or due to intolerance to side effects. Material and method: A retrospective review of 158 patients with overactive bladder was carried out. The patients were divided into two groups; the first group; 56 patients where the anticholinergic treatment showed to be ineffective, and the second group; 102 patients who presented intolerance to anticholinergic side effects. Results: For the first group where fesoterodine fumarate was used to improve effectiveness of the anticholinergics, improvement in the components of urinary urgency (p=0.001), insufficient emptying (p=0.001), incontinence (p=0.009), and in the number of pads/day (p<0.001) was detected. As to the second group where fesoterodine fumarate was used as an alternative to anticholinergics to avoid side effects, a high reduction in the incidence of dry mouth (p<0.001) and constipation (p=0.015) was seen, as well as a significant clinical improvement. Conclusion: Fesoterodine fumarate is an optimal treatment option when the clinical response to anticholinergics has not been satisfactory, either by the lack of therapeutic action or by intolerance to side effects, and especially when the treatment is expected to be long (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Urinary Bladder, Overactive/diagnosis , Urinary Bladder, Overactive/drug therapy , Fumarate Hydratase/administration & dosage , Fumarate Hydratase/therapeutic use , Urinary Bladder, Overactive/physiopathology , Retrospective Studies , Cholinergic Antagonists/therapeutic use , Surveys and QuestionnairesABSTRACT
Background: An increase in asthma prevalence is reported from developed as well as developing nations, with rising costs from acute asthma and great expenditures to health care systems. Venezuelas Ministry of Health ambulatory facilities care for 80% or more of a mostly urban and impoverished population of 26 million inhabitants, registering close to a million acute asthma visits per year; a nebulised fixed fenoterol-ipratropium bromide combination (Berodual®, Boehringer-Ingelheim) in repeated dosing isthe standard treatment. Objectives: to simplify acute asthma care and management in a cost effective manner employing Formoterol Fumarate powder, a long acting beta agonist with immediate bronchodilator effects. Methodology: Fifty acute asthmatic children (5-12 years old) were randomly assigned (25 patients ineach group) to receive either a nebulised single dose (US $1.35) of two 12 g Formoterol Fumarate capsules (Foradil® 12 g/cap, Novartis Pharma AG, Basel, Switzerland) diluted in 2.5 ml of sterile saline solution; or 3 doses of Albuterol (US $ 6.73) every twenty minutes for one hour (Glaxo Smith Kline Albuterol ampoules, 2.5 mg/2.5 ml, at a dose of 0.15 mg/kg/dose, maximum dose 2.5 mg). Symptoms score, oxygen saturation and lung function testing were recorded before and one hour after commencing treatments. Results: Both groups improved significantly on all parameters, except for FEV 1 in the Albuterol group. Conclusions: Single dose nebulised Formoterol Fumarate (dry powder) in sterile saline solution, as depicted in this trial, is equivalent to three doses of Albuterol every twenty minutes for one hour in acute asthma in children, simplifying acute care management and at one fifth of medication costs. A pursuit of simpler and more cost effective approaches is found wanting in developing nations with depressed economies and unique cultural and socio-medical contexts; also, in countries where pharmaco-economics orients quality of health policies, novel approaches like this are worth exploring
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