Acute Disease ; Atropine ; therapeutic use ; Cholinergic Antagonists ; therapeutic use ; Humans ; Organophosphate Poisoning ; Scopolamine Hydrobromide ; therapeutic use

Adrenergic beta-Agonists ; therapeutic use ; Aged ; Androstadienes ; therapeutic use ; Cholinergic Antagonists ; therapeutic use ; Fluticasone ; Humans ; Male ; Middle Aged ; Scopolamine Derivatives ; therapeutic use ; Silicosis ; drug therapy ; Tiotropium Bromide

Airway Remodeling ; drug effects ; Cholinergic Antagonists ; therapeutic use ; Humans ; Pulmonary Disease, Chronic Obstructive ; drug therapy ; immunology ; metabolism ; Scopolamine Derivatives ; therapeutic use ; Tiotropium Bromide

OBJECTIVETo evaluate the effectiveness and safety of the combined therapy of doxazosin and tolterodine for BPH patients with dominant storage symptoms.

METHODSFrom May 2009 to April 2010, 76 patients diagnosed as benign prostatic hyperplasia (BPH) by International Prostate Symptom Score (IPSS), flowmetry, ultrasound for prostate volume, residual urine and other methods were included in the study, all of them fulfilled the study's inclusive/exclusive criteria. The principal exclusive criteria were prostate volume > 50 ml, maximum flow rate (Qmax) < 10 ml/s and residual urine > 100 ml. All 76 patients had bothering storage symptoms and divided randomly into two groups:doxazosin group (n = 36) in which patients were treated with doxazosin 2 mg once daily for 8 weeks, and combination group (n = 40) in which patients were treated with doxazosin 2 mg once daily and tolterodine 2 mg twice daily for 8 weeks.

RESULTSAt baseline, there was no significant differences. The IPSS was significantly improved in the two groups after treatment, but the reduction of IPSS in combination group was significantly greater (18.7 ± 2.2 vs 12.7 ± 3.9) than that in doxazosin group (18.6 ± 3.0 vs 15.2 ± 3.8) (P < 0.05), and the decreased storage IPSS was the main contribution to the reduction of IPSS in combination group. There was no difference between the groups for Qmax and residual urine.

CONCLUSIONSCombined therapy with doxazosin plus tolterodine for BPH patients with dominant storage symptoms can improve the IPSS, especially the storage IPSS, without any negative effects on uroflow rate and residual urine.

Adrenergic alpha-Antagonists ; therapeutic use ; Aged ; Aged, 80 and over ; Cholinergic Antagonists ; therapeutic use ; Doxazosin ; therapeutic use ; Drug Therapy, Combination ; Humans ; Male ; Middle Aged ; Prostatic Hyperplasia ; drug therapy ; Treatment Outcome

OBJECTIVETo compare the clinical effectiveness and safety of alpha-blocker alone and combined tamsulosin with an anticholinergic drug for bladder outlet obstruction (BOO) with overactive bladder (OAB).

METHODSLiterature search was performed using PubMed, EMBASE, Ovid, Wanfang, and CNKI from inception to October 2013 for comparative studies assessing alpha-blocker alone and combined alpha-blocker with an anticholinergic drug for BOO+OAB. Data were extracted and evaluated by two reviewers independently according to the Cochrane Handbook for systematic reviews. Meta-analyses were conducted using RevMan 5.2.

RESULTSA total of 7 studies involving 3 458 patients were included for the analysis. The values of total IPSS and storage IPSS reduced significantly after treatment in combination group (RR = -0.23, 95%CI: -0.44--0.02, P = 0.03; RR = -0.69, 95%CI: -0.88--0.51, P < 0.01). There were no significant differences between the two groups in voiding IPSS and Qmax (P = 0.86 and 0.89). The incidences of dry mouth (OR = 2.53), constipation (OR = 3.74), dizziness (OR = 0.73), and urinary retention (OR = 0.26) were higher in combination group than in alpha-blocker alone group (P < 0.05). But most adverse events were mild in degree.

CONCLUSIONAlpha-blocker combined with an anticholinergic drug in the treatment of BOO+OAB was better than that of alpha-blocker alone, and was safe and well tolerated.

Adrenergic alpha-Antagonists ; therapeutic use ; Cholinergic Antagonists ; therapeutic use ; Drug Therapy, Combination ; Humans ; Sulfonamides ; therapeutic use ; Treatment Outcome ; Urinary Bladder Neck Obstruction ; drug therapy ; Urinary Bladder, Overactive ; drug therapy

Urinary incontinence is the involuntary loss of urine. There are many types of incontinence and different management options available, ranging from lifestyle modifications, medication to surgical intervention. Untreated urinary incontinence can result in a myriad of problems, including skin irritations, infections, social phobia, major depression and premature institutionalisation of elderly family members. Common barriers to optimal management include the socially embarrassing nature of the condition, which impedes open discussion, as well as the misperceptions that management must be invasive and the condition cannot be adequately managed within the community. We discuss the common types of incontinence encountered in the community and their management in the primary care setting.
Cholinergic Antagonists ; therapeutic use ; Diagnosis, Differential ; Exercise Therapy ; Female ; Humans ; Male ; Medical History Taking ; Primary Health Care ; Urinalysis ; Urinary Incontinence ; diagnosis ; etiology ; therapy

We investigated the efficacy and tolerability of various anticholinergics in Korean children with non-neurogenic overactive bladder (OAB). A total of 326 children (males:females= 157:169) aged under 18 yr (mean age 7.3+/-2.6 yr) who were diagnosed with OAB from 2008 to 2011 were retrospectively reviewed. The mean duration of OAB symptoms before anticholinergic treatment was 16.9+/-19.0 months. The mean duration of medication was 5.6+/-7.3 months. Urgency urinary incontinence episodes per week decreased from 1.9+/-3.1 to 0.4+/-1.5 times (P<0.001). The median voiding frequency during daytime was decreased from 9.2+/-5.4 to 6.3+/-4.2 times (P<0.001). According to 3-day voiding diaries, the maximum and average bladder capacity were increased from 145.5+/-66.9 to 196.8+/-80.3 mL and from 80.8+/-39.6 to 121.8+/-56.5 mL, respectively (P<0.001). On uroflowmetry, maximum flow rate was increased from 17.6+/-8.4 to 20.5+/-8.2 mL/sec (P<0.001). Adverse effects were reported in 14 (4.3%) children and six children (1.8%) discontinued medication due to adverse effects. Our results indicate that anticholinergics are effective to improve OAB symptoms and tolerability was acceptable without severe complications in children.
Child ; Child, Preschool ; Cholinergic Antagonists/adverse effects/*therapeutic use ; Constipation/etiology ; Dizziness/etiology ; Female ; Humans ; Male ; Retrospective Studies ; Treatment Outcome ; Urinary Bladder, Overactive/*drug therapy

PURPOSE: In order to gain insight into the physicians' awareness of and attitude towards management of overactive bladder (OAB) in males, we performed a nationwide survey of the current strategies that urologists use to diagnose and manage OAB in male patients. MATERIALS AND METHODS: A probability sample was taken from the Korean Urological Association Registry of Physicians, and a random sample of 289 Korean urologists were mailed a structured questionnaire that explored how they manage benign prostatic hyperplasia (BPH). RESULTS: A total of 185 completed questionnaires were returned. The consent rate in the survey was 64.5%. Eighty-one (44%) urologists believed that of all males with lower urinary tract symptoms (LUTS), 20% or more had OAB and 72 (39%) believed that 10-20% had OAB. Half of the urologists surveyed believed that the most bothersome symptom in male OAB patients was nocturia. Seventy-three percent of respondents reported that they prescribed alpha blockers with anticholinergics for first line management, while 19% of urologists prescribed alpha blocker monotherapy but not anticholinergics for OAB patients. Though acute urinary retention (AUR) was considered the anticholinergic adverse event of most concern, the most frequently observed adverse event was dry mouth (95%). CONCLUSION: The present study provides insights into urologist views of male OAB. There is a discrepancy between the awareness of urologists and actual patterns of diagnosis and treatment of male OAB. This finding indicates the need to develop further practical guidelines based on solid clinical data.
Adrenergic alpha-Antagonists/therapeutic use ; Cholinergic Antagonists/therapeutic use ; *Health Knowledge, Attitudes, Practice ; Humans ; Male ; Physician's Practice Patterns ; Physicians/*psychology ; Prostatic Hyperplasia/diagnosis/drug therapy/pathology ; Questionnaires ; Urinary Bladder Neck Obstruction/diagnosis/drug therapy/pathology ; Urinary Bladder, Overactive/*diagnosis/drug therapy/pathology ; Urinary Retention/diagnosis/drug therapy/pathology ; *Urology

BACKGROUNDA pharmacokinetic study in an Asian population showed that tiotropium 5 µg via Respimat leads to the same plasma levels compared to 18 µg via HandiHaler. The objective of the trial was to compare the efficacy and safety of longterm treatment (1 year) with tiotropium bromide (5 µg) via Respimat® with placebo in patients with chronic obstructive pulmonary disease (COPD).

METHODSA total of 3991 patients were randomized in this double-blind, placebo controlled, parallel group study, while in China 338 patients (309 males, 29 females) received either tiotropium bromide (n = 167) or placebo (n = 171). Tiotropium bromide solution or matching placebo was delivered via Respimat® at a dosage of 5 µg (2×2.5 µg/puff) once daily for 48 weeks. Co-primary endpoints were trough forced expiratory volume in one second (FEV1) and the time to first exacerbation.

RESULTSStatistically significant improvements in trough FEV1 and trough forced vital capacity (FVC) in the tiotropium group were achieved at weeks 4, 24, and 48 compared with those in the placebo group. A statistically significant difference (P = 0.0027) in favour of tiotropium was also observed for the time to first exacerbation. The total numbers of exacerbations during treatment were 90 and 128 in the tiotropium and placebo groups, respectively, with a rate ratio of 0.69 (P = 0.0164). The difference between the treatment groups in the adjusted mean changes from baseline of St. George Respiratory Questionnaire (SGRQ) total score was -3.9 (95% CI: -7.5, -0.2) and was of statistical significance (P = 0.0367). The incidences of serious adverse events (SAEs) in the tiotropium and placebo groups were 16.2% and 17.0%, respectively. Seven deaths occurred whilst patients were on treatment, four in the tiotropium group and three in the placebo group, all of which were assessed as non-related study drugs by the investigators.

CONCLUSIONSTiotropium significantly improved lung function and quality of life, delayed the time to first exacerbation, reduced the number of exacerbations. Overall, tiotropium was well tolerated.

Administration, Inhalation ; Aged ; Bronchodilator Agents ; adverse effects ; therapeutic use ; Cholinergic Antagonists ; adverse effects ; therapeutic use ; Double-Blind Method ; Female ; Forced Expiratory Volume ; Humans ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive ; drug therapy ; physiopathology ; Scopolamine Derivatives ; adverse effects ; therapeutic use ; Tiotropium Bromide