SELECTED ARTICLES FROM THE RECENT LITERATURE 2004

9/9/04

Quantitation of the tremor side effects of inhaled salbutamol (albuterol)

Summary
Background - Hand tremor, particularly with fine motions, occurs commonly as a side effect of inhaled salbutamol (albuterol) therapy in some patients. However, the extent and intensity of this tremor has generally not been quantitated.

Findings - Nizef et al of the Rijnstate Hospital in Arnheim, Netherlands has reported a method for quantifying albuterol-induced hand tremor using a simple approach. This approach involved assessing the patients' projection of the light of a commercial laser light pointer onto the center of a series of concentric circles in a target type format placed on a screen 5 meters away. In a study of 44 COPD patients and 65 healthy controls, they found a dose-dependent increase in hand tremor severity induced by prior albuterol inhalation. The extent of this tremor, initially measured with the arm outstretched, was reduced when the arm was supported by an armrest and increased after the subject held a 2 Kg weight until arm fatigue occurred. There was no age-dependency of this albuterol-induced tremor effect. Of note, there was no significant association between the tremor detected objectively by this test approach and the subject's pre-test perception of the presence/extent of his/her tremor after inhaling albuterol.

Reference
Respir Med 2004;98:844-50

Editor's Comments
I have reviewed this report because many patients treated with inhaled albuterol have to perform fine hand movements in work or hobby activities, including use of a laser pointer in lecturing during academic or business activities. Because the extent of the hand tremor may not be obvious to the patient, their first true recognition of the problem may come during an embarrassing inability to maintain a laser pointer “on target” during such lectures. Therefore, advance warning about possible tremor effects should be given when albuterol inhalers are prescribed.

 

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