Been using it since the Cochrane review came out (1999). Got our chest
physicians and anaesthetists on board a couple of year back. Not a lot of
RCTs; and nothing convincing looking at survival as an outcome measure, but
that sort of trial is difficult to do. I think the trials the Cochrane
review looked at are enough to convince me it makes at least some sick
asthmatics better. If you keep an eye on the patient, it's not a
particularly toxic drug (certainly compared to Aminophylline)- you do get a
bit of a drop in BP sometimes (as you'd expect with a smooth muscle
relaxant), but it doesn't seem to be too much of a problem. In view of the
sickness of the patients and the relatively low toxicity of the drug I'm
prepared to accept a few OK ish trials with proxy measures on outcome to
convince me that on the whole my patients are better with it than without if
I pick the patients that look to me like they're not doing as well as I'd
like.
Matt Dunn
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