by Lam Kuo. / Year shown on spine: 1997. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1996. / Includes bibliographical references (leaves 107-121). / Acknowledgments / List of Abbreviations / Summary / List of Contents / List of Tables / List of Figures / Chapter Chapter 1 --- Introduction and the objectives of the study --- p.1-6 / Chapter Chapter 2 --- Overviews of Bronchopulmonary Dysplasia (BPD) and bronchodilator therapy -- a literature review --- p.7-29 / Chapter 2.1 --- Overview of Bronchopulmonary Dysplasia (BPD) --- p.7-9 / Chapter 2.2. --- Bronchodilator therapy --- p.10-18 / Chapter 2.2.1 --- Therapeutic value on infants with Bronchiolitis / Chapter 2.2.2. --- Therapeutic value on infants with Bronchopulmonary Dysplasia (BPD) / Chapter 2.3. --- "Three modes of aerosol delivery devices --jet nebuliser , ultrasonic nebuliser and metered dose inhaler" --- p.18-29 / Chapter 2.3.1. --- Jet nebuliser / Chapter 2.3.2. --- Ultrasonic nebuliser / Chapter 2.3.3. --- Metered dose inhaler / Chapter 2.3.4. --- Comparison of the therapeutic efficiency between jet nebuliser， ultrasonic nebuliser and Metered dose inhaler / Chapter 2.3.4.a. --- Comparison of particle size / Chapter 2.3.4.b. --- Comparison of aerosol deposition / Chapter 2.3.4.c. --- Comparison of pulmonary function / Chapter Chapter 3 --- Pulmonary function test in neonates --a literature review --- p.30-40 / Chapter 3.1. --- Overview of pulmonary function test in neonates --- p.30 / Chapter 3.2. --- Assessment of pulmonary function test in neonates --- p.31-40 / Chapter 3.2.1. --- Pulmonary mechanics / Chapter 3.2.1.a. --- Lung compliance / Chapter 3.2.1.b. --- Airway resistance / Chapter 3.2.1.c. --- Functional residual capacity (FRC) / Chapter Chapter 4 --- Subjects and methods --- p.41-48 / Chapter 4.1. --- Subjects --- p.41-42 / Chapter 4.2. --- Methods --- p.42-48 / Chapter 4.2.1. --- Delivery of Salbutamol aerosol / Chapter 4.2.1.1. --- Spontaneously breathing non-ventilated infants (group 1) / Chapter 4.2.1.2. --- Ventilator-dependent infants (group 2) / Chapter 4.2.2. --- Monitoring the clinical parameters / Chapter 4.2.3. --- Measurement of pulmonary function / Chapter 4.2.4. --- Statistics / Chapter Chapter 5 --- Results --- p.49-53 / Chapter 5.1. --- Clinical parameters --- p.50-51 / Chapter 5.2. --- Pulmonary function tests --- p.51-53 / Chapter Chapter 6 --- Discussion --- p.54-61 / Chapter 6.1. --- Non-ventilated group --- p.55-58 / Chapter 6.2. --- Ventilated group --- p.58-61 / Chapter Chapter 7 --- Conclusion --- p.62-63 / Tables and Figures / References

Whereas first line therapy for chronic obstructive pulmonary disease (COPD) usually includes a short-acting bronchodilator, there are suggestions that these agents may increase the risk of cardiac arrhythmias. In this thesis, we first assessed the risks associated with short-acting beta-agonists (SABA), long-acting beta-agonists (LABA), ipratropium bromide (IB), and methyl xanthines (MX) within a cohort of COPD patients using the health databases of Saskatchewan. In order to confirm these findings and to address some methodological issues we then replicated this analysis within a larger cohort of patients using the health databases of Quebec. / Our first study cohort consisted of 6,018 adults aged 55 and older, newly treated with bronchodilator medications. We found that new users of both IB and LABA increased the risk of arrhythmia (RR 2.39 [95% CI 1.42-4.05] and (RR 4.55 [95% CI 1.43-14.45] respectively). When the cohort was restricted by excluding subjects who had recently either been hospitalised or experienced an exacerbation, the elevated risk associated with the new use of IB persisted (RR 3.65 [95% CI 1.72-7.74]), an effect was detected with new use of MX (RR 5.17 [95% CI 1.38-19.30]), but there was insufficient power to detect an effect associated with the new use of LABA. / Due to both power issues and the limited availability of LABA within the Saskatchewan data, we replicated the analysis in a larger new-user cohort of 76,661 Quebec adults aged 67 and over. This study confirmed our earlier results, with an elevated risk of arrhythmia associated with the new use of both IB and LABA (RR 1.43 [95% CI 1.08-1.88]) and (RR 1.54 [95% CI 1.00-2.36]) respectively, as well as with new use of SABA (RR 1.28 [95% CI 1.02-1.61]). Finally, using marginal structural models, we demonstrated that both exacerbations of COPD as well as minor non-event arrhythmias were moderate time-dependent confounders within this setting. / In conclusion, we found that new use of bronchodilators in COPD, particularly IB and LABA, was associated with an increase in the risk of cardiac arrhythmias. We also demonstrated the method by which the time-dependent confounder status of specific model covariates may be evaluated.

No description available.