Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropium-induced bronchodilation in patients with stable COPD

Abstract

Please cite this article as: Cazzola M, Santus P, D'Adda A, Pizzolato S, Di Marco F, Centanni S. Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropiuminduced bronchodilation in patients with stable COPD, Pulmonary Pharmacology & Therapeutics (2008), doi: 10.1016/j.pupt.2008 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Accepted ManuscriptTitle: Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropium-induced bronchodilation in patients with stable COPD ARTICLE IN PRESS AbstractKnowledge on the effects of the additive bronchodilatory effects of short-acting agents on the top of the effect of long-acting bronchodilators is limited. In this trial, we examined the influence of higher than conventional doses of the shortacting inhaled β2-adrenergic agent salbutamol and the short-acting anticholinergic drug ipratropium bromide on bronchodilation induced by a regular treatment with the long-acting anticholinergic drug tiotropium 18 μg/day in 30 patients with stable COPD. On 3 separate days, a dose-response curve to inhaled salbutamol (100 μg puff-1), ipratropium bromide (20 μg puff-1) or placebo was constructed 3 hours after inhalation of last dose of tiotropium, using one puff, one puff, two puffs and two puffs, for a total cumulative dose of 600 μg salbutamol or 120 μg ipratropium bromide. Doses were given at 30-min intervals and Both drugs did not affect heart rate and SpO2. Our results indicate that there is not much difference in bronchodilation between adding higher than conventional doses of salbutamol or ipratropium bromide to tiotropium in patients with stable COPD. Effective improvement of the pulmonary function may be achieved in such a type of patients by adding salbutamol 600 μg or ipratropium bromide 120 μg to regular tiotropium. These is an interesting finding mainly for those COPD patients suffering from cardiovascular co-morbidities that are at highest risk of myocardial infarction, congestive heart failure, cardiac arrest and sudden cardiac death when treated with elevated doses of a ß2-agonist. (EudraCT number: 2007-001597-82)

Additive efficacy of short-acting bronchodilators on dynamic hyperinflation and exercise tolerance in stable COPD patients treated with long-acting bronchodilators

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Functional imaging using computer methods to compare the effect of salbutamol and ipratropium bromide in patient-specific airway models of COPD

“…33 Using higher doses, there is no substantial difference between using a short-acting beta-agonist or a short-acting muscarinic agonist. It has also been demonstrated that there is an effective improvement in FEV 1 on adding a high dose of salbutamol (600 μg) or a high dose of ipratropium bromide (120 μg) to regular tiotropium 34. A limitation of this study is the fact that we only studied patients with more severe GOLD Stage III COPD who are known to have more volume response.…”

Approaches to drug therapy for COPD in Russia: a proposed therapeutic algorithm

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