Acute on Chronic Comparative Effects of a Combination of Fenoterol-Ipratropium Bromide and Terbutaline in Patients with Chronic Obstructive Lung Disease

Grassi, Vittorio; Bruni, Biagio Maria; Peccini, F.; Tantucci, Claudio; Todisco, Tommaso

doi:10.1159/000195133

Cited by 8 publications

(6 citation statements)

References 11 publications

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“…Short-acting bronchodilators indeed appear to have a relatively flat dose-response curve, as has been shown for salbutamol and IPRA [31][32][33]. Hence, with the combination, significant relief of airway obstruction can be obtained using lower dosages of each component than would be required when using them separately, thereby improving their safety margins [17,18,28,34] and patient compliance [19]. Also, their combination combines the more rapid onset of action of a SABA such as FEN with the somewhat more prolonged duration of action of the SAAC IPRA [26,29].…”

Section: The Drugsmentioning

confidence: 89%

“…CFC: Chlorofluorocarbon; DPI: Dry powder inhaler; HFA: hydrofluoroalkane; pMDI: Pressurized metered-dose inhaler. offers a larger degree of bronchodilation than can be achieved by single administration of each of them separately, as has been shown both in asthma and, particularly, in COPD in numerous studies using a combination of short-acting bronchodilators [17][18][19][20][21][22][23][24][25][26][27][28][29], and as has been reviewed for COPD by Donohue [30]. Short-acting bronchodilators indeed appear to have a relatively flat dose-response curve, as has been shown for salbutamol and IPRA [31][32][33].…”

Section: The Drugsmentioning

confidence: 99%

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Clinical efficacy and safety of the combination of ipratropium bromide and fenoterol inhaled via the Respimat© Soft Mist ™ inhaler for relief of airflow obstruction

Vincken¹

2008

Expert Review of Respiratory Medicine

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Bronchodilators are key drugs in symptomatic as well as maintenance treatment of obstructive lung diseases such as chronic obstructive pulmonary disease and asthma. The short-acting anticholinergic ipratropium bromide and the short-acting beta(2)-adrenergic receptor agonist fenoterol hydrobromide have been available for combined use both as a pressurized metered-dose inhaler and as a solution for nebulization. Their combination at half the dose in the novel device, the Respimat Soft Mist inhaler (RMT), has been shown to provide therapeutic equivalence to their combination into a conventional pressurized metered-dose inhaler, both in terms of efficacy and safety in patients with chronic obstructive pulmonary disease or asthma, both adults and children. Dose reduction with the RMT has been made possible due to the physical characteristics of the aerosol cloud emitted from the RMT, facilitating correct inhalation and ensuring higher pulmonary deposition of the aerosolized bronchodilators. Post-marketing studies using validated questionnaires confirm a high level of satisfaction with the performance and convenience of the RMT device, a large majority of patients preferring the RMT to other inhaler systems.

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Section: The Drugsmentioning

confidence: 89%

Section: The Drugsmentioning

confidence: 99%

Clinical efficacy and safety of the combination of ipratropium bromide and fenoterol inhaled via the Respimat© Soft Mist ™ inhaler for relief of airflow obstruction

Vincken¹

2008

Expert Review of Respiratory Medicine

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“…As shown in table 1, many reasons provide a good rationale for combining an anticholinergic agent and a b 2 -adrenergic receptor agonist. Numerous studies have demonstrated that the degree of bronchodilatation achieved with the combination is larger than that of either agent alone [12][13][14][15][16][17]. The more rapid onset of action of the SABA complements the more prolonged duration of action of the SAAC, and their combination usually allows dosage reduction of either component, thereby increasing safety margins [13,14] and patient compliance [16].…”

Section: The Combination Of a Saac With A Sabamentioning

confidence: 99%

“…Numerous studies have demonstrated that the degree of bronchodilatation achieved with the combination is larger than that of either agent alone [12][13][14][15][16][17]. The more rapid onset of action of the SABA complements the more prolonged duration of action of the SAAC, and their combination usually allows dosage reduction of either component, thereby increasing safety margins [13,14] and patient compliance [16]. Furthermore, the combination of ipratropium and albuterol (salbutamol) was shown to reduce exacerbation rates [18] and to result in appreciable cost savings [19].…”

Section: The Combination Of a Saac With A Sabamentioning

confidence: 99%

Bronchodilator treatment of stable COPD: long-acting anticholinergics

Vincken¹

2005

European Respiratory Review

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Since airflow obstruction in chronic obstructive pulmonary disease (COPD) is to some extent reversible, bronchodilators play an important role in the maintenance treatment of COPD the more they reduce hyperinflation and, as a result, improve dyspnoea and exercise capacity. Since parasympathetic activity is the dominant reversible component of airflow obstruction in COPD, inhaled short-acting anticholinergic agents (SAAC), in particular ipratropium, became an efficient and safe first-line treatment, especially when combined with a short-acting b 2 -adrenergic receptor agonist. Even better results were obtained when combining the SAAC ipratropium to a long-acting b 2 -adrenergic receptor agonist (LABA), once they became available.Recently, tiotropium bromide, the first of a new class of selective and long-acting anticholinergic agents was introduced for once-daily maintenance treatment of COPD patients. Several large long-term randomised clinical trials comparing tiotropium to placebo as well as to the SAAC ipratropium and the LABA salmeterol, have confirmed the long-acting and superior bronchodilator effect of tiotropium without any evidence of drug tolerance developing. These studies also have clearly demonstrated that tiotropium positively affects several other important health outcomes, such as dyspnoea sensation, exercise capacity, utilisation of rescue bronchodilators, health-related quality of life, COPD exacerbations and hospitalisations because of exacerbations. The improvement in these real-life outcomes appears related to the reduction in both static and dynamic hyperinflation. In all these studies, tiotropium was well tolerated and safe; the only relevant side-effect encountered being dry mouth, usually mild and often transitory. Finally, it has been shown that the combination of tiotropium with a LABA affords superior bronchodilatation than both agents alone, indicating that both classes of longacting bronchodilators should be regarded as complements rather than opponents.In conclusion, a sufficiently large and convincing database now exists to propose the once-daily long-acting anticholinergic tiotropium as first-line maintenance treatment for all chronic obstructive pulmonary disease patients in global initiative for chronic obstructive lung disease (GOLD)-class II and above, with a step-up to its combination with a long-acting b 2 -adrenergic receptor agonist in case of suboptimal clinical effect.

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“…Thus combining a short‐acting β 2 ‐agonist with an inhaled anticholinergic should theoretically result in an additive bronchodilating effect in patients with chronic obstructive pulmonary disease (COPD). A number of studies have shown this, 2‐8 while others have failed to do so 9‐11 …”

mentioning

confidence: 99%

Bronchodilatory Responses to Formoterol, Ipratropium, and Their Combination in Patients With Stable Copd

Sichletidis

Kottakis

Marcou

et al. 1999

Int J Clinical Practice

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SUMMARYWe studied 27 patients with stable chronic obstuctive pulmonary disease (COPD) in a randomised, single‐blind, within‐patient, placebo‐controlled clinical study. Each patient was assigned on six separate days to receive one of the following drug regimens in random order: A. 40 μg ipratropium bromide (Atrovent MDI, 20 μg/puff) plus 2 puffs placebo; B. 12 μg formoterol fumarate (Foradil MDI,12 μg/puff) plus 3 puffs placebo; C. 80 μg ipratropium; D. 24 μg formoterol plus 2 puffs placebo; E. 12 μg formoterol plus 40 μg ipratropium plus 1 puff placebo; F. 4 puffs placebo. On each study day, Spirometric indices and vital signs were measured at 5, 10, 15 and 60 minutes, and hourly thereafter up to and including 12 hours after study drug administration. Mean peak FEV1 change (primary endpoint) was maximum with the administration of the combination of ipratropium and formoterol (335.2 ml, SE 24.6), and it differed significantly from the observed peak changes following single administration of the two tested doses of ipratropium (p<0.05 and p<0.05 respectively). Safety and tolerability were satisfactory throughout the study.

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Acute on Chronic Comparative Effects of a Combination of Fenoterol-Ipratropium Bromide and Terbutaline in Patients with Chronic Obstructive Lung Disease

Cited by 8 publications

References 11 publications

Clinical efficacy and safety of the combination of ipratropium bromide and fenoterol inhaled via the Respimat© Soft Mist ™ inhaler for relief of airflow obstruction

Clinical efficacy and safety of the combination of ipratropium bromide and fenoterol inhaled via the Respimat© Soft Mist ™ inhaler for relief of airflow obstruction

Bronchodilator treatment of stable COPD: long-acting anticholinergics

Bronchodilatory Responses to Formoterol, Ipratropium, and Their Combination in Patients With Stable Copd

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