Decreased duration of emergency department treatment of chronic obstructive pulmonary disease exacerbations with the addition of ipratropium bromide to β-agonist therapy

Shrestha, Mahesh; O'Brien, Terence; Haddox, Robert; Gourlay, H Scott; Reed, Gary

doi:10.1016/s0196-0644(05)81472-6

Cited by 47 publications

(20 citation statements)

References 11 publications

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“…Most studies examining the effects of combination therapy do not report any added benefit of adding a second agent (156,(160)(161)(162). One study demonstrated a greater improvement in FEV 1 with combination therapy than with a beta-agonist alone (163), while another showed shorter emergency room stays for the group on combination therapy (164). None of these studies are well standardized in terms of dose of medication or dosing frequency.…”

Section: Bronchodilator Therapymentioning

confidence: 99%

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Balter

Forge

Low

et al. 2003

Canadian Respiratory Journal

116

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Acute exacerbations of chronic bronchitis (AECB) account for over 1.5 million physician visits annually in Canada and are a cause of significant morbidity and mortality. This document represents a joint effort between respirologists, microbiologists, infectious disease specialists and family physicians to update the Canadian AECB guidelines published in 1994. Treatment recommendations are graded on the strength of evidence in the published literature where possible. The role for oral corticosteroid therapy in preventing treatment failures, speeding up recovery and delaying the time to next exacerbation is discussed. Risk factors for treatment failure were used to stratify patients into risk groups to help guide antibiotic treatment recommendations. The importance of emerging antimicrobial resistance to current antibiotics is reviewed and strategies to prevent future AECB episodes are suggested.

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Section: Bronchodilator Therapymentioning

confidence: 99%

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Balter

Forge

Low

et al. 2003

Canadian Respiratory Journal

116

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“…Short-acting anticholinergic bronchodilators and short-acting β-agonists appear to be equally effective in treating exacerbations of COPD [42, 44]. In some patients, the combined administration of an anticholinergic bronchodilator with a short-acting β-agonist can generate better bronchodilation than either agent alone [20, 25, 38, 40, 68, 75]. …”

Section: The Clinical Value Of Anticholinergics In Comparative Studiesmentioning

confidence: 99%

Anticholinergics in the Treatment of Chronic Obstructive Pulmonary Disease

Beeh¹,

Welte

Buhl³

2002

Respiration

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Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. In the majority of cases, the disease is the result of years of cigarette smoking. Contributing factors leading to bronchial obstruction in COPD include mucus hypersecretion and an increase in bronchial muscle tone, which is triggered mainly by cholinergic mechanisms. Anticholinergic bronchodilators reduce vagal cholinergic tone, the main reversible component of COPD; hence they are the first-line treatment for bronchial obstruction in COPD. In addition to improving lung function, anticholinergics improve dyspnea, quality of life and exercise tolerance, and they reduce exacerbations. When compared with other bronchodilators, anticholinergics show at least equivalent bronchodilator potency, but with fewer side effects. In addition, due to their unique site of action, anticholinergics can be effectively combined with other bronchodilators. The introduction of new, long-acting anticholinergics is a promising addition to the treatment of COPD and is expected to lead to improved treatment outcomes and improved patient compliance.

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“…3 Currently, short-acting inhaled b 2 -adernergic (SABA) agonists are the mainstay of pharmacological therapy in patients with acute exacerbation of COPD (AECOPD). [5][6][7][8][9] Overall, patients in theses studies had marginally shorter length of stay and proportionally larger increase in forced expiratory volume in the first second of expiration. Numerous studies have described the use of anticholinergics with SABA agents to reverse airflow limitation in AECOPD.…”

Section: Introductionmentioning

confidence: 99%

Magnesium Sulfate Versus Ipratropium Bromide in Chronic Obstructive Pulmonary Disease Exacerbation

Bouida

Grissa

Beltaïef

et al. 2014

American Journal of Therapeutics

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Treatment with short-acting β2-agonists for exacerbations of chronic obstructive pulmonary disease (COPD) results in clinical improvement. It has not been established whether combining short-acting β2-agonists to other bronchodilators is more effective than β2-agonists alone. We conducted a study in patients presenting to the emergency department with exacerbation of COPD. They were randomized to receive nebulized ipratropium bromide (IB group; n = 62) or combined nebulized and intravenous bolus of magnesium sulfate (MgSO4 group; n = 62). All nebulized drugs were administered at 30-minute intervals for 2 hours. Primary outcome included hospital admission, endotracheal intubation, and hospital death rates. Secondary outcome measures were improvement in peak expiratory flow, dyspnea score, and arterial blood gas changes within the first 3 hours. There were no significant differences in primary outcome between MgSO4 and IB groups. Patients given IB average 32 L greater improvement in peak expiratory flow rate compared with magnesium sulfate (95% confidence interval, 19-43 L) at 180 minutes. Simultaneously, there was a significant reduction in PaCO2 compared with baseline values in IB group but not in MgSO4 group. There was a statistically nonsignificant trend toward a decrease in dyspnea score in both groups although adverse events were similar. Although the improvement in peak expiratory flow rate and arterial blood gas favored nebulized IB over magnesium sulfate, there was a nonsignificant difference between both drugs with regard to hospital admission, intubation, and hospital death rates in patients with COPD treated in the emergency department for acute exacerbation.

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Decreased duration of emergency department treatment of chronic obstructive pulmonary disease exacerbations with the addition of ipratropium bromide to β-agonist therapy

Cited by 47 publications

References 11 publications

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Canadian Guidelines for the Management of Acute Exacerbations of Chronic Bronchitis

Anticholinergics in the Treatment of Chronic Obstructive Pulmonary Disease

Magnesium Sulfate Versus Ipratropium Bromide in Chronic Obstructive Pulmonary Disease Exacerbation

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