Use of Ipratropium Bromide in Patients with Severe Airways Obstruction

Abstract

In ten adult patients with severe, partially reversible airflow obstruction due to asthma, with or without co-existent chronic bronchitis, the acute bronchodilator responses of ipratropium bromide (40 micrograms) and terbutaline (500 micrograms) from metered-dose inhalers, atropine methonitrate (2 mg) as a wet aerosol and placebo were compared in a double blind trial. Also the combination of ipratropium bromide and terbutaline aerosols was compared with both ipratropium and terbutaline alone in short-term and long-term studies. In the short-term study, all the drugs produced significant bronchodilatation compared with placebo. The responses to ipratropium bromide and terbutaline alone were not significantly different. The combination of ipratropium bromide with terbutaline did not produce significantly greater changes in the FEV1, SGaw or static lung volume than terbutaline alone. Atropine methonitrate however, produced significantly greater changes of the airway conductance (SGaw) and static lung volumes (TLC and RV) but not FEV1, when compared to ipratropium bromide. When administered over randomised periods of one month each there were no significant differences between the combination of ipratropium bromide and terbutaline and each drug alone in daily airflometer recordings, daily symptom scores or fortnightly spirometry and clinical assessment. It is concluded that ipratropium bromide, in the conventional dose of 40 microgramm by metered-dose inhaler produces safe, effective bronchodilatation. Its effect, however, did not significantly augment that of the beta adrenergic stimulant, terbutaline and was less than that of atropine methonitrate 2 mg by wet aerosol.

Effect of Nebulized Ipratropium Bromide on Lung Function in Nonallergic Bronchial Asthma

“…IB (40 ng), delivered as a single dose by a nebulizer to patients with acute bron chial asthma, has the same effect as terbutaline (0.5 mg) [Pierce et al, 1982]. Paying regard to the fact that IB has very few side effects [Simonsson et al, 1975], we thought it of interest to investigate whether there is a linear dose-response relationship for the drug regarding static lung volumes and dynamic variables reflecting conditions in large and small airways and the intrapul monary gas distribution before and 1 h af ter inhalation of larger doses of the drug.…”

Combined Bronchodilator Protection Against Histamine‐induced Bronchoconstriction in Man

“…Studies to date have shown conflicting data as to whether the combination of inhaled P-agonists and inhaled anticholinergics results in a greater effect. Jenkins et al (1982) and Ruffin et al (1982) have reported a greater bronchodilator effect for the combination of P-agonist with an anticholinergic drug than either alone, but Pierce et al (1982) and Lawford and Palmer (1983) were unable to show an additional bronchodilator effect of adding an anticholinergic agent. The comparison of bronchodilator effects can be difficult because of the variability of asthma, baseline lung function and the bronchodilator responsiveness on separate days (Freedman 1974).…”

Ipratropium Bromide (Atrovent®) as Inhalation Powder

“…In addition to P-mimetica, ipratropium bromide (Atrovent®), an anticholinergic bronchodilator, has gained a permanent place in the therapy of chronic obstructive respiratory diseases. Both short-and long-term studies have shown that ipratropium bromide is an effective and safe drug (4,13,14). Up to now, ipratropium bromide has only been given as an aerosol, either as a pressure aerosol or with conventional nebulising devices.…”