A comparison of three high doses of ipratropium bromide in chronic asthma

Hockley, Brian G.; Johnson, N M

doi:10.1016/0007-0971(85)90072-5

Cited by 19 publications

(4 citation statements)

References 7 publications

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“…Single dose response studies by ALLEN and CAMPBELL [14] and HOCKLEY and JOHNSON [15] revealed maximum FEV1 responses to 120 µg IB (compared with 40 µg) and 200 µg (compared with 80 µg), respectively, when given through the pMDI, but although these differences were statistically significant, they were very small and probably clinically irrelevant. These contrasting results may be explained by the preselection of our patients as we only included those with a good response to IB, in order to obtain potential improvements in FEV1 that would be sufficient to compare the efficacy of the two devices.…”

Section: Discussionmentioning

confidence: 98%

Comparative efficacy and potency of ipratropium via Turbuhaler and pressurized metered-dose inhaler in reversible airflow obstruction

Böllert

Matusiewicz²,

Dewar³

et al. 1997

Eur Respir J

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Ipratropium bromide (IB), typically delivered by pressurized metered dose inhaler (pMDI), is used to treat patients with reversible airways obstruction. Use of the pMDI, unlike the Turbuhaler® (TH), demands co-ordination of actuation with inspiration for efficient use. Two studies were carried out to compare the relative efficacy and potency of IB delivered by TH or pMDI.Both studies were of a randomized, double-blind and cross-over design. For the efficacy study, 15 patients received a cumulative dose of 160 µg IB via TH or pMDI as doses of 20, 20, 40 and 80 µg at 45 min intervals on two days. Forced expiratory volume in one second (FEV1) was measured prior to and 40 min after dosing. For the potency study, 33 patients received 10, 20 or 40 µg of IB via TH, 20 µg IB via pMDI, or placebo, on five days. FEV1 was recorded prior to and 15-360 min after dosing.For the efficacy study, there was no difference in FEV1 response to a cumulative dose of IB via pMDI and TH. More than 80% of the maximum effect was seen at the lowest dose (20 µg of IB). Regarding the potency study, the FEV1 response to 20 µg IB administered via pMDI was similar to that of 10 µg via TH; 20 µg via TH was significantly more effective than 20 µg via pMDI (p<0.05).In conclusion, the efficacy study showed that maximum FEV1 occurred at low doses of IB, negating any opportunity to identify differences between devices. The potency study indicated that the 10 µg dose via TH was of similar efficacy to the 20 µg dose via pMDI, confirming an efficacy ratio of 1.5-2.0:1 for the TH device. Eur Respir J 1997; 10: 1824-1828 The controversy surrounding β 2 -agonist bronchodilators has led to a renewed interest in the anticholinergic bronchodilator ipratropium bromide (IB) which has been available for about 20 yrs and has a good safety profile. IB is used to treat patients with reversible airways obstruction, e.g. patients with chronic obstructive pulmonary disease (COPD) [1], elderly patients with asthma [2], and patients still symptomatic despite treatment with β 2 -agonists [3]. Typically, delivery is by pressurized metered-dose inhaler (pMDI); however, use of the pMDI, unlike the Turbuhaler® (TH) (Astra Draco AB, Lund, Sweden), demands co-ordination of actuation with inspiration for efficient use [4]. Chlorofluorocarbons (CFCs), which act as the propellant gas in most pMDIs, deplete the ozone layer and their use will have ceased by the end of the century. As an alternative, inspiratory flow-driven dry powder devices have been developed. Their advantages include ease of use as well as lack of local irritation and paradoxical bronchoconstriction secondary to the propellants/surfactants [5,6]. TH, a multidose dry powder inhaler, contains pure drug (budesonide or terbutaline) or IB and lactose as diluent; an inspiratory flow of as low as 30 L·min -1 is sufficient for efficacy from the device [7]. Previous studies with other drugs have shown the TH to be of greater efficacy than the pMDI at the same nominal dose [8][9][10][11][12][13].Two studies were...

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Section: Discussionmentioning

confidence: 98%

Comparative efficacy and potency of ipratropium via Turbuhaler and pressurized metered-dose inhaler in reversible airflow obstruction

Böllert

Matusiewicz²,

Dewar³

et al. 1997

Eur Respir J

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“…20 Minuten und ein Wirkungsmaximum nach 30 -60 Minuten. Höhere Dosierungen als üblicherweise verwendet werden im allgemeinen gut vertragen [28].…”

Section: Anticholinergikaunclassified

Therapie der schweren Exazerbation bei chronisch obstruktiver Lungenerkrankung (COPD)

Schäfer¹,

Ewig²,

Gillissen³

2000

Intensivmedizin und Notfallmedizin

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“…Ipratropium bromide (IB) given by a metered dose inhaler in excess of re commended doses has been shown to have a proportional dose-bronchodilatorresponse effect on large airways as meas ured by the spirometric dynamic variables vital capacity (VC), forced vital capacity (FVC) and forced expiratory volume in Is (FEV|) [Hockley and Johnson, 1985).…”

Section: Introductionmentioning

confidence: 99%

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

Wegener¹,

Hedenström²

1987

Respiration

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The present investigation was performed on 64 randomly chosen never-smoking patients, 40–60 years old, with nonallergic bronchial asthma with an average FEV₁ of 69–73 % of predicted, a positive methacholine test, a normal serum IgE level, and a negative RAST or skin test to common allergens and not receiving oral steroid treatment. Sensitive spirometric tests were used to evaluate the dose-response effect of inhalation of 0.08, 0.15 or 0.25 mg of ipratropium bromide. The drug caused bronchodilatation with a nearly linear dose-response relationship for static lung volumes, while the total lung capacity was unchanged after this inhalation. Airway resistance decreased and specific airway conductance increased after all doses. Ventilation and flows were better after doses of 0.15 and 0.25 mg than after 0.08 mg. The intrapulmonary gas distribution improved only after inhalation of 0.25 and 0.15 mg. The currently recommended dose of 0.08 mg seems to be suboptimal for dilatation of both small and large airways

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A comparison of three high doses of ipratropium bromide in chronic asthma

Cited by 19 publications

References 7 publications

Comparative efficacy and potency of ipratropium via Turbuhaler and pressurized metered-dose inhaler in reversible airflow obstruction

Comparative efficacy and potency of ipratropium via Turbuhaler and pressurized metered-dose inhaler in reversible airflow obstruction

Therapie der schweren Exazerbation bei chronisch obstruktiver Lungenerkrankung (COPD)

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

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