Bronchodilator Response to Ipratropium Bromide in Infants with Bronchopulmonary Dysplasia

Abstract

Although the muscarinic antagonist Ipratropium bromide is used clinically as a bronchodilator in infants ventilated because of bronchopulmonary dysplasia (BPD), no studies have compared the response or efficacy of different dosages or its effectiveness in combination with beta-adrenergic agonists. We measured the response of respiratory system mechanics in 10 ventilated infants (25 +/- 2 days of age) to 75, 125, and 175 micrograms ipratropium bromide (IB), 125 micrograms IB plus 0.04 mg salbutamol (SAL), 175 micrograms IB plus 0.04 mg SAL, and saline vehicle, delivered via nebulizer into the ventilator circuit. Respiratory system resistance (Rrs) and compliance (Crs) were measured by the passive flow-volume technique. Rrs and Crs were measured before and at 1 to 2 h and at 4 h after delivery of the five drug dosages or saline. All six studies were completed within a 72-h period. Saline had no significant effect on mechanics. Significant responses to ipratropium alone were seen only after 175 micrograms where Rrs decreased 20 +/- 3% (SEM) (p less than 0.05) at 1 to 2 h and 16 +/- 5% (p less than 0.05) at 4 h. After 125 micrograms IB + SAL and 175 micrograms IB + SAL, Rrs was significantly decreased both at 1 to 2 h and at 4 h, and Crs was significantly increased 20 +/- 6% and 20 +/- 4%, respectively, at 1 to 2 h. The greatest decrease in Rrs (26 +/- 6%) was seen 1 to 2 h after 175 micrograms IB + salbutamol.(ABSTRACT TRUNCATED AT 250 WORDS)

Delivery of salbutamol to nonventilated preterm infants by metered-dose inhaler, jet nebulizer, and ultrasonic nebulizer

“…Bronchodilator aerosols are commonly used for the treatment of bronchiolar constriction associated with chronic lung disease of the newborns [1][2][3][4][5][6][7][8][9]. The aerosols may be delivered by a metered dose inhaler (MDI) used in conjunction with a spacer device, a jet nebulizer, or an ultrasonic nebulizer.…”

Efficacy and Tolerance of High-Dose Inhaled Ipratropium Bromide vs. Terbutaline in Intubated Premature Human Neonates

“…0.05) at 1-2 h and 16 8 5% (p ! 0.05) at 4 h, the greatest decrease in Rrs (26 8 6%) was seen 1-2 h after a combination of 175 g IB + SAL [33] .…”

Response to bronchodilators in clinically stable 1-year-old patients with bronchopulmonary dysplasia

“…However, in the present study there was no improvement in pulmonary resistance after inhalation of bronchodilators. Many studies have evaluated the response to bronchodilators in very early BPD when [2,3,7,9,17,21]. In these ventilated babies improvement of pulmonary compliance and airway resistance has been reported after beta mimetic and anticholinergic drugs but also after administration of caeine [18], aminophylline [8] and diuretics [4].…”

“…In patients with BPD, an improvement in pulmonary mechanics after administration of bronchodilators has been well documented in the acute stage of the disease [2,3,7,9,17,21]. Therefore it has been suggested that long-term treatment with bronchodilators may be bene®cial [2,5,7,17].…”

“…Therefore it has been suggested that long-term treatment with bronchodilators may be bene®cial [2,5,7,17].…”