Comparison of Bronchodilator Effects of Fenoterol/lpratropium Bromide and Salbutamol in Patients with Chronic Obstructive Lung Disease

Abstract

A double-blind, randomized cross-over trial was carried out in 24 patients with chronic airflow obstruction. The patients were required to demonstrate a minimum 15% absolute increase in forced expiratory volume (FEV₁ after a standard dose (0.4 mg) of fenoterol (F). On a separate occasion the effect of ipratropium bromide (IB; 0.04 mg) on FEV₁ was tested also; according to the increase in FEV₁ the patients were grouped into IB responders (ΔFEV₁ 15%) and IB nonresponders (ΔFEV₁ < 15%). Two puffs of F/IB (0.1 mg/0.04 mg), salbutamol (S; 0.2 mg) and placebo (P) were given by metered-dose inhaler at the same time of the day on three different occasions. FEV₁ and specific airway resistance (sRaw) were assessed before and at specific intervals following inhalation. The results showed that F/IB and S produced similar maximal increases in FEV₁ (ΔFEV₁ 32% for F/IB and 31% for S) and decreases in sRaw (ΔsRaw 24% for F/IB and 21% for S). These effects were significantly different both from baseline values and from P. FEV₁ was still significantly different 8 h after inhalation from P in the F/IB group, but not in the group that received S. The effect of IB on FEV₁ in the pretest was compared with the subsequent response to F/IB. In IB responders F/IB seemed to produce slightly more effective bronchodilation. Side effects were minimal and clinically insignificant. In conclusion, F/IB, with its ability to effect sustained bronchodilation without adverse side effects, is a viable alternative to a monotherapy in chronic obstructive pulmonary disease.

Effects of formoterol, salmeterol or oxitropium bromide on airway responses to salbutamol in COPD

“…In fact, since β 2 -agonists and anticholinergic agents are distinct classes of drugs with different mechanisms of action, an additive effect may be expected [24][25][26]. Prior attenuation of vagal tone by anticholinergic drug permits optimal achievable dilatation to be attained by subsequent inhalation of a short acting β 2 -agonist.…”

Anticholinergics in the Treatment of Chronic Obstructive Pulmonary Disease

“…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]. …”

The use of short-acting bronchodilators in patients with chronic bronchoobstructive pathology at the present stage

“…В рамках двой ного слепого перекрестного плацебоконтролируемого исследования было продемонстрировано, что у пациентов с ХОБЛ и наличием прироста ОФВ1 > 15% в бронходилатационном тесте комбинация фенотерол + ипратропия бромид предоставляет сравнимый максимальный бронходилатационный эффект с применением сальбутамола, но при этом длительность эффекта была больше у пациентов, которые были хорошими «ответчиками» на ипратропий (37,5% пациентов). Также следует отметить, что бронходилатационный эффект комбинации фенотерола и ипратропия (0,2 мг и 0,04 мг соответственно) у этих пациентов был сравним с эффектом 0,4 мг фенотерола [14]. Эти данные показывают, что есть группа пациентов, у которых назначение комбинации КДХЛ и КДБА предоставляет клинические преимущества, при том что снижение дозы бета-агониста представляется важным с точки зрения уменьшения вероятности развития побочных эффектов.…”