Comparison of the effects of salmeterol and ipratropium bromide on exercise performance and breathlessness in patients with stable chronic obstructive pulmonary disease

Patakas, D.; Andreadis, Dimitrios; Mavrofridis, E.; Argyropoulou, Paraskevi

doi:10.1016/s0954-6111(98)90404-8

Cited by 25 publications

(12 citation statements)

References 21 publications

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“…As the results after 50 and 75 mg of salmeterol were similar, they suggested that 50 mg was the best dose of salmeterol in these patients. It has been shown that this recommended dose of 50 mg salmeterol produces a similar [11] or even greater improvement [16] in airway obstruction than the recommended dose of 40 mg ipratropium bromide. To date, only one clinical trial has been carried out on the efficacy of combined administration of salmeterol and ipratropium in COPD.…”

Section: Discussionmentioning

confidence: 86%

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

et al. 2000

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The efficacy and safety of salmeterol alone was compared with the combination of salmeterol plus ipratropium and with placebo during long-term treatment in patients with stable chronic obstructive pulmonary disease. In addition, the single-dose effect in response to the first dose of treatment was studied over 12 h.The patients (n=144; age 64 7 yrs, forced expiratory volume in one second (FEV1) 44 11% pred) participated in a three-centre double-blind double-placebo parallel group study and were randomized after a run-in period of 2 weeks to receive either salmeterol 50 mg b.i.d., salmeterol 5 mg b.i.d. plus ipratropium 40 mg q.i.d. or placebo for a period of 12 weeks.The single-dose study demonstrated that salmeterol produced a significant increase in FEV1 (peak of 7% pred) and specific airway conductance (sGaw) (maximum of 60% baseline) for $12 h. The combination of salmeterol plus ipratropium elicited a greater bronchodilator response (11% and 94% increases respectively) than salmeterol alone during the first 6 h after inhalation. During treatment there were significant improvements in daytime symptom scores and morning peak expiratory flow in both the salmeterol and the salmeterol plus ipratropium groups (p<0.001), with an associated decrease in the use of rescue salbutamol. Improvements in FEV1 and sGaw were greater in the salmeterol plus ipratropium group than in the patients receiving only salmeterol. Thirty-five patients had an exacerbation; 11 (23%) in the salmeterol group (versus placebo NS), six (13%) in the salmeterol plus ipratropium group (versus placebo p<0.01) and 18 (36%) in the placebo group.In conclusion, in patients with severe stable chronic obstructive pulmonary disease, long-term treatment with either salmeterol alone or salmeterol plus ipratropium is safe and effective. There was added benefit from the combination therapy in terms of improvement in airways obstruction, but not for improvement in symptom control or need for rescue salbutamol. Eur Respir J 2000; 15: 878±885. Chronic obstructive pulmonary disease (COPD) is defined as a disease state characterized by the presence of airflow obstruction, due to chronic bronchitis or emphysema, and is generally progressive but may be partially reversible [1]. The goals of pharmacotherapy in this disorder are to induce bronchodilation and facilitate expectoration in order to improve symptoms, prevent recurrent exacerbations and so enhance the quality of life [2]. In patients with stable COPD, the spirometric response to bronchodilators such as b 2 -agonists, anticholinergic drugs and methylxanthines is at best very modest. However, even in the absence of significant bronchodilation, an improvement in symptoms and exercise tolerance can be demonstrated [3].Salmeterol xinofoate, a long-acting b 2 -agonist, has been shown in single-dose studies to induce a spirometric improvement over a 12-h period in patients with COPD [4± 6]. In addition, three studies in patients with COPD over periods of 1±3 months have found that treatment with salmet...

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Section: Discussionmentioning

confidence: 86%

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

et al. 2000

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“…In a previous study, PATAKAS et al [25] compared 50 mg (two puffs) of S and 120 mg (six puffs) IB on breathlessness during treadmill exercise in 15 patients with COPD. The authors found that the distance walked increased significantly with both S and with IB, but the distance walked on the treadmill when patients had no breathlessness was increased with S (pv0.05), but not with IB.…”

Section: Discussionmentioning

confidence: 99%

“…The authors found that the distance walked increased significantly with both S and with IB, but the distance walked on the treadmill when patients had no breathlessness was increased with S (pv0.05), but not with IB. PATAKAS et al [25] concluded that the overall effects of these two medications were similar as related to the dyspnoea sensation during exercise. Thus, the present results both confirm and extend these observations on the effectiveness of S and IB.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of salmeterolversusipratropium bromide on exertional dyspnoea in COPD

Ayers¹,

Mejia²,

Ward³

et al. 2001

Eur Respir J

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The hypothesis of the study was that salmeterol and ipratropium would have similar dyspnoea ratings during steady-state cycle ergometry at 1 h, but that salmeterol would reduce dyspnoea at 6 h after administration in patients with chronic obstructive pulmonary disease (COPD).The study design was a randomized, double-blind trial in 16 patients (aged 63¡11 yrs) with symptomatic COPD. Two days after familiarization with testing procedures, patients were randomly assigned to receive either two puffs (42 mg) of salmeterol and two puffs of placebo inhaler, or two puffs (36 mg) of ipratropium from each of two inhalers (total, 72 mg). Two days later, patients received the alternative medication. During exercise at 60% of peak oxygen consumption patients rated dyspnoea and performed inspiratory capacity manoeuvres each minute.Forced expiratory volume in one second was 1.13¡0.48 L (37¡13% predicted). Dyspnoea ratings were similar for salmeterol and ipratropium at 1 and 6 h. Inspiratory capacity was similar for salmeterol and ipratropium at 1 h, but significantly higher for salmeterol at 6 h (D~120 mL; p~0.03).It is concluded that with the doses used, salmeterol and ipratropium provided similar dyspnoea ratings during exercise at 1 and 6 h after administration.

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“…Although the maximum bronchodilation for salmeterol was higher than for ipratropium, the results of this group comparison study are difficult to interpret since the patients in the ipratropium group were more seriously ill, in clinically relevant terms, at the start of the study than the patients in the salmeterol and placebo groups [49]. In a single-dose study, the efficacy of ipratropium and salmeterol was shown to be comparable with respect to improved performance and improvement in dyspnea in COPD patients [61]. Additionally, in single-dose comparative studies, no difference was observed in the bronchodilator potency of 80 µg ipratropium compared with 12 µg formoterol.…”

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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Comparison of the effects of salmeterol and ipratropium bromide on exercise performance and breathlessness in patients with stable chronic obstructive pulmonary disease

Cited by 25 publications

References 21 publications

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

Long-term treatment of chronic obstructive pulmonary disease with salmeterol and the additive effect of ipratropium

Effectiveness of salmeterolversusipratropium bromide on exertional dyspnoea in COPD

Anticholinergics in the Treatment of Chronic Obstructive Pulmonary Disease

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