Efficacy of salbutamol and ipratropium bromide in decreasing bronchial hyperreactivity in children with cystic fibrosis

Abstract

A proportion of patients with cystic fibrosis (CF) suffer from increased airway hyperreactivity but their response to bronchodilators is variable. Adrenergic agents may produce an increase, no change or a decrease in forced expiratory volume in 1 second (FEV1). We hypothesized that the variable response might be related to poor aerosol distribution caused by the presence of secretions. Therefore, in 11 children with CF and airway hyperreactivity the influence of pretreatment with either 0.9% saline, salbutamol, or ipratropium bromide on the methacholine challenge test was evaluated in a double-blind, randomized, cross-over study. FEV1 (mean +/- S.E.) did not change following pretreatment with saline, salbutamol, or ipratropium (1.64 +/- 0.22, 1.63 +/- 0.16 and 1.67 +/- 0.19, respectively). All patients demonstrated airway hyperreactivity with a PC20 below 8 mg/mL (geometric mean, 0.41 mg/mL) after saline pretreatment. Salbutamol inhalation significantly increased the PC20 to 1.24 mg/mL (P less than 0.01), but ipratropium bromide was found to be even more effective than salbutamol (PC20 = 7.37 mg/mL) (P less than 0.0001). We conclude that the variable response to bronchodilator is not secondary to impaired aerosol distribution since ipratropium bromide effectively blocked the response to methacholine. The improvement in PC20 without a change in baseline FEV1 following salbutamol suggests that the adrenergic agent altered the contractile mechanism of smooth muscle.

Do inhaled corticosteroids impair long-term growth in prepubertal cystic fibrosis patients?

“…The overall bronchial lability in the patients was low but concordant with values reported in previous studies in young CF children [3]. Bronchial lability may be more pronounced in older more ill patients.…”

Safety, Tolerability, and Plasma Exposure of Tiotropium Respimat® in Children and Adults with Cystic Fibrosis

“…(6)(7)(8) In patients with COPD, tiotropium delivered using the Respimat Ò SMI at doses of 5 and 10 lg has consistently shown superior efficacy to ipratropium bromide. (15) Given the differences between the diseases, it is unknown whether tiotropium will have a similar effect in patients with CF.…”

“…Ipratropium bromide, a short-acting anticholinergic compound, has been shown to improve lung function in singledose studies in patients with CF; (6)(7)(8) however, its long-term effects in CF have not been studied. Tiotropium is a longacting, anticholinergic bronchodilator for the maintenance treatment of patients with chronic obstructive pulmonary disease (COPD).…”

Fibrosis quística: Reporte de casos en un hospital de Lima, Perú.

“…La radiografía mostrará conforme la enfermedad progrese, cambios difusos. La enfermedad pulmonar pueden llegar a complicarse con hiperreactividad bronquial, hemoptisis, neumotórax y aspergilosis broncopulmonar alérgica (8,11,12,13,14).…”

“…Se realiza el seguimiento de 6 pacientes, 5 (83%) de ellos presentan hiperreactividad bronquial (12,13).…”