Ipratropium bromide nasal spray in non‐allergic rhinitis: efficacy, nasal cytological response and patient evaluation on quality of life

Abstract

Intranasal fluorocarbon anticholinergic agents have been used to treat the nasal hypersecretion of perennial non-allergic rhinitis, but chronic use has been restricted either due to the potential for systemic anticholinergic adverse events or due to the irritating properties of the fluorocarbon metered dose formulations. This study evaluates a new aqueous nasal formulation of ipratropium bromide (Atrovent Nasal Spray 0.03%) in subjects with perennial non-allergic rhinitis in a double-blind, placebo-controlled trial. Two hundred and twenty-eight patients were randomized to receive two sprays per nostril of either ipratropium bromide (42 micrograms/nostril) or placebo-administered three times a day as an aqueous nasal spray over an 8-week interval. Patients were evaluated bi-weekly and maintained daily diaries for duration and severity of nasal symptoms. Ipratropium bromide reduced the mean severity and duration of rhinorrhoea within the first week and throughout the 8 weeks of active treatment compared with placebo (P< 0.05). Secondary endpoints of efficacy (patient and physician global assessments and a quality of life assessment) also supported the use of ipratropium bromide nasal spray for rhinitis symptom control. With the reduction in rhinorrhoea by the ipratropium bromide nasal spray, patients reported a marked improvement in daily moods vs placebo (P < 0.01). Both placebo and ipratropium bromide nasal spray induced a modest reduction of nasal congestion, sneezing and postnasal drip. This improvement in these other nasal symptoms was consistent with the known soothing effects of a nasal saline vehicle. There were no drug-related serious or systemic anticholinergic adverse events.(ABSTRACT TRUNCATED AT 250 WORDS)

The diagnosis and management of rhinitis: An updated practice parameter

“…435 Intranasal anticholinergics [Summary Statements 83,84] The nasal anticholinergic ipratropium bromide is effective in reducing rhinorrhea caused by allergic rhinitis, nonallergic rhinitis (including cold-induced rhinitis 436 and gustatory rhinitis 66 ), and the common cold. [437][438][439][440][441][442][443][444][445][446][447] Ipratropium bromide is only approved (down to the age of 5 years) for the treatment of rhinorrhea, although 1 pediatric study showed modest benefit for controlling nasal congestion. 448 Ipratropium bromide has no adverse effect on physiologic nasal functions (eg, sense of smell, ciliary beat frequency, or mucociliary clearance) and has a low incidence of adverse events, in particular epistasis and nasal dryness.…”

“…449 Atrovent (ipratropium bromide; Boehringer-Ingelheim, Ridgefield, Conn) nasal spray 0.03% has been approved for use in patients 6 years of age and older on the basis of its effectiveness in treating rhinorrhea caused by perennial allergic and nonallergic rhinitis in adults and children. [437][438][439][440][441][442] The 0.06% concentration has been approved for patients 5 years of age and older for rhinorrhea associated with the common cold. Ipratropium bromide is approved only for the treatment of rhinorrhea, although 1 pediatric study showed modest benefit for controlling nasal congestion.…”

Intranasal sodium hyaluronate on the nasal cytology of patients with allergic and nonallergic rhinitis

“…The evidence for symptomatic relief in patients with allergic rhinitis is far more unequivocal, with nasal corticosteroids and sodium cromoglycate improving multiple symptomatic endpoints in a large number of well‐designed studies . Furthermore, ipratropium bromide produced a significant reduction in rhinorrhea and postnasal drip in 1 randomized controlled study . Endoscopic outcomes are less well reported and no improvements in these have been seen with the currently used agents in randomized controlled studies.…”

A Systematic Overview of the Measurement Properties of the Chronic Respiratory Questionnaire

“…One surprising use of the CRQ is in studies of allergic (32) and nonallergic (19) rhinitis. In the former population, Meltzer et al (32) used the dyspnea and emotional function domains of CRQ in a double-blind, multicentre, randomized, placebo controlled, parallel group study of four weeks.…”