Myasthenia gravis: Protective Effect of Ipratropiumbromide (Atrovent®) on Airways Obstruction Caused by Edrophonium Chloride (Tensilon®)

Abstract

The preventive effect of Atrovent® Dosier-Aerosol on the airway flow resistance (R_aw) caused by Tensilon® was studied on 10 patients suffering from myasthenia gravis. Atrovent completely prevented the increase of R_aw in 8 cases and considerably decreased it in 2 cases. The measure of the reaction observed may be influenced by the intensity of the cholinergic symptoms occurring on administration of Tensilon as well as by the magnitude of the initial R_aw value. No side-effect which may be attributed to the administration of Atrovent could be observed, the substance did not increase the myasthenic symptoms. According to the study, Atrovent is a suitable medicine for the prevention of airway obstruction caused by Tensilon.

The myasthenic patient in crisis: an update of the management in Neurointensive Care Unit

“…Bronchodilators may be useful in maintaining airway patency and overcoming bronchospasm. Inhaled ipratropium bromide may be of choice because it is safe and can decrease bronchial secretions 41 . Terbutaline, a β2 adrenergic agonist, may be an effective adjunct therapy in these patients, although confirmation with larger trials will be required 42 .…”

Anticholinergic agents for the treatment of “death rattle” in patients with myasthenia gravis

“…Ipratroprium has been used to improve airway resistance in patients in whom it was worsened with anti-myasthenic agents, without apparent antagonism of the desired effects. 7,8 Also, glycopyrrolate has been reported to improve abdominal distention and diarrhea produced by these agents, also without apparent worsening of myasthenic symptoms. 9 Gyawali and Rangedara, however, reported a case of a man who developed myasthenic crisis requiring intubation after treatment with oxybutynin and hyoscine.…”

Respiratory Care for Myasthenic Crisis

“…In myasthenic crisis, bronchodilators may be useful in maintaining airway patency and overcoming bronchospasm. For myasthenics with concomitant chronic obstructive pulmonary disease (COPD), inhaled ipratropium bromide may be the bronchodilator drug of choice because it is safe and can decreased bronchial secretions which may limit the use of cholinesterase inhibitors (Szathmáry et al, 1981;Liggett et al, 1988). A recent pilot study also suggests that terbutaline, a β 2 adrenergic agonist, may be an effective adjunct therapy in these patients, although confirmation with larger trials will be required (Soliven et al, 2011).…”