The effect of aerosol ipratropium bromide and salbutamol on exercise tolerance in chronic bronchitis.

Leitch, A. G.; Hopkin, J. M.; Ellis, D A; Merchant, Sylvia; McHardy, G. J. R.

doi:10.1136/thx.33.6.711

Cited by 85 publications

(33 citation statements)

References 7 publications

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“…Although some authors have reported that cycle ergometer exercise capacity was not increased after fenoterol aerosol in COPD patients [37], other previous studies based on simple measurements such as 6-and 12-min walking test have shown encouraging results on exercise tolerance in patients with chronic airflow limitation after inhaled Pi-agonists [38][39][40], Whether the exercise perfor mance might be really improved in patients with partly reversible airway obstruction by long-term treatment with inhaled pi-agonists, is a question which needs to be more deeply addressed in the future.…”

Section: Discussionmentioning

confidence: 99%

Ineffectiveness of Intravenous β<sub>2</sub>-Agonists on Improving Exercise Tolerance in Patients with Reversible Chronic Airway Obstruction

Malerba

Boni²,

Tantucci³

et al. 1996

Respiration

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The effects on exercise tolerance after acute administration of β₂-agonists were investigated in 11 patients with partly reversible chronic airway obstruction after 400 μg of salbutamol (S) given intravenously (i.v.) and after 400 μg i.v. of a new selective β₂-agonist, broxaterol (B), by a cardiopulmonary incremental exercise test. At rest, while VE increased in respect to basal conditions (C) after S (from 13.3 ± 2.2 to 14.4 ± 2.8 l/min;p < 0.05) and after B (from 13.6 ± 3.1 to 15.5 ± 3.61/min; p < 0.05), VO₂, VCO₂ and VO₂/HR showed no substantial variations. A small, not significant reduction of PaO₂ was observed both after S (from 82.7 ± 11.7 to 79.1 ± 16.7 mm Hg) and B (from 81.6 ± 10.5 to 78.0 ± 11.0 mm Hg). The maximum workload increased neither after S (from 67.5 ± 39.1 to 66.6 ± 37.0 W) nor after B (from 65.7 ± 39.3 to 60.0 ± 35.8 W). At peak of exercise, VO₂, VCO₂ and VO₂/HR did not change after S and B as compared with C, whereas VE remained higher after both β₂-agonists throughout the effort. VO₂ at ventilatory anaerobic threshold (AT) was significantly greater either after S (from 744 ± 378 to 815 ± 302 ml/min; p < 0.05) and after B (from 756 ± 290 to 842 ± 292 ml/min; p < 0.05). The PaO₂ increase shown by these patients during effort was greater after β₂-agonists administration, ΔPaO₂ from rest to peak of exercise amounting to 14.9 ± 14.3 vs. 7.8 ± 8.2 mm Hg after Sand to 17.8 ± 15.1 vs. 8.8 ± 10.9 mm Hg after B, in respect to relative baseline (p < 0.05). We conclude that β₂-agonists, when given acutely, do not improve exercise tolerance in patients with reversible chronic airflow obstruction, although these drugs can induce a small increment of ventilatory AT. In addition, arterial blood gases do not deteriorate at rest and are better preserved during exercise after β₂-agonists.

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Section: Discussionmentioning

confidence: 99%

Ineffectiveness of Intravenous β<sub>2</sub>-Agonists on Improving Exercise Tolerance in Patients with Reversible Chronic Airway Obstruction

Malerba

Boni²,

Tantucci³

et al. 1996

Respiration

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“…Eleven patients were extrinsic asthmatics, defined as having labile airways obstruction ( > 15 % response in FEV1 to a bronchodilator inhalation on at least three occasions), and positive skin-prick test reactions to at least two allergens. Eighteen were intrinsic asthmatics, with a bronchodilator 25 and 75 % of the total response was from salbutamol whatever the order (three patients); grade IV-> 75% of TR from either ipratropium or salbutamol whichever was given first (five patients); grade V-> 75% of TR from ipratropium if given first, % if given second (mirror image of grade II) (three patients); grade VI-> 75 % total response from ipratropium, whatever the order (mirror image of grade I) (no patients).…”

Section: Methodsmentioning

confidence: 99%

Influence of age on response to ipratropium and salbutamol in asthma.

Ullah¹,

Newman²,

Saunders³

1981

Thorax

179

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We studied the differential response to inhaled salbutamol and ipratropium of 29 asthmatic patients, 18 intrinsic, 11 extrinsic, using peak expiratory flow rate (PEFR), forced expiratory volume in one second (FEV1), and forced vital capacity (FVC). Thirty minutes after a theoretically maximally bronchodilating dose of salbutamol (400 ,g) or ipratropium (80 ug), second doses frequently caused further bronchodilatation. We suspect that second doses may reach bronchi untouched by the first inhalation. Analysis of variance showed a powerful intrinsic versus extrinsic effect, and there were clearly differences between patients in their response to treatment (patient versus drug interaction) but these differences were not removed by dividing the patients into intrinsic and extrinsic groups. Results for the group as a whole favoured salbutamol, but examination of individual results by a pattern-recognition technique showed ipratropium equally effective in eight patients and more effective in three. All patients with a definite predominant salbutamol response were less than 40 years old. The response to salbutamol declined significantly with age, whereas that to ipratropium did not. In general in patients aged less than 40 years salbutamol is the drug of choice. With advancing age, and the apparent decline of fl-adrenergic responsiveness, the initially comparatively small response to ipratropium becomes relatively more important and may predominate. In older patients ipratropium, or continued therapy with both drugs, may be preferable.

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“…Some studies have found synergistic effect [9][10][11][12][13][14][15], whereas others have not [16][17][18][19]. The additive effect of the two agents could be explained on the basis of differences in the mechanism of bronchodilation; anticholinergics act through the parasympathetic system whereas beta-agonists act through the sympathetic system.…”

Section: Discussionmentioning

confidence: 99%

Comparison of nebulized glycopyrrolate and metaproterenol in chronic obstructive pulmonary disease

Tzelepis¹,

Komanapolli²,

Tyler³

et al. 1996

Eur Respir J

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We assessed the bronchodilating effect of glycopyrrolate (GP) and compared it with that of metaproterenol (MP), alone and in combination (GP+MP), in patients with chronic obstructive pulmonary disease (COPD).In a double-blind study, 11 patients (aged (mean±SD) 69±6 yrs; forced expiratory volume in one second (FEV1) 1.2±0.4 L) with stable COPD inhaled nebulized GP 1.0 mg, MP 15 mg, or GP 1.0 mg + MP 15 mg. Spirometry was performed before inhalation and at hourly intervals for 8 h after inhalation.It was found that GP produced a bronchodilating effect that was about equal to that of MP but lasted longer (8 vs 5 h). The combination of GP and MP produced a bronchodilating effect that was greater than that of either drug alone and was evident mostly during the effect of MP. The mean peak percentage improvement in FEV1 over baseline was 35% for GP+MP and 25% for either drug alone.These data suggest that nebulized glycopyrrolate is an effective bronchodilator in some patients with chronic obstructive pulmonary disease. Concurrent administration of glycopyrrolate and metaproterenol produces additional bronchodilation that is primarily apparent during the bronchodilator effect of metaproterenol. Eur Respir J., 1996, 9, 100- Glycopyrrolate (GP), a quarternary ammonium compound, is an anticholinergic agent that has primarily been used with anaesthesia to reduce gastric acidity and salivary secretions or to reverse neuromuscular blockade [1]. Recently, GP has been used as a bronchodilator in patients with asthma [2][3][4][5]. This study was designed to investigate the bronchodilator effect of GP in patients with stable chronic obstructive pulmonary disease (COPD) and compare it with that of another commonly used bronchodilator, the β-adrenergic agonist metaproterenol (MP). In addition, we examined whether the concurrent administration of GP and MP provided any further bronchodilation than GP alone in this group of patients. MethodsEleven men with diagnoses of chronic bronchitis, emphysema, or both [6] were recruited from out-patient pulmonary clinics to participate in the study (table 1). Stability of their disease was defined as no hospitalizations or change in therapy over a 6 month period prior to the study. All patients had a forced expiratory volume in one second/forced vital capacity ratio (FEV1/FVC) of less than 70%, and a history of cigarette smoking. A positive bronchodilator response following inhalation of metaproterenol, as defined by the American Thoracic Society (ATS) criteria [6], was documented during previous pulmonary function testing. None of the subjects had a history of bronchial asthma or were on oral steroids. The study was approved by the institutional review committee and informed consent was obtained from all patients.Measurements of FVC and FEV1 were performed on a Collins Eagle One spirometer (Braintree, MA, USA). The medications were mixed with normal saline to a total volume of 7.5 mL and aerosolized using a Misty-Neb nebulizer (Airlife) with a flow rate of 10 L·min -1 delivered over ...

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The effect of aerosol ipratropium bromide and salbutamol on exercise tolerance in chronic bronchitis.

Cited by 85 publications

References 7 publications

Ineffectiveness of Intravenous β<sub>2</sub>-Agonists on Improving Exercise Tolerance in Patients with Reversible Chronic Airway Obstruction

Ineffectiveness of Intravenous β<sub>2</sub>-Agonists on Improving Exercise Tolerance in Patients with Reversible Chronic Airway Obstruction

Influence of age on response to ipratropium and salbutamol in asthma.

Comparison of nebulized glycopyrrolate and metaproterenol in chronic obstructive pulmonary disease

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