Efecto del bromuro de ipratropio sobre la hiperinflación pulmonar dinámica en pacientes con enfermedad pulmonar obstructiva crónica / Effect of ipratropium bromide on lung dynamic hyperinflation in patients with chronic obstructive lung disease

BACKGROUND: The six minute walk test (6 MW) elicits dynamic hyperinflation (DH) in severe COPD patients, which can be evaluated by reductions in inspiratory capacity (IC). Although IC is currently used to determine the effects of bronchodilators on DH during exercise tests on a cycle ergometer, its usefulness during a walking test has not been evaluated. AIM: To study the acute effects of ipratropium bromide (IB) on forced expiratory volume at l second (FEV1) and IC at rest and on DH during exercise assessed by the 6 MW. SUBJECTS AND METHODS: Fifteen stable COPD patients were randomly allocated in a double-blind, placebo-controlled, crossover fashion to 2 treatment periods using a single dose of nebulized IB 500 mg or placebo. Spirometry, including IC, and 6 MW were measured at baseline and after IB and placebo. IC was also measured 15 min after exercise. Dyspnea, oxygen saturation (SpO2) and heart rate were assessed at the end of exercise. RESULTS: After IB, 8/15 patients exhibited a clinically significant increase in IC (> or = 10 per cent predicted). A similar increase in FEV1 was observed in only one patient. No changes were observed with placebo. A significant increase in 6 MW from baseline (p = 0.007) was found after IB (45 +/- 14 m) compared to placebo (0.5 +/- 9 m), whereas dyspnea was significantly lower. Inspiratory capacity fell after 6 MW with both treatments, but it reached their baseline values at 15 min after exercise only with IB. CONCLUSIONS: Our results demonstrate that IC provides additional information to conventional spirometry on the acute effects of bronchodilators and confirm its value to assess DH during a walking test.

Effect of inhalation of salbutamol, beclomethasone dipropionate & ipratropium bromide on mucociliary clearance in some patients with chronic stable bronchial asthma.

BACKGROUND & OBJECTIVES: Asthma is now regarded as an inflammatory disease and bronchial inflammation may disrupt mucociliary function. Inhaled drugs may act by improving mucociliary function. The aim of the study was to investigate the effect of salbutamol, ipratropium bromide and beclomethasone on mucociliary clearance in patients with chronic stable asthma and to compare the efficacy of these drugs on mucociliary clearance. METHODS: Ten patients with chronic stable asthma were enrolled in the study, but two patients did not complete the study. Patients with bronchial asthma were chosen on clinical grounds. (99m)Tc phytate radioaerosol generated through a nebulizer, was given to each patient on four days. After each administration the radioactivity over the thorax was constantly measured in sequential frame mode for 120 min. Radioactivity in the thorax was also measured after 24 h. A base-line pulmonary function test with reversibility was obtained. Salbutamol, ipratropium bromide, beclomethasone dipropionate and placebo inhalation were given randomly to each patient on four days. RESULTS: The mean age of patients (n = 8) was 36 +/- 9.3 yr and mean duration of symptoms was 5 +/- 6.6 yr. There was no visual impression that mucociliary clearance was enhanced with any of the drugs. The time activity curves did not show any visually recognisable change in slope. In only one patient the curve tended to show a steeper slope with ipratropium inhalation. In the rest of the patients the curves showed no difference at all with medication when compared with placebo. All the quantitative indices analyzed by two-way ANOVA at the end of one and two hours were comparable for the three test drugs and placebo. None of the three test drugs demonstrated statistically significant mucociliary clearance effect compared with placebo. However, the temporal difference in airways clearance efficiency (ACE) was significant with beclomethasone and ipratropium bromide. INTERPRETATION & CONCLUSION: Inhalation of any of the three drugs tested did not produce any immediate improvement in mucociliary clearance as compared to placebo in patients with stable bronchial asthma suggesting the need for further studies using higher doses of drugs for longer duration in a large sample.

Pulmonary function profile in chronic congestive heart failure and the effect of ipratropium bromide.

Twenty-five symptomatic patients of chronic heart failure were subjected to spirometry to detect abnormalities of pulmonary function and to assess the effect of ipratropium bromide in reversing or minimising these abnormalities. All the patients exhibited abnormal pulmonary function manifesting as obstructive (15/25) or restrictive (10/25) ventilatory defect. There was overall improvement in lung functions with ipratropium bromide especially in those with obstructive ventilatory defects and mostly comprised of smokers. Forced expiratory volume in one second increased by 47.7 percent (p < 0.02), forced expiratory volume in one second/forced vital capacity ratio by 14.1 percent (p < 0.001) and maximal voluntary ventilation by 40.6 percent (p < 0.05) in these patients. It is concluded that ipratropium bromide can prove as a promising adjunctive therapeutic intervention in improving quality of life in patients of chronic congestive heart failure who are incapacitated by dyspnoea and have clearly documented ventilatory defects.

Caracterización de los pacientes portadores de enfermedad pulmonar obstructiva crónica y su respuesta a ipratropio y teofilina / Characterization of chronic obstructive pulmonary disease patients and their response to ipratropium and theophylline

La respuesta clínica y funcional a dos broncodilatadores, bromuro de ipratropio y teofilina en enfermedad pulmonar obstructiva crónica fue evaluada en 62 pacientes, procedentes del programa de enfermedades bronquiales obstructivas del Instituto Nacional del Tórax. Conjuntamente se describen las características clínicas, radiológicas y de laboratorio de los 62 pacientes. El estudio duró 6 meses y los pacientes recibieron bromuro de ipratropio 40 mg 4 veces al día por vía inhalatoria o teofilina oral 200 mg 2 veces al día. Por distribución aleatoria se dividieron en dos series : ipratropio (n=30) y teofilina (n=32) realizándose cambio de terapia a los 3 meses. Los pacientes fueron sometidos mensualmente a un seguimiento clínico y funcional durante el tiempo de duración del estudio. Al final del período de tratamiento, la disnea mejoró solo durante el período con ipratropio (p<0,01), aunque no se apreció cambios significativos en la función pulmonar con ninguno de los dos medicamentos. Durante el período con ipratropio se presentó una menor frecuencia de reacciones adversas severas (p < 0,05)

Efecto broncodilatador de salbutamol más bromuro de ipratropio en niños asmáticos: relación dosis respuesta / Bronchodilator effect of ipratropium bromide plus salbutamol in asthmatic children: dose response relationship

El bromuro de ipratropio (BI) asociado con un agente beta 2 agonista en aerosol producido por inhalador de dosis medida (IDM) es frecuentemente empleado en lactantes y niños con obstrucción bronquial. En este estudio se evaluó el efecto broncodilatador de dos dosis diferentes (2 y 4 puffs) de una mezcla de BI más salbutamol (S) en IDM (Combivent) en 28 niños con asma leve a moderada. El estudio fue aleatorio, cruzado, controlado con placebo y simple ciego. La CVF, VEF1 y FEF25-75 se midieron en condiciones basales, antes y después de placebo y de cada una de las dosis empleadas. El análisis estadístico se realizó mediante pruebas no paramétricas para muestras pareadas. No hubo diferencias significativas en ninguno de los índices espirométricos descritos al usar 2 o 4 "puffs" de BI+S. Sin embargo, en los pacientes que tuvieron un aumento del VEF1 > o igual 15 por ciento con cualquiera de las 2 dosis de BI+S, el aumento del FEF25-75 fue significativamente mayor al usar 4 "puffs". Lo anterior sugiere que 2 "puffs" de BI+S serían igualmente efectivos para producir broncodilatación en niños asmáticos. Sin embargo, en aquellos pacientes que presentan un mayor grado de obstrucción bronquial, o como en este estudio, una reversibilidad bronquial más alta al broncodilatador, el empleo de 4 "puffs" de BI+S podría ser más eficiente para obtener una mejor broncodilatación

Broncodilatadores en síndrome bronquial obstructivo del lactante / Bronchodilator agents in obstructive bronchial syndrome in infants

Se evalúa la respuesta clínica a diferentes broncodilatadores en 100 lactantes con síndrome bronquial obstructivo que, por la intensidad de éste requerían hospitalización, mediante un estudio prospectivo doble ciego, en el que se asignaron 25 niños menores de lactantes por grupo. Los niños del grupo I recibieron ipratropio (I), los del grupo II cloruro de sodio 9 por ciento (NaCI), en el grupo III se empleó fenoterol-ipratropio (FI) y en el grupo IV salbutamol (S), en todos los casos por nebulización. La calificación de Tal era similar al ingreso en los 4 grupos (día 0). Al día 1 del tratamiento era significativamente menor (p<0,05) en FI, como también el día 2 (p<0,01): (promedios día 1: 4,6 (I); 4,5 (NaCI); 3,8 (FI); 4,6 (S); día 2: 3,8 (I) 4,1 (NaCI); 2,1 (FI); 3,9 (S); día 3: 3,0 (I); 3,4 (NaCI); 1,6 (FI); 3,2 (S). El promedio de días estada fue I: 4,64 ñ 1,29; NaCI: 5,44 ñ 1,61; FI: 3,08 ñ 1,28; S: 5,28 ñ 1,69; p<0,001 a favor de FI. Los niños tratados con NaCI requirieron con mayor frecuencia terapia adicional con broncodilatadores (p<0,05) en claro contraste con los manejados con FI, que requirieron menos broncodilatadores adicionales que el resto (p<0,01) desde el día 1 del ingreso. No se registraron efectos secundarios indeseables con los diferentes regímenes aplicados

A comparative study of bronchodilator actions of ipratropium bromide (atrovent) & salbutamol (ventolin) on exercise induced bronchial asthma.

The bronchodilator actions of salbutamol and ipratropium bromide were compared in 30 established cases of bronchial asthma, before and after exercise. It was noticed that after exercise (brisk walk for 3 min.) the PFT values of FVC, PEFR and FEV-1, decreased remarkably from the basal values, the mean fall of 17.91%, 10.68% & 14.8% respectively was noticed. Salbutamol showed improvement in FVC, PEFR, FEV-1, of 20.86%, 15.96% & 17.98% respectively from basal values, while Ipratropium bromide showed improvement by 18.31%, 13.01% & 20.90% respectively. It was also noted that salbutamol is a better drug amongst smokers, patients with family history of bronchial asthma, and in younger age groups. Ipratropium bromide was better in elderly patients (> 40 yrs.) and in those with eosinophillia.

Brometo de ipratrópio / Ipratropium bromide

O objetivo deste trabalho é fazer uma análise crítica do brometo de ipratrópio (BI), discutindo suas propriedades farmacológicas, comparaçöes e combinaçöes com outras drogas broncodilatadoras e seu papel na terapêutica de patologias broncopulmonares