Effect of Inhaled Anti-Cholinergic by Pressurized Metered Dose Inhaler (PMDI) or Dry Powder Inhaler (DPI) on Eyes of Patients of Chronic Obstructive Pulmonary Diseases (COPD).

ABSTRACT

Background: COPD is characterized by persistent airflow limitation associated with an enhanced chronic inflammatory response to noxious particles or gases in airways and lungs. Anticholinergics are bronchodilators which lead to side-effects like dry mouth, worsening glaucoma, dry cough and blurred vision on administration. Glaucoma is frequently seen in patients with chronic bronchitis who require treatment with nebulized bronchodilator drugs. Aims and objectives: The present study was done to find out the efficacy and safety of inhaled anticholinergics on intraocular pressure (IOP) in eyes of COPD and potential glaucoma patients. Methods: Total 110 patients of suspected COPD aged between 40 to 80 years were observed in this study. The diagnosis was also confirmed by spirometry and patient condition was allocated into stages as per GOLD 2014. Level of IOP before and after inhalation of drug in both eyes of patients at 2nd hour, 8th day, 15th day, 22nd day and at 28th day was analyzed. Study group (N=70) received ipratropium 40μg eight hourly or tiotropium 18 μg once a day and formoterol 6 μg twice a day plus fluticasone 125 μg twice a day and control group (N=40) received formoterol 6 μg twice a day and fluticasone 125 μg twice a day except anticholinergics. Comparison of IOP was done by statistical analysis. Results: In the present study, patients of COPD with mean age of 59± 8.84 years were observed for IOP. In study group, mean change in IOP was more (3.3±2.3 mmHg) in stage 2 than in stage 3 (1.5±1.5 mmHg) and least in stage 4 (1.3±1.06 mmHg) (p=0.035). During distribution of angle at 28th day after inhaled anticholinergics, 4 patients with narrow angle and 3 with open angle developed IOP beyond normal range(>20mmHg), but all were normal on fundoscopic examination (ocular hypertension). At the end of 28th day, there were 4 patients with ocular symptoms in study group which disappeared after discontinuing tiotropium inhaler. Conclusion: Inhaled formetrol and fluticasone with anticholinergic drugs given by PMDI leads to ocular hypertension in COPD patients whose eyes were normal at initial clinical examination whereas formetrol and fluticasone without anticholinergics did not cause any significant change in IOP. Inhaled anticholinergics increased intraocular pressure in COPD patients.