ABSTRACT
IMPORTANCE OF THE FIELD: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality throughout the world. Combination therapy with albuterol and ipratropium bromide was approved > 15 years ago for the treatment of COPD. We review the mechanism of action, clinical efficacy, and safety of albuterol, ipratropium and combined albuterol-ipratropium therapy. AREAS COVERED IN THIS REVIEW: We conducted a PubMed literature search using the keywords COPD, albuterol, ipratropium bromide and Combivent (Boehringer Ingelheim Corp., Ridgefield, CT, USA); pertinent references within the identified citations are included in the review. Data from the manufacturers are also evaluated. WHAT THE READER WILL GAIN: At the time of its approval, albuterol/ipratropium bromide was an innovative combination of existing medications for the treatment of COPD. The combined formulation provides better improvement in airflow than either component alone and, by reducing the number of separate inhalers, simplifies therapy and improves compliance compared with the individual components. TAKE HOME MESSAGE: The recent development and approval of longer acting and more potent beta agonists, anticholinergics and newer combination treatments have surpassed many of the advantages of combined albuterol-ipratropium for the treatment of patients with stable COPD.
Subject(s)
Albuterol/therapeutic use , Ipratropium/therapeutic use , Pulmonary Disease, Chronic Obstructive/drug therapy , Albuterol/adverse effects , Albuterol/chemistry , Albuterol/pharmacology , Albuterol, Ipratropium Drug Combination , Bronchodilator Agents/adverse effects , Bronchodilator Agents/chemistry , Bronchodilator Agents/pharmacology , Bronchodilator Agents/therapeutic use , Clinical Trials as Topic , Humans , Ipratropium/adverse effects , Ipratropium/chemistry , Ipratropium/pharmacologyABSTRACT
The inflammatory response is modulated through interactions among the nervous, endocrine, and immune systems. Intercommunication between immune cells and the autonomic nervous system is a growing area of interest. Spatial and temporal information about inflammatory processes is relayed to the central nervous system (CNS) where neuroimmune modulation serves to control the extent and intensity of the inflammation. Over the past few decades, research has revealed various routes by which the nervous system and the immune system communicate. The CNS regulates the immune system via hormonal and neuronal pathways, including the sympathetic and parasympathetic nerves. The immune system signals the CNS through cytokines that act both centrally and peripherally. This review aims to introduce the concept of neuroimmune interaction and discuss its potential clinical application, in an attempt to broaden the awareness of this rapidly evolving area and open up new avenues that may aid in the treatment of inflammatory diseases.
