Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropium-induced bronchodilation in patients with stable COPD
Articolo
Data di Pubblicazione:
2009
Citazione:
Acute effects of higher than standard doses of salbutamol and ipratropium on tiotropium-induced bronchodilation in patients with stable COPD / M. Cazzola, P. Santus, A. D’Adda, S. Pizzolato, F. Di Marco, S. Centanni. - In: PULMONARY PHARMACOLOGY & THERAPEUTICS. - ISSN 1094-5539. - 22:3(2009), pp. 177-182. [10.1016/j.pupt.2008.10.010]
Abstract:
Knowledge on the effects of the additive bronchodilatory effects of short-acting agents on the top of the effect of long-acting bronchodilators is limited. In this trial, we examined the influence of higher than conventional doses of the short-acting inhaled b2-adrenergic agent salbutamol and the short-acting anticholinergic drug ipratropium bromide on bronchodilation induced by a regular treatment with the
long-acting anticholinergic drug tiotropium 18 mg/day in 30 patients with stable COPD. On 3 separate days, a dose-response curve to inhaled salbutamol (100 mg puff-1), ipratropium bromide (20 mg puff-1) or
placebo was constructed 3 h after inhalation of the last dose of tiotropium, using one puff, one puff, two puffs and two puffs, for a total cumulative dose of 600 mg salbutamol or 120 mg ipratropium bromide.
Doses were given at 30-min intervals and measurements made 15 min after each dose. At the highest cumulative dose, salbutamol showed a trend to be more effective than ipratropium bromide in improving FEV1 (0.157 L vs 0.125 L), and reducing sRaw ( 4.52 kPa/s vs 3.57 kPa/s), although the differences between the two treatments were always not significant (p > 0.05), whereas there was no substantial difference between the two drugs in changing FVC (0.179 L vs 0.168 L), IC (0.254 L vs 0.240 L),
TGV ( 0.444 L vs 0.441 L), TLC ( 0.334 L vs 0.318 L) and RV ( 0.467 L vs 0.498 L). Both drugs did not affect heart rate and SpO2. Our results indicate that there is not much difference in bronchodilation
between adding higher than conventional doses of salbutamol or ipratropium bromide to tiotropium in patients with stable COPD. Effective improvement of the pulmonary function may be achieved in such a type of patients by adding salbutamol 600 mg or ipratropium bromide 120 mg to regular tiotropium.
These is an interesting finding mainly for those COPD patients suffering from cardiovascular co-morbidities
that are at highest risk of myocardial infarction, congestive heart failure, cardiac arrest and sudden cardiac death when treated with elevated doses of a b2-agonist
Tipologia IRIS:
01 - Articolo su periodico
Keywords:
COPD ; Tiotropium ; Salbutamol ; Ipratropium bromide ; Dose-response curve
Elenco autori:
M. Cazzola, P. Santus, A. D’Adda, S. Pizzolato, F. Di Marco, S. Centanni
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