Skip to main content
NCBI home page
Thorax logoLink to Thorax
. 1981 Jul;36(7):523–529. doi: 10.1136/thx.36.7.523

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

M I Ullah, G B Newman, K B Saunders
PMCID: PMC1020435  PMID: 6458920

Abstract

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 microgram) or ipratropium (80 microgram), 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 beta-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.

Full text

PDF
523

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Alliott R. J., Lang B. D., Rawson D. R., Leckie W. J. Effects of salbutamol and isoprenaline-phenylephrine in reversible airways obstruction. Br Med J. 1972 Feb 26;1(5799):539–542. doi: 10.1136/bmj.1.5799.539. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Baigelman W., Chodosh S. Bronchodilator action of the anticholinergic drug, ipratropium bromide (Sch 1000), as an aerosol in chronic bronchitis and asthma. Chest. 1977 Mar;71(3):324–328. doi: 10.1378/chest.71.3.324. [DOI] [PubMed] [Google Scholar]
  3. Douglas N. J., Davidson I., Sudlow M. F., Flenley D. C. Bronchodilatation and the site of airway resistance in severe chronic bronchitis. Thorax. 1979 Feb;34(1):51–56. doi: 10.1136/thx.34.1.51. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Empey D. W., Laitinen L. A., Jacobs L., Gold W. M., Nadel J. A. Mechanisms of bronchial hyperreactivity in normal subjects after upper respiratory tract infection. Am Rev Respir Dis. 1976 Feb;113(2):131–139. doi: 10.1164/arrd.1976.113.2.131. [DOI] [PubMed] [Google Scholar]
  5. Fish J. E., Rosenthal R. R., Summer W. R., Menkes H., Norman P. S., Permutt S. The effect of atropine on acute antigen-mediated airway constriction in subjects with allergic asthma. Am Rev Respir Dis. 1977 Mar;115(3):371–379. doi: 10.1164/arrd.1977.115.3.371. [DOI] [PubMed] [Google Scholar]
  6. Gold W. M., Kessler G. F., Yu D. Y. Role of vagus nerves in experimental asthma in allergic dogs. J Appl Physiol. 1972 Dec;33(6):719–725. doi: 10.1152/jappl.1972.33.6.719. [DOI] [PubMed] [Google Scholar]
  7. Holgate S. T., Baldwin C. J., Tattersfield A. E. beta-adrenergic agonist resistance in normal human airways. Lancet. 1977 Aug 20;2(8034):375–377. doi: 10.1016/s0140-6736(77)90304-x. [DOI] [PubMed] [Google Scholar]
  8. Hruby J., Butler J. Variability of routine pulmonary function tests. Thorax. 1975 Oct;30(5):548–553. doi: 10.1136/thx.30.5.548. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Lee L. Y., Bleecker E. R., Nadel J. A. Effect of ozone on bronchomotor response to inhaled histamine aerosol in dogs. J Appl Physiol Respir Environ Exerc Physiol. 1977 Oct;43(4):626–631. doi: 10.1152/jappl.1977.43.4.626. [DOI] [PubMed] [Google Scholar]
  10. Leitch A. G., Hopkin J. M., Ellis D. A., Merchant S., McHardy G. J. The effect of aerosol ipratropium bromide and salbutamol on exercise tolerance in chronic bronchitis. Thorax. 1978 Dec;33(6):711–713. doi: 10.1136/thx.33.6.711. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Maggi A., Schmidt M. J., Ghetti B., Enna S. J. Effect of aging on neurotransmitter receptor binding in rat and human brain. Life Sci. 1979 Jan 22;24(4):367–373. doi: 10.1016/0024-3205(79)90333-3. [DOI] [PubMed] [Google Scholar]
  12. Parker C. W., Baumann M. L., Huber M. G. Alterations in cyclic AMP metabolism in human bronchial asthma. II. Leukocyte and lymphocyte responses to prostaglandins. J Clin Invest. 1973 Jun;52(6):1336–1341. doi: 10.1172/JCI107305. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Parker C. W., Huber M. G., Baumann M. L. Alterations in cyclic AMP metabolism in human bronchial asthma. 3. Leukocyte and lymphocyte responses to steroids. J Clin Invest. 1973 Jun;52(6):1342–1348. doi: 10.1172/JCI107306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Parker C. W., Smith J. W. Alterations in cyclic adenosine monophosphate metabolism in human bronchial asthma. I. Leukocyte responsiveness to -adrenergic agents. J Clin Invest. 1973 Jan;52(1):48–59. doi: 10.1172/JCI107173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Petrie G. R., Palmer K. N. Comparison of aerosol ipratropium bromide and salbutamol in chronic bronchitis and asthma. Br Med J. 1975 Feb 22;1(5955):430–432. doi: 10.1136/bmj.1.5955.430. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Rosenthal R. R., Norman P. S., Summer W. R., Permutt S. Role of the parasympathetic system in antigen-induced bronchospasm. J Appl Physiol Respir Environ Exerc Physiol. 1977 Apr;42(4):600–606. doi: 10.1152/jappl.1977.42.4.600. [DOI] [PubMed] [Google Scholar]
  17. Turner-Warwick M. On observing patterns of airflow obstruction in chronic asthma. Br J Dis Chest. 1977 Apr;71(2):73–86. doi: 10.1016/0007-0971(77)90086-9. [DOI] [PubMed] [Google Scholar]
  18. Vestal R. E., Wood A. J., Shand D. G. Reduced beta-adrenoceptor sensitivity in the elderly. Clin Pharmacol Ther. 1979 Aug;26(2):181–186. doi: 10.1002/cpt1979262181. [DOI] [PubMed] [Google Scholar]
  19. Walker S. R., Evans M. E., Richards A. J., Paterson J. W. The clinical pharmacology of oral and inhaled salbutamol. Clin Pharmacol Ther. 1972 Nov-Dec;13(6):861–867. doi: 10.1002/cpt1972136861. [DOI] [PubMed] [Google Scholar]
  20. Yu D. Y., Galant S. P., Gold W. M. Inhibition of antigen-induced bronchoconstriction by atropine in asthmatic patients. J Appl Physiol. 1972 Jun;32(6):823–828. doi: 10.1152/jappl.1972.32.6.823. [DOI] [PubMed] [Google Scholar]
  21. Zedda S., Sartorelli E. Variability of plethysmographic measurements of airway resistance during the day in normal subjects and in patients with bronchial asthma and chronic bronchitis. Respiration. 1971;28(2):158–166. doi: 10.1159/000192812. [DOI] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES