Skip to main content
Thorax logoLink to Thorax
. 1993 Nov;48(11):1151–1155. doi: 10.1136/thx.48.11.1151

Bronchodilator reversibility to low and high doses of terbutaline and ipratropium bromide in patients with chronic obstructive pulmonary disease.

D M Newnham 1, D P Dhillon 1, J H Winter 1, C M Jackson 1, R A Clark 1, B J Lipworth 1
PMCID: PMC464905  PMID: 8296260

Abstract

BACKGROUND--There is uncertainty regarding the use of monotherapy or combination therapy with beta 2 agonists and anticholinergic drugs in patients with chronic obstructive pulmonary disease (COPD). The measurement of forced expiratory volume in one second (FEV1) or relaxed vital capacity (RVC) in the assessment of reversibility in these patients has also caused considerable debate. METHODS--Twenty seven patients with COPD were evaluated on two occasions. Patients received the following treatments in sequence: (sequence 1) low dose terbutaline 500 micrograms, high dose terbutaline 5000 micrograms, low dose ipratropium 40 micrograms, high dose ipratropium 200 micrograms; (sequence 2) low dose ipratropium 40 micrograms, high dose ipratropium 200 micrograms, low dose terbutaline 500 micrograms, high dose terbutaline 5000 micrograms. RVC, FEV1 and FVC were measured at baseline and 30 minutes after successive treatments. RESULTS--Values for FEV1 at baseline on the first and second study days were not significantly different: 0.90 (0.87-0.93) 1 v 0.90 (0.87-0.93) 1. Likewise, baseline values for RVC and FVC were not different. The number of patients showing a greater than 330 ml overall improvement in RVC was 20 of 27 for sequence 1 and 22 of 27 for sequence 2; similar trends were observed for FEV1 and FVC. For all three parameters there was a significant difference between mean responses to low and high doses of terbutaline when the latter was given as the first drug in sequence 1. When ipratropium was given first in sequence 2 there was, however, no significant improvement with high dose terbutaline over and above the response to low dose terbutaline. The latter effect was more noticeable with RVC than with either FEV1 or FVC. The total bronchodilator response at the end of each sequence was similar whether ipratropium was given first or second. CONCLUSIONS--The measurement of RVC, FEV1, and FVC were equally effective at picking up those patients who had a significant overall bronchodilator response to combined therapy with inhaled beta 2 agonist and anticholinergic medication. There was no significant benefit of adding a higher dose of terbutaline when ipratropium bromide had been given previously, particularly when using RVC as the parameter of response.

Full text

PDF
1151

Selected References

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

  1. Barnes P. J. Muscarinic receptor subtypes: implications for lung disease. Thorax. 1989 Mar;44(3):161–167. doi: 10.1136/thx.44.3.161. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Bellamy D., Hutchison D. C. The effects of salbutamol aerosol on lung function in patients with pulmonary emphysema. Br J Dis Chest. 1981 Apr;75(2):190–196. doi: 10.1016/0007-0971(81)90052-8. [DOI] [PubMed] [Google Scholar]
  3. Brown R. A., Beck J. S. Statistics on microcomputers. A non-algebraic guide to their appropriate use in biomedical research and pathology practice. 3. Analysis of variance and distribution-free methods. J Clin Pathol. 1988 Dec;41(12):1256–1262. doi: 10.1136/jcp.41.12.1256. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Chrystyn H., Mulley B. A., Peake M. D. Dose response relation to oral theophylline in severe chronic obstructive airways disease. BMJ. 1988 Dec 10;297(6662):1506–1510. doi: 10.1136/bmj.297.6662.1506. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Connellan S. J., Gough S. E. The effects of nebulized salbutamol on lung function and exercise tolerance in patients with severe airflow obstruction. Br J Dis Chest. 1982 Apr;76(2):135–142. [PubMed] [Google Scholar]
  6. 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]
  7. Easton P. A., Jadue C., Dhingra S., Anthonisen N. R. A comparison of the bronchodilating effects of a beta-2 adrenergic agent (albuterol) and an anticholinergic agent (ipratropium bromide), given by aerosol alone or in sequence. N Engl J Med. 1986 Sep 18;315(12):735–739. doi: 10.1056/NEJM198609183151205. [DOI] [PubMed] [Google Scholar]
  8. Gleeson J. G., Price J. F. Nebuhaler technique. Br J Dis Chest. 1988 Apr;82(2):172–174. doi: 10.1016/0007-0971(88)90039-3. [DOI] [PubMed] [Google Scholar]
  9. Grandordy B. M., Thomas V., de Lauture D., Marsac J. Cumulative dose-response curves for assessing combined effects of salbutamol and ipratropium bromide in chronic asthma. Eur Respir J. 1988 Jun;1(6):531–535. [PubMed] [Google Scholar]
  10. Hutchison D. C., Barter C. E., Martelli N. A. Errors in the measurement of vital capacity. A comparison of three methods in normal subjects and in patients with pulmonary emphysema. Thorax. 1973 Sep;28(5):584–587. doi: 10.1136/thx.28.5.584. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Lightbody I. M., Ingram C. G., Legge J. S., Johnston R. N. Ipratropium bromide, salbutamol and prednisolone in bronchial asthma and chronic bronchitis. Br J Dis Chest. 1978 Jul;72(3):181–186. doi: 10.1016/0007-0971(78)90039-6. [DOI] [PubMed] [Google Scholar]
  12. Lipworth B. J., Clark R. A., Dhillon D. P., McDevitt D. G. Comparison of the effects of prolonged treatment with low and high doses of inhaled terbutaline on beta-adrenoceptor responsiveness in patients with chronic obstructive pulmonary disease. Am Rev Respir Dis. 1990 Aug;142(2):338–342. doi: 10.1164/ajrccm/142.2.338. [DOI] [PubMed] [Google Scholar]
  13. Lipworth B. J., Tregaskis B. F., McDevitt D. G. Beta-adrenoceptor responses to inhaled salbutamol in the elderly. Br J Clin Pharmacol. 1989 Dec;28(6):725–729. doi: 10.1111/j.1365-2125.1989.tb03568.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Pakes G. E., Brogden R. N., Heel R. C., Speight T. M., Avery G. S. Ipratropium bromide: a review of its pharmacological properties and therapeutic efficacy in asthma and chronic bronchitis. Drugs. 1980 Oct;20(4):237–266. doi: 10.2165/00003495-198020040-00001. [DOI] [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. Poppius H., Salorinne Y. Comparative trial of a new anticholinergic bronchodilator, Sch 1000, and salbutamol in chronic bronchitis. Br Med J. 1973 Oct 20;4(5885):134–136. doi: 10.1136/bmj.4.5885.134. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Ramsdell J. W., Tisi G. M. Determination of bronchodilation in the clinical pulmonary function laboratory. Role of changes in static lung volumes. Chest. 1979 Dec;76(6):622–628. doi: 10.1378/chest.76.6.622. [DOI] [PubMed] [Google Scholar]
  18. Tashkin D. P., Ashutosh K., Bleecker E. R., Britt E. J., Cugell D. W., Cummiskey J. M., DeLorenzo L., Gilman M. J., Gross G. N., Gross N. J. Comparison of the anticholinergic bronchodilator ipratropium bromide with metaproterenol in chronic obstructive pulmonary disease. A 90-day multi-center study. Am J Med. 1986 Nov 14;81(5A):81–90. doi: 10.1016/0002-9343(86)90468-7. [DOI] [PubMed] [Google Scholar]
  19. Tweeddale P. M., Alexander F., McHardy G. J. Short term variability in FEV1 and bronchodilator responsiveness in patients with obstructive ventilatory defects. Thorax. 1987 Jul;42(7):487–490. doi: 10.1136/thx.42.7.487. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Ullah M. I., Newman G. B., Saunders K. B. Influence of age on response to ipratropium and salbutamol in asthma. Thorax. 1981 Jul;36(7):523–529. doi: 10.1136/thx.36.7.523. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Wempe J. B., Postma D. S., Breederveld N., Kort E., van der Mark T. W., Koëter G. H. Effects of corticosteroids on bronchodilator action in chronic obstructive lung disease. Thorax. 1992 Aug;47(8):616–621. doi: 10.1136/thx.47.8.616. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. van Schayck C. P., Folgering H., Harbers H., Maas K. L., van Weel C. Effects of allergy and age on responses to salbutamol and ipratropium bromide in moderate asthma and chronic bronchitis. Thorax. 1991 May;46(5):355–359. doi: 10.1136/thx.46.5.355. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Thorax are provided here courtesy of BMJ Publishing Group

RESOURCES