and placebo groups were essentially the same.
He studied 30 chronic obstructive pulmonary disease patients with an [FEV.sub.1] less than 70% of predicted; on each of four occasions, they used albuterol (2.5 mg), leval-buterol (1.25 mg), ipratropium
and albuterol (0.5 mg and 2.5 mg), or placebo.
A study was included if it met the population and outcome criteria noted and was a placebo-controlled randomized trial evaluating ipratropium
bromide (by nebulizer of meter-dose inhaler) as an adjunct to [Beta]-agonist therapy.
The effects of salmeterol and ipratropium
, were measured by forced expiratory volume in 1 second (Chest 115:957-65, 1999).
Clinical question Does the addition of ipratropium
bromide to continuously nebulized albuterol improve pulmonary function, hasten discharge from the emergency department, or decrease hospitalization rates in adult patients with acute bronchospasm?
bromide is a safe and effective medication for the treatment of acute exacerbations of asthma, but large trials have not been conducted to determine its impact on hospital admissions.
Levalbuterol saved a significant 5556 in total costs compared with racemic albuterol, after adjustment for forced expiratory volume in 1 second at baseline, the use of ipratropium
bromide, and diagnosis.
The inhalation of atropine is avoided in therapy since it is associated with significant systemic side effects owing to a high rate of absorption across the respiratory tract mucosa into the bloodstream.[20,21] Ipratropium
, a new synthetic derivative, is poorly absorbed into the circulation and has been shown to have an important role in aerosol therapy and to cause few side effects.[22,23]
Nor was the combination of ipratropium
and albuterol more effective at increasing forced expiratory volume in 1 second ([FEV.sub.1]) than albuterol alone.
(Atrovent), a short-acting anticholinergic, is an effective COPD therapy, but needs to be taken four times per day.
* Comment: In a Novartis-supported study of 780 patients with COPD, Foradil was better than placebo and ipratropium
bromide in improving lung function over 12 weeks.