Ipratropium chronic obstructive pulmonary disease

Jubran A, Gross N, Ramsdell J, et al. Comparative cost-effectiveness analysis of theophylline and ipratropium bromide in chronic obstructive pulmonary disease. A three-center study. Chest 1993 103 678-84. 

Ipratropium bromide is an antimuscarinic agent indicated in asthma and in chronic obstructive pulmonary disease but it is more effective in the latter. The drug is available only for inhalation because of the potential side-effects if given orally. 

Ipratropium is classified as an anticholinergic because it blocks acetylcholine release. It is indicated in asthma and chronic obstructive pulmonary disease and is available for inhalation. 

Prakash O, Kumar R, Rahman M, Gaur SN. (2006) The clinico-physiological effect of inhaled tiotropium bromide and inhaled ipratropium bromide in severe chronic obstructive pulmonary disease. Ind J Allergy Asthma Immunol 20 105-111 For further information http //www.rxlist.com/spiriva-drug.htm (accessed on 24.12.2010). 

Ipratropium has been used concomitantly with other drugs, including beta-adrenergic bronchodilators, sympathomimetic bronchodilators, methyixanthines, steroids, commonly used in the treatment of chronic obstructive pulmonary disease, without adverse drug reactions. 

Ipratropium bromide (Atrovent) is a quaternary amine derivative that is used via inhalation in the treatment of chronic obstructive pulmonary disease and to a lesser extent, asthma. Ipratropium has a slower onset of action (1-2 hours for peak activity) than Pz-adrenoceptor agonists and thus may be more suitable for prophylactic use. Compared with p2-adrenoceptor agonists, ipratropium is generally at least as effective in chronic obstructive pulmonary disease but less effective in asthma. 

Ipratropium has greater effectiveness than P2-adreno-ceptor agonists in two settings in psychogenic asthma and in patients taking Pj-adrenoceptor antagonists. A fixed combination of ipratropium and albuterol (Combivent) is approved for use in chronic obstructive pulmonary disease. 

Ipratropium appears to be at least as effective in patients with chronic obstructive pulmonary disease that includes a partially reversible component. A longer-acting, selective antimuscarinic agent, tiotropium, is in clinical trials as treatment for COPD. This drug s 24-hour duration of action is a potentially important advantage. 

Ipratropium is a QTA produced by N-alkylation (iso-propyl) of hyoscyamine (Fig. 1). When inhaled as aerosolized agent it is a short-acting (3-6 h) antimusca-rinic especially on MR subtypes Ml-3 present in the lung. Therefore, it is clinically used as bronchodilator, antiasthmatic and drug for chronic obstructive pulmonary disease (COPD) [31, 33], Ipratropium is part of the WHO list of essential medicines [41],... 

Inhaled ipratropium [i pra TROE pee um], a quaternary derivative of atropine (see Figure 22.5, p. 220), is useful in treating asthma and chronic obstructive pulmonary disease in patients unable to take adrenergic agonists. Ipratropium is also used in the management of chronic obstructive pulmonary disease (see p. 222). Important characteristics of the muscarinic antagonists are summarized in Figure 5.6. 

Kassner, F., Hodder, R., and Bateman, E. D. (2004), A review of ipratropium bromide/fenoterol hydrobromide (berodual) delivered via respimat soft mist inhaler in patients with asthma and chronic obstructive pulmonary disease, Drugs, 64, 1671-1682. 

In the respiratory tract, ipratropium s is a useful bronchodilator in chronic obstructive pulmonary disease and acute asthma. 

A 68-year-old man s visual acuity dramatically improved (20/100 to 20/40) after he discontinued ipratropium bromide, which he had been taking in a dose of two puffs every 6 hours for chronic obstructive pulmonary disease. 

Salmeterol 42 micrograms bd has been compared with inhaled ipratropium bromide 36 micrograms/day and inhaled placebo in a randomized, double-blind study for 12 weeks in 405 patients with chronic obstructive pulmonary disease (6). Both salmeterol and ipratropium bromide significantly increased the peak expiratory flow rate compared with placebo. Non-specific ear, nose, and throat symptoms (for example sore throat and upper respiratory tract infections) were more common with salmeterol and ipratropium than placebo. There were no significant differences between the groups in the total number of ventricular and supraventricular extra beats. There was no tolerance to the bronchodilating effects of salmeterol. 

The combination of albuterol sulfate and ipratropium bromide is available commercially in a metered-dose inhaler device for humans. In human patients with chronic obstructive pulmonary disease, this anticholinergic p2 agonist combination provides more complete bronchodilatation than... 

In 36 patients with chronic obstructive pulmonary disease, the bron-chodilator effect of ipratropium bromide was greater with delivery via Respimat (total dose 160 ttg) than via MDI (total dose of 320 (tg). Between 45 min after the first drug inhalation and 45 min after the final dose, a greater bronchodilatory effect was obtained at half the cumulative dose of ipratropium. The safety profile was similar. 

Ikeda A, Nishimura K, Koyama H, et al. Dose-response study of ipratropium bromide aerosol on maximum exercise performance in stable patients with chronic obstructive pulmonary disease. Thorax 1996 51 48-53. 

Tsukino M, Nishimura K, Ikeda A, et al. Effects of theophylline and ipratropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease. Thorax 1998 53 269-273. 

Combivent Inhalation Aerosol Study Group. In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone. Chest 1994 105 1411-1419. 

Ipratropium is a quaternary ammonium compound formed by introducing an isopropyl group to the N atom of atropine, oxitropium and tiotropium, two quaternary derivatives of scopolamine, and flutropium, a fluoroethyl derivative, which are mainly used in the treatment of chronic obstructive pulmonary disease, whereas N-butylscopolamine, N-methylscopolamine and AT-methylhomatropine (Fig. 11) are used to relieve of gastrointestinal spasms. 

Ipratropium and tiotropium can produce bronchodilation, tachycardia, and inhibition of secretion similar to that of atropine but with less inhibitory effect on mucociliary clearance relative to atropine. Hence, inhaled ipratropium and tiotropium provide useful antichohnergic therapy of chronic obstructive pulmonary disease and asthma while minimizing the increased accumulation of lower airway secretions encountered with atropine. 

C. Effects Ipratropium reverses bronchoconstriction in some asthma patients (especially children) and in many patients with chronic obstructive pulmonary disease (COPD). It has no effect on the inflammatory aspects of asthma. 

Wang MT, Tsai CL, Lo YW, Liou JT, Lee WJ, Lai IC. Risk of stroke associated with inhaled ipratropium bromide in chronic obstructive pulmonary disease a population-based nested case-control study. Int J Cardiol July 12, 2012 158(2) 279-84. 

---