The effect of inhaled ipratropium bromide alone and in combination with oral terfenadine on bronchoconstriction provoked by adenosine 5′-monophosphate and histamine in asthma

Abstract

The aim of this study was to investigate the effect of terfenadine, an antihistamine, 180 mg orally, the anticholinergic drug, ipratropium bromide (IB), 0.5 mg nebulized aerosol, the combination of these two drugs, and placebo tablets and aerosol on histamine- and adenosine 5′-monophosphate (AMP)-induced bronchoconstriction in a randomized, double-blind fashion. Airway response was evaluated as FEV 1. After placebo, the geometric mean (GM) provocative concentration causing a 20% in FEV 1 from the postsaline baseline value (PC 20) for histamine and AMP was 0.63 and 5 mg/ml, respectively. Terfenadine displaced the FEV 1 concentration-response curves obtained with both histamine (GM PC 20 values increasing to 26.92 mg/ml) and AMP (GM PC 20 values increasing to 26.7 mg/ml) to the right. IB had a small, but significant, protective effect against the fall in FEV 1 produced by histamine and AMP, the GM PC 20 values increasing to 1.69 and to 12.6 mg/ml, respectively. Terfenadine and IB in combination produced protection against histamine and AMP that was more than the production produced by either drug alone, the GM PC 20 values increasing to 54.76 and 47.7 mg/ml, respectively. There was no correlation between degree of bronchodilatation induced by active treatments and concentration ratios for AMP or histamine. These data suggest that histamine release and vagal reflexes both contribute to AMP-induced bronchoconstriction in clinical asthma in man.