Ipratropium Bromide Group Research Articles

Comparison of Effectiveness of Nebulized N-Acetylcysteine Solution (Mucolytic Therapy), Nebulized Salbutamol and Nebulized Ipratropium Bromide In Treatment of Children with Acute Bronchiolitis

Background: Bronchiolitis is a viral mediated disease that results in acute inflammation in the lower respiratory tract. It occurs in infants and children under 2 years of age. The vast majority of infants’ experience at least 01 episode of bronchiolitis and 2-3% of all infants can be hospitalized for bronchiolitis in the 1st year. With an increasing rate having risen by an average of 1.8% annually in European country and a small percentage even need critical care. Children who are hospitalized for bronchiolitis currently only receive fluid replacement, additional oxygen and respiratory support. Bronchiolitis is most common motivator for hospital admissions in many nations. Respiratory syncytial virus (RSV) is most common virus causes bronchiolitis, and also causes infections during the winter months. Objective: To determine the comparison of effectiveness of nebulized N-acetylcysteine solution (mucolytic therapy), nebulized salbutamol and nebulized ipratropium bromide in treatment of children with acute bronchiolitis at a tertiary care hospital. Materials & Methods: All patients who fulfilled the inclusion criteria and visited to Baqai Medical University Hospital, Karachi from April 17, 2019 to October 16, 2019 were included in this Prospective Randomized Control Trial (lottery method). Informed consent was taken after explaining the procedure, risks and advantages of the study. Children from either gender having provisional diagnosis of acute bronchiolitis between 2 to 24 months of age were included and divided in three groups in our study. Each group obtained three treatments every day, introduced at intervals of eight hours for three days. Patients had been tested on admission, at 8 hours and every morning for severity of disease. For assessing improvement, scientific severity score turned into used to peer the effectiveness of nebulized N-acetylcysteine solution (mucolytic therapy), nebulized salbutamol and nebulized ipratropium bromide in bronchiolitis. All the collected data were entered into the proforma attached at the end and used electronically for research purpose. Results: 81 study cases of these, 44 (54.3%) were males while 37 (45.7%) were females. Our study cases mean age in Nebulized N-acetylcysteine was 9.4±6.3, in Nebulized Salbutamol and Ipratropium Bromide was 10.8±6.7 and 12.0±6.6 months, respectively. In group wise comparison of clinical severity score at baseline, 8, 24 and 72 hours, highly significant difference was found among the group at baseline, 8, 24 and 72 hours i.e., P ≤ (0.05) within the groups while on the other hand non-significant difference i.e., (0.633) was showed between the group at baseline among nebulized N-acetylcysteine, nebulized salbutamol and ipratropium bromide group respectively. Conclusion: In the lights of our findings, it is to be concluded that nebulized salbutamol was more effective in improvement of clinical severity score with shorter duration of hospital stay. Furthermore, it is to be concluded that there is a need to have further studies with larger sample size in different centers in Pakistan to validate the findings of current study. Keywords: N-acetylcysteine Solution, Nebulized Salbutamol, Nebulized Ipratropium Bromide, Acute Bronchiolitis

Effects of 4-DAMP on allergic rhinitis in guinea pigs and its potential mechanism.

BackgroundAllergic rhinitis (AR) is a non-infectious chronic inflammatory disease of the nasal mucosa mainly mediated by immunoglobulin E (IgE), which seriously affects the life quality of affected patients. This study aimed to observe the effects of 1,1-dimethyl-4-diphenylacetoxypiperidinium iodide (4-DAMP; a selective M3 receptor antagonist) on ovalbumin (OVA)-induced AR guinea pigs, and to explore its potential mechanism of involvement.MethodsAn AR model was established by inducing male guinea pigs (4–6 weeks of age) with OVA. AR guinea pigs were randomly divided into a model group, 0.6 mg/kg ipratropium bromide (IB) group, 0.12 and 0.6 mg/kg 4-DAMP group (n=18). The 0.6 mg/kg IB group, 0.12 and 0.6 mg/kg 4-DAMP group animals were treated with IB (0.6 mg/kg) and 4-DAMP (0.12 or 0.6 mg/kg) by intranasal instillation per nostril daily. Animals in the model group and normal group were treated with saline as control. The AR symptom scores were counted and nasal secretion weights were measured. Histopathological methods were used to observe nasal mucosa. Enzyme-linked immunosorbent assay (ELISA) was used to detect the levels of histamine and cytokines. Western blot and quantitative real-time polymerase chain reaction (qRT-PCR) were used to detect the expressions of mucin 5AC (MUC5AC), matrix metalloproteinase 9 (MMP9), and epidermal growth factor receptor (EGFR).ResultsCompared with model group animals, the AR symptom scores and nasal secretion weights of animals treated with 4-DAMP were reduced significantly, goblet cell metaplasia was reversed, and eosinophil infiltration was visibly alleviated. The levels of histamine and cytokines in nasal lavage fluid (NLF) were decreased, and the protein and messenger RNA (mRNA) expressions of MUC5AC, MMP9, and EGFR were inhibited.ConclusionsTreatment with 4-DAMP has a certain effect on AR, especially for mucus hypersecretion, which provides a new idea for clinical treatment of AR.

Metered-dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non-randomized, observational study.

Ipratropium bromide (IB), when administered with β2-agonists, is effective in reducing hospital admissions of children presenting to the emergency department (ED) with severe asthma. While IB is commonly delivered in its nebulized form, using a metered-dose inhaler (MDI), can, reportedly, shorten patients' length of stay in the ED. However, the effectiveness and safety of IB administration using an MDI with a spacer have not been established. This study aimed to investigate the effectiveness and safety of MDI-delivered IB in pediatric patients with acute asthma exacerbation. This prospective, non-randomized, observational study included patients aged ≥4years with a history of severe asthma exacerbation. Patients received IB via MDI with a spacer three times at 20-min intervals. IB use was determined by the physicians' treatment policy. Propensity score matching was used to adjust the confounding factors related to IB administration. Of the 158 patients, 88 were treated with IB and 70 were treated without IB. A propensity score-matching analysis extracted 54 patients from each group. We found no statistical difference in the admission rate of the two groups (IB group: 25.9% vs non-IB group: 31.5%; P=0.67). The post-treatment modified pulmonary index scores (mean±SD) were also similar (IB: 6.6±2.0 vs non-IB: 6.3±2.5; P=0.53). Only one patient (1.0%) treated with IB experienced vomiting, which resolved spontaneously. The metered-dose inhaler IB was ineffective in reducing the admission rate possibly because it was less effective than a nebulizer for IB inhalation.

Nebulized Ipratropium bromide protects against tracheal and bronchial secretion during bronchoscopy

Background:Anticholinergic administration prior to flexible bronchoscopy has been investigated, but studies have not yielded consistent results.Methods:Patients were randomized 1:1 to receive nebulized 4 ml ipratropium bromide (1 mg, n = 125) or placebo (n = 125) for 15 minutes as premedication, 20 to 40 minutes before bronchoscopy. Airway secretions, bleeding, patient discomfort, procedure time, and procedure-related adverse events were compared between the groups.Results:Nebulized ipratropium bromide prior to bronchoscopy could reduce airway secretions and patient discomfort (P = .02; P < .001, respectively), but not tracheobronchial bleeding or procedure time (P = .51, P = .36, respectively). Chest nodule or mass was the most common indication for performing bronchoscopy. The adverse events were higher in ipratropium bromide group, and hypertension was the most common complication.Conclusion:Nebulized ipratropium bromide prior to bronchoscopy is a more effective regimen that shows a practical benefit on the airway secretions and patient comfort, though these effects may not translate into any marked reduction in bleeding or of procedure time under general anesthesia. We suggest that routine nebulized ipratropium bromide premedication for bronchoscopy could be useful and beneficial.Trial Registration:chictr.org.cn: ChiCTR1800016881.

IPRATROPIUM BROMIDE FOR ACUTE ASTHMA IN CHILDREN: A RETROSPECTIVE TRIAL.

Inhaled anticholinergics such as ipratropium bromide (IB), when administered with β2-agonists, are effective in reducing hospital admissions of children presenting to the emergency department with moderate to severe asthma. However, treatment of acute asthma with IB is still uncommon in Japan. The aim of this study was to investigate the effectiveness and safety of IB for the treatment of pediatric acute asthma. We conducted a retrospective study to compare the admission rate of patients who received IB with those who did not. Patients aged 4 years or older with a history of moderate to severe attacks were included. For analysis, propensity score matching was used to adjust the confounding factors related to IB use. Patients received IB by metered-dose inhaler (40μg per dose) with a spacer three times at 20-min intervals. Among 175 patients included in the analysis, 102 patients were treated with IB (IB group) and 73 patients were treated without IB (Non-IB group). A propensity score matching analysis extracted 63 patients from each group. There was no statistical difference between the two groups in terms of admission rate (IB group 12.7% vs Non-IB group 9.5%; p=0.78). One patient (1.0%) treated with IB experienced dryness of the mouth, which resolved spontaneously. The admission rate did not decline with IB use. Several confounding factors could have influenced and limited our results. A prospective study is needed to investigate the effectiveness of IB in Japan.

Metered-dose inhaler ipratropium bromide in moderate acute asthma in children: A single-blinded randomised controlled trial.

To determine if the addition of ipratropium bromide (IB) by metered-dose inhaler in moderate acute asthma in children affects hospital admission rates when compared with inhaled salbutamol and oral prednisolone alone. A prospective, single-blinded, randomised, controlled, equivalence trial in a tertiary paediatric emergency department. Patients aged 2-15 years with acute, moderate asthma were randomised to two groups, one receiving salbutamol, prednisolone and IB, the other receiving only salbutamol and prednisolone. The managing doctor was blinded to treatment. Admission rates were compared, and less than 15% difference was accepted as statistically equivalent. Recruitment ran from June 2007 until January 2011. Three hundred forty-seven subjects were analysed. The admission rate in the IB group was 70.1% (122/174) compared with 64.2% (111/173) in the non-IB group. The absolute difference of +5.9% (95% confidence interval -4.0% to 15.8%) is not statistically equivalent but does not show a statistically significant decrease in admission rates when IB was given. Adverse effects were more prevalent in the IB group, at 13.2% (23/174), compared with 4.6% (8/173) in the non-IB group, a relative risk of 2.86 (95% confidence interval 1.31-6.21). In children with acute asthma of moderate severity who are treated with adequate doses of salbutamol and prednisolone, the addition of IB is not significantly associated with a reduction in admission rates. There is a significantly higher rate of adverse effects if IB is given. IB should be reserved for children with severe asthma exacerbations.

Magnesium for acute exacerbation of chronic obstructive pulmonary disease: A systematic review of randomised trials.

The efficacy of magnesium sulphate in chronic obstructive pulmonary disease (COPD) was assessed by conducting a systematic review of published randomized clinical trials through extensive searches in MEDLINE and SCOPUS with no date limits, as well as manual review of journals. Outcome measures varied depending on route(s) of administration of magnesium sulphate and medications co-administered. Risk of bias was evaluated and quality of evidence was graded. Four (4) randomized trials were included. All trials had a moderate risk of bias and were of average methodological quality. Magnesium sulphate given intravenously did not seem to have an immediate bronchodilatory effect; however it appears to potentiate the bronchodilatory effect of inhaled beta-2 agonists. Increase in peak expiratory flow rate (PEFR) at 30 and 45 min was greater in those who received magnesium sulphate compared to placebo (P = 0.03), although the mean percentage change in PEFR was just 24%, without significant differences in dyspnoea scores, hospital admission rates, or emergency department readmission rates compared to placebo. Nebulized magnesium sulphate with salbutamol versus nebulized salbutamol with saline placebo showed no significant differences is forced expiratory volume in 1 s (FEV1) measured at 90 min after adjustment for baseline FEV1 (P = 0.34) or differences in the need for hospital admission. Combined inhalational and intravenous magnesium sulphate versus intravenous saline placebo and nebulized ipratropium bromide were comparable in terms of hospital admission, intubation and death, but the ipratropium bromide group showed better bronchodilator effect and improvement in arterial blood gas parameters. Overall, trial evidence for trial evidence for magnesium sulphate in acute exacerbation of COPD is poor, and further well-designed trials are needed.

ACUTE SEVERE ASTHMA

Objective: To compare the improvement in peak expiratory flow rate (PEFR) of patients presentingto the emergency department with acute severe asthma by using the following two regimens of broncho-dilator therapy.a) Salbutamol nebulization. b) Salbutamol plus Ipratropium bromide nebulization. c) To compare the hospital admissionrates in the above mentioned two treatment groups. Design: A comparative study. Place and Duration of Study:Military Hospital Rawalpindi, Feb 2002 to Dec 2002. Material and Methods: Sixty adult asthmatic patients with peakexpiratory flow rate (PEFR) less than 200 liters per minute were randomly assigned to nebulization treatment withsalbutamol (5.0 mg initial dose followed by 2 more doses at 30 and 60 minutes) or the same salbutamol regimen plusipratropium bromide (0.5 mg). The primary end point was change in PEFR. The PEFR was measured at 30 minutes,60 minutes and 90 minutes after the onset of study protocol. The proportion of admission in the two groups wasexamined as secondary end point. Results: The increase in PEFR over time was significantly greater in combinedipratropium plus salbutamol group (p = 0.01) also the proportion of admitted patients was less in combined salbutamolplus ipratropium bromide group 4/30 vs 11/30, p = 0.036. Conclusion: The data suggested that combined iratropiumbromide plus salbutamol nebulization was superior to salbutamol nebulization alone and it should be used in the initialmanagement of patients who present with acute severe asthma.

Inhaled budesonide for the treatment of acute wheezing and dyspnea in children up to 24 months old receiving intravenous hydrocortisone

Background: Inhaled corticosteroids are highly effective in the treatment of asthma at all ages, and their use in younger children is increasing. There are no data currently available on the treatment of infants with acute wheeze and dyspnea with nebulized budesonide. Objective: Our purpose was to assess the clinical effect of nebulized budesonide in infants with acute wheeze and dyspnea. Methods: A prospective study was performed comparing the addition of nebulized budesonide 0.25 mg every 6 hours (group A, n = 32) and nebulized ipratropium bromide 0.1 mg every 6 hours (group B, n = 39) with the normal treatment regimen with intravenous fluid, hydrocortisone, and nebulized fenoterol. A clinical score was made at admission and every 12 hours. The score included wheezing and costal retraction (0-6) and respiratory rate (counts per minute). Results: Seventy-one infants aged 3 to 24 months were studied (42 boys). A statistically significant reduction was seen in clinical score and respiratory rate in both groups 12 hours after admission. The children who received budesonide improved significantly faster than the children who received ipratropium bromide, and the hospitalization period was significantly lower in the budesonide group (66.4 hours) compared with the ipra-tropium bromide group (93 hours) (P < .01). Three patients from the budesonide group and 2 from the ipratropium bromide group were readmitted within the first 4 weeks. Conclusion: Treatment of infants with acute wheeze with nebulized budesonide is associated with faster clinical improvement and reduction in hospital stay period. (J Allergy Clin Immunol 2000;105:699-703.)

A multicenter study of nebulized bronchodilator solutions in chronic obstructive pulmonary disease

A multicenter, 85-day, double-blind, randomized study was conducted to compare the effects of a single-dose and chronic inhalation of ipratropium bromide solution (500 micrograms) to the beta-adrenergic agonist metaproterenol (5% solution, 15 mg) in patients with chronic obstructive pulmonary disease (COPD). Patients were required to have a relatively stable, moderately severe COPD, forced expiratory volume in 1 second (FEV1) < 65% of predicted normal, FEV1 <70% of forced vital capacity (FVC), and a smoking history of > 10 pack-years. Following a 2-week baseline period, patients were randomized into either the ipratropium bromide (106 patients) or metaproterenol (107 patients) study groups. Pulmonary function testing was performed on days 1, 43, and 85. Secondary efficacy variables examined included peak expiratory flow rates, physician's global evaluation, quality of life, COPD symptom score, and use of concomitant medications. FEV1 was comparable between the two groups on day 1 (1.00 and 1.02 liters, ipratropium bromide vs metaproterenol, respectively; p = nonsignificant). The baseline FEV1 increased significantly in the ipratropium bromide group between day 1 and 43 by 10% (from 1.00 to 1.10 liters, p < 0.002) and remained 7% elevated on day 85 (1.07 liters) compared to day 1 (p < 0.02); it did not change in the metaproterenol group across all three test days. A clinically significant (> 15%) mean FEV1 response was observed on each of the 3 test days following drug inhalation in both treatment groups. The median duration of action was similar between groups (5 hours) on test day 1, but on day 85 the median duration for ipratropium bromide was r.5 hours compared to 3.0 hours for metaproterenol (p < 0.04). The secondary efficacy variables were uniformly better in the ipratropium bromide than the metaproterenol group. Side effects were infrequent and generally mild in both groups. These data suggest that the availability of a high-dose ipratropium bromide solution offers a safe and effective means of producing prolonged bronchodilation in patients with COPD.

Nebulized bronchodilators for outpatient management of stable chronic obstructive pulmonary disease

The bronchodilator efficacy, safety, and persistence of effect of the anticholinergic agent ipratropium bromide and the beta-adrenergic agonist albuterol, both given by nebulization, were compared in 223 patients with stable, severe chronic obstructive pulmonary disease (COPD). The study was a randomized, double-blind, parallel group trial conducted over 85 days. Patients took the study drugs (either 500 micrograms of ipratropium bromide or 2.5 mg of albuterol) three times daily on an outpatient basis throughout the study. The acute bronchodilator responses to nebulized ipratropium bromide and albuterol were studied on days 1, 43, and 85. The forced expiratory volume in 1 second (FEV1) response was similar for both drugs on day 1 (33% peak increase after ipratropium bromide and 36% peak increase after albuterol). However, albuterol's effect on FEV1 decreased over time. Clinical improvement was noted in both study groups, but the ipratropium bromide group had a greater symptomatic benefit. Patients receiving ipratropium bromide scored higher on a quality-of-life questionnaire evaluating dyspnea, fatigue, emotional function, and mastery. Side effects were relatively infrequent and generally mild for both study drugs. These results show that ipratropium bromide, given by nebulization, is safe and effective in the outpatient treatment of COPD.