Inhalation Of Ipratropium Research Articles

Hiding in Plain Sight: Quantifying Salbutamol and Ipratropium Inhaler Wastage in Hospitals.

Previous studies have found significant inhaler wastage in the inpatient setting, which contributes to unnecessary health care expenditures. Wastage may involve inhalers available in automated dispensing cabinets (ADCs). To evaluate whether salbutamol and ipratropium inhalers were unnecessarily withdrawn from ADCs for hospital inpatients. This cross-sectional study included patients from 16 health care facilities in British Columbia. ADC reports were run for the period August 2021 to January 2022 to identify salbutamol and ipratropium inhalers removed from ADCs. Over the study period, 8.3% (2180/26 324) of salbutamol and ipratropium inhalers were withdrawn from ADCs unnecessarily for the same patient encounter within a 2-day timeframe, and another 1118 (4.2%) represented instances when multiple inhalers were withdrawn for the same patient at the same time. Overall, 12.5% (3298/26 324) of all salbutamol and ipratropium inhalers were withdrawn unnecessarily. The total cost of these inhalers was about $31 600 over the 6-month period. This evaluation revealed considerable wastage of inhalers, leading to wasted expenditures. Other health authorities should conduct similar analyses to determine whether similar problems exist in their settings.

Study of voice disorders in patients with bronchial asthma and chronic obstructive pulmonary disease

BackgroundChronic obstructive pulmonary disease (COPD) and bronchial asthma are known to cause adverse effects on voice, which might affect the quality of life of an individual.AimThe study was designed to study the voice disorders in patients with COPD and bronchial asthma and its relation to disease severity and medication.Patients and methodsTotally, 60 patients were recruited: 30 stable bronchial asthma patients and 30 stable COPD patients. All participants underwent spirometry and study of voice parameters using auditory perceptual assessment, videolaryngostroboscopy system, voice recording, and acoustic analysis.ResultsImpaired voice quality and various grades of dysphonia were detected in the COPD group in 30% by means of auditory perceptual assessment; structural changes in the vocal folds (diffuse congestion, unhealthy mucosa, and edema) were detected in 36.6%. In the bronchial asthma group, impaired voice quality and various grades of dysphonia were detected in 16.7% and structural changes were detected in 20% of them, whereas acoustic analysis showed a highly significant increase in jitter and shimmer and decreased harmonic-to-noise ratio in 100% of patients of both groups. These changes were greater in metered dose inhaler users than in dry-powder inhaler users. In the bronchial asthma group, fluticasone propionate users had a significantly decreased harmonic-to-noise ratio compared with beclomethasone dipropionate and budesonide users, as well as the least pitch and highest shimmer and jitter. A significant statistical correlation was found between ipratropium inhalation usage and increased shimmer in the COPD group. There was a highly significant correlation between spirometric severity and both grade of dysphonia and character of voice in bronchial asthma patients.ConclusionAll COPD and bronchial asthma patients had dysphonia, either due to organic causes or due to functional causes. Voice changes were directly correlated with degree of severity and fluticasone propionate inhalation use in bronchial asthma patients, and with ipratropium bromide inhalation in the COPD group.

Inhaled Salmeterol Induces Salivary Alpha Amylase Activity in Healthy Subjects

FEBRUARY 2015 AB4 Abstracts S A T U R D A Y 12 Inhaled Salmeterol Induces Salivary Alpha Amylase Activity in Healthy Subjects Andrea A. Pappalardo, MD, Sherlyana Surja, MD, Caitlin M. Campion, Sarah J. Aldrich, James N. Moy, MD; Asthma and Allergy Center, Bloomingdale, IL, Rush University Medical Center, Chicago, IL, John H. Stroger Hospital of Cook County, Chicago, IL. RATIONALE: Salivary alpha-amylase (sAA) secretion is an indirect method of measuring beta-receptor activation. Increases in sAA are seen in isoproterenol-infused mice (attenuated by beta-receptor antagonists) and in humans under physical or mental stress. We previously demonstrated that albuterol given by inhalation increases sAA (peaking at 15 minutes) in healthy volunteers and patients with asthma. We hypothesized that inhaled salmeterol, but not the anticholinergic ipratropium, will induce sAA secretion. METHODS: Five healthy volunteers were enrolled. Spirometry was performed; and sAA, blood pressure and heart rate were collected at baseline and at 15, 30, 60 and 120 minutes after inhalation of fluticasonesalmeterol HFA (90 mcg/42 mcg). Two weeks later, two of the subjects repeated the protocol after inhaling ipratropium (34mcg). Three additional subjects performed spirometry maneuvers alone to confirm stability of sAA during forced expiratory maneuvers. RESULTS: Baseline sAAwas 143651 (U/mL6SEM) , which increased after salmeterol inhalation to 190657, 230668, 2766100, and 239670 at 15, 30, 60, and 120minutes, respectively; peaking at 60minutes (p<0.05 at 60 and 120 minutes; ANOVA). sAA did not change after ipratropium inhalation or spirometry alone. FEV1 did not change from baseline after inhalation of salmeterol or ipratropium in these healthy volunteers. No significant changes in blood pressure and heart rate were observed in any group. CONCLUSIONS: Salmeterol induces sAA in healthy subjects, but peaks later than albuterol, consistent with its pharmacokinetic properties. These findings reinforce the concept that sAA is a surrogate marker for beta-2receptor activation and may be useful in assessing tachyphylaxis or unresponsiveness to beta-2-agonists.

Effects of Ipratropium on Exercise-Induced Cough in Winter Athletes: A Hypothesis-Generating Study

Background: Exercise-induced cough (EIC) is frequently reported by winter athletes, but this symptom is not always associated with exercise-induced bronchoconstriction (EIB). The aims of this study were to determine if EIC can be inhibited or reduced with the inhalation of ipratropium, and if EIC in winter athletes is associated with EIB. Methods: On 2 visits, 24 cross-country skiers (10 males and 12 females, mean age 17 ± 3 years) performed an outdoor exercise in the winter (30-minute warm-up, followed by a 3-minute sprint), randomly preceded by the inhalation of ipratropium or a placebo. A spirometry was done at baseline and 20 minutes after inhalation of ipratropium or placebo. Exercise was then performed, followed by the measurement of forced expiratory volume in 1 second and the recording of the number of coughs until 60 minutes after exercise. Before and after exercise, the perception of cough intensity was evaluated using a modified Borg scale. Results: Twelve of 16 athletes who completed the study (75%) were symptomatic following exercise with placebo (number of coughs ≥ 5), but none developed EIB. For these athletes, the number of coughs after exercise (mean number of coughs ± standard deviation: placebo, 26 ± 14; ipratropium, 25 ± 23; P value, nonsignificant) and the maximal perception score for cough intensity (mean Borg score ± standard deviation: placebo, 1.9 ± 1.2; ipratropium, 2.0 ± 1.1; P value, nonsignificant) were not significantly different between ipratropium and placebo. A decrease in the number of coughs was observed in 6 of the symptomatic athletes and an increase was observed in the other 6, resulting in a nonsignificant mean effect. Conclusions: Ipratropium does not appear to significantly influence the number and the perception of cough following exercise. Moreover, these results suggest that EIC is not mainly associated with EIB. However, a subgroup of athletes seems to show a beneficial response to ipratropium, suggesting different cough responses in this population.

Pulmonary Mucormycosis in a Patient with Crohn Disease on Immunosuppressive Medications including Infliximab

Case presentation A 68-year-old man presented to hospital with a two-day history of increasing shortness of breath, left-sided pleuritic chest pain and chills. His medical history was significant for longstanding Crohn disease (>55 years) requiring multiple bowel resections in the 1970s in addition to high-dose corticosteroid therapy. For the past five years, he had been maintained on infliximab with only low-dose steroids for iatrogenic adrenal insufficiency. Additional medical problems included short gut syndrome, hypothyroidism and bronchiectasis; there was no history of diabetes. He experienced two hospital admissions in the preceding six months for pneumonia, one of which was due to Pneumocystis jirovecii confirmed by open lung biopsy. His medications on this admission included budesonide 6 mg orally three times daily, azathioprine 100 mg orally twice daily, infliximab 600 mg intravenously every four weeks, levothyroxine 25 µg orally daily, atovaquone 1500 mg orally daily, and salbutamol and ipratropium inhalers as needed. His most recent dose of infliximab was one month before admission. A physical examination revealed signs of consolidation in the left lung. His complete blood count included a white blood cell

Efficacy and safety of short-acting anticholinergics in patients with acute exacerbation of chronic obstructive pulmonary disease receiving maintenance therapy with tiotropium

The aim of the study was to assess efficacy and safety of ipratropium and ipratropium/fenoterol in patients with acute exacerbation of COPD receiving maintenance therapy with tiotropium. Design: prospective, randomized, controlled cross-over study. Patients and methods. Thirty six patients with COPD exacerbation (mean age 66 yrs; mean FEV 1 26 %) were included in the study. Patients were randomized to receive either ipratropium or ipratropium/fenoterol on two different test days. The study consisted of two different protocols. In the 1st protocol, the patients received either nebulized solution of ipratropium 500 μg or ipratropium/fenoterol 500/1000 μg. In the 2nd protocol, patients received either ipratropium 80 μg via metered dose inhaler (MDI) and spacer or ipratropium/fenoterol 80/200 μg. Spirometry, clinical and hemodynamic measurements were performed immediately before and at 1 and 4 hours after inhalation of ipratropium or ipratropium/fenoterol. Nebulized therapy with ipratropium or ipratropium/fenoterol resulted in statistically and clinically significant improvement in FEV1 , FVC and IC at 1 and 4 hours after inhalation ( р &lt; 0.01). In terms of the bronchodilator effect, add-on therapy with ipratropium/fenoterol was nonsignificantly superior to add-on ipratropium. There were no serious adverse events after inhaled therapy including hemodynamic parameters (BP, ECG, QTc). Only ipratropium/fenoterol resulted in increase of heart rate, approximately by 3.8 beats per minute (bpm) at 1 hour after inhalation ( p &lt; 0.001). Inhaled therapy with ipratropium or ipratropium/fenoterol via MDI and spacer led to similar results as nebulized therapy. Heart rate was increased at 1 hour after inhalation of ipratropium/fenoterol via MDI and spacer by 3.7 bpm ( p &lt; 0.001). In patients with acute exacerbation of COPD receiving maintenance therapy with tiotropium, the addition of ipratropium or ipratropium / fenoterol provides significant bronchodilator effect without any serious adverse events.

A 68-Year-Old Man With Intractable Dyspnea and Wheezing 45 Years After a Pneumonectomy

A 68-year-old man with a 20-year history of wheezing presented with a recent increase in dyspnea, productive cough, and inability to clear secretions. He denied fevers, rigors, chest pain, palpitations, lightheadedness, syncope, headaches, nasal symptoms, or gastroesophageal reflux. During the last 15 years, he received treatment with albuterol and ipratropium inhalers in addition to daily nebulizers, prednisone, salmeterol, montelukast, and fluticasone for presumed asthma. His symptoms had worsened despite being compliant with medication. In fact, during the 5 years prior to our evaluation, he had been hospitalized 12 times for asthma exacerbations, bronchitis, and recurrent respiratory infections. The patient was a nonsmoker, had no secondhand smoke exposure, and had no occupational exposures to toxic substances. Family history was not significant. The patient had no known drug allergies. At the age of 5 years, however, he had aspirated a foreign body that was incompletely removed, resulting in recurrent respiratory infections and a left pneumonectomy at age 23. Physical examination revealed rhonchi and wheezing over the trachea and right hemithorax. Transmitted bronchial sounds were audible on the left. The trachea was slightly deviated to the left, but the rest of the examination was normal. The results of blood tests consisted of normal CBC count and normal basic metabolic panel. Dobutamine stress echocardiography was normal. Pulmonary function testing showed severe reduction in expiratory volumes (FVC, 43% of predicted; FEV1, 39% of predicted; FEV1/FVC ratio, 0.63; peak expiratory flow, 29% of predicted). There was worsening in spirometry values after administration of bronchodilators. The chest radiograph is shown in Figure 1.

Comparison of the effects of ipratropium bromide and salbutamol on autonomic heart rate control

B2-agonists and anticholinergic drugs may alter cardiac autonomic modulation. The aim of this study was to investigate the effects of inhaled salbutamol and ipratropium bromide on heart rate variability (HRV). A randomized, double-blind, crossover design study was conducted on 13 healthy volunteers. Salbutamol, ipratropium or placebo was administered in three different testing sessions. Time domain parameters; mean R-R interval (mean-RR), the standard deviation of R-R interval (SDNN) and the root mean square of successive R-R interval differences (RMSSD) and power spectral analysis of HRV were assessed in the supine position and during handgrip exercise before and after taking each drug. In time domain analyses, ipratropium administration resulted in a reduced mean-RR, SDNN and RMSSD during handgrip exercise compared with baseline values (775 +/- 30 ms vs. 748 +/- 21 ms, P < 0.05; 57 +/- 5 ms vs. 50 +/- 5 ms, P < 0.05; 30 +/- 2 ms vs. 26 +/- 2 ms, P < 0.01, respectively). This effect was not detected with salbutamol or placebo administration. In frequency domain analyses, salbutamol but not ipratropium and placebo inhalation increased high frequency power/total power during handgrip exercise compared with baseline (0.09 +/- 0.02 vs. 0.12 +/- 0.02, P < 0.05). Ipratropium inhalation may alter autonomic control of the heart rate in therapeutic doses during mild sympathetic stimulation in healthy subjects, while salbutamol does not show these effects.

Comparison of the effects of salmeterol and ipratropium bromide on exercise performance and breathlessness in patients with stable chronic obstructive pulmonary disease

To compare the effects of salmeterol, an adrenergic drug, and ipratropium bromide, an anticholinergic drug, on breathlessness and gas exchange during exercise in patients with chronic obstructive lung disease (COPD), we performed a progressive treadmill exercise test on 15 patients on 3 days (24 h apart), after inhalation placebo, ipratropium bromide (120 μg) or salmeterol (50 μg) in a randomized fashion. Dyspnoea during exercise was evaluated from the regression slope between Borg scale (BS) scores and distance walked each minute on the treadmill. The regression was expressed as the distance walked at BS score 5, the threshold load of dyspnoea (TLD) and breakpoint load of dyspnoea. During and after the exercise, oxygen saturation was monitored by pulse oxymeter and we measured the lower SaO 2 during exercise and the recovery time of SaO 2 after exercise. In comparison to placebo inhalation we found the same small but significant improvement in airflow limitation after salmeterol or ipratropium inhalation, also the distance walked on treadmill increased after bronchodilators. After bronchodilators the magnitude of oxyhaemoglobin desaturation with exercise was similar to that observed after placebo but the duration of the recovery from sustained SaO 2 desaturation after exercise was shorter to the same extent as after ipratropium or salmeterol. Dyspnoeic sensation, when assessed by the TLD and by the distance walked at BS score 5, was decreased after salmeterol and after ipratropium bromide to a similar extent. We conclude that the salmeterol, when given in conventional doses, produces significant improvement in the airway obstruction in the recovery of postexercise HbO 2 desaturation and in dyspnoeic sensation in patients with COPD, effects which were similar to those observed after inhalation of the anticholinergic agent ipratropium bromide.

Pneumomediastinum: an unusual presentation of a carcinoma of the carina

A 49-year-old bagpipe teacher developed central chest pain and a swollen neck after a violent cough. A few days earlier, he had noticed hoarseness associated with an irritating cough and he had a single episode of frank haemoptysis. He was a life-long non-smoker due to mild asthma for which he used salbutamol and ipratropium inhalers. He had recently consulted his General Practitioner about his cough and had been commenced on oral prednisolone and erythromycin. On admission, he was hoarse and distressed because of pain when coughing but he had no cardiorespiratory embarrassment. He was apyrexial and had gross surgical emphysema in his neck. Auscultation of his chest revealed a positive Hammans sign and a soft ejection systolic murmur radiating from his aortic area into his carotids. A chest radiograph revealed a pneumomediastinum with clear lung fields and no pneumothorax. His electrocardiogram, cardiac enzymes, arterial blood gases, haemoglobin and white cell count were all normal. A barium swallow showed no evidence of an oesophageal leak and an echocardiogram showed good left ventricular function with a normal aortic valve. He was treated with broad spectrum antibiotics and parenteral opiates. Indirect laryngoscopy revealed a left vocal cord paralysis. A bronchoscopy was performed under general anaesthesia and revealed an extensive carcinoma of the carina. The tumour appeared to have arisen in, and almost occluded, the left main bronchus, and extended across the midline to infiltrate the right main bronchus. Biopsy of the tumour yielded an undifferentiated non-small cell cancer. In view of the inoperability of the cancer, he was treated by radiotherapy.

Chlorpyrifos poisoning treated with ipratropium and dantrolene: A case report

A patient suffering from chlorpyrifos poisoning and manifesting copious endotracheal secretions was successfully treated by inhalation of ipratropium.

Additive effects of isoproterenol-phenylephrine aerosol following ipratropium bromide on airway obstruction in older patients with intrinsic asthma and chronic bronchitis.

The additive bronchodilating effect of isoproterenol-phenylephrine aerosol following ipratropium bromide was examined in seven intrinsic asthmatic patients and seven chronic bronchitic patients. FVC, FEV1 and Zrs were measured before and 30 min. after inhalation of ipratropium, 40 micrograms. Then inhalation of isoproterenol, 600 micrograms and phenylephrine, 570 micrograms was added and the pulmonary functions were measured 30 min. later. The age, baseline values of FVC and FEV1, and the increases in FEV1 and 1/Zrs with ipratropium did not differ between the two. Isoproterenol-phenylephrine aerosol following ipratropium produced further increases in FEV1 and 1/Zrs in asthmatic patients but no additive increases in bronchitic patients. These findings indicate that the role of autonomic nervous system, especially adrenergic system, on airway obstruction may be different between asthmatic and bronchitic patients and the method applied in this study may be helpful in differentiating these airway disorders.

Reversible airway obstruction: neurohumoral mechanisms and treatment. Lecture on asthma: clinical overview.

Asthma is an airway obstruction which is reversible, either spontaneously or in response to treatment. Repeated peak expiratory flow rate (PEFR) measurements, up to six times daily, allows this characteristic reversibility to be recognised, to guide diagnosis and therapy. Chronic asthmatics may eventually become relatively irreversible, and then appear similar to chronic bronchitics - unless an adequate history is taken. The commonest world-wide allergen is the fecal pellet of the house mite. Modern therapy of asthma starts with inhaled beta 2 agonists, but difficulty in using metered dose inhalers is helped by the 'spacer', or reservoirs (e.g. 'Nebuhaler'). Interaction between slow-release oral theophyllines and beta 2 agonists by inhalation maximises bronchodilatation but minimises tremor. High-dose ipratropium inhalation, as isotonic wet nebulisation with a beta 2 agonist, is useful in acute severe asthma. High doses of inhaled topical steroid are valuable in the difficult asthmatic, but pituitary adrenal suppression occurs if dosage exceeds 1,500 micrograms/day. Cromoglycate and a beta 2 agonist by inhalation can prevent exercise-induced asthma. Long-term oral steroids (never over 10 mg/day) are only used if inhaled therapy (+/- oral slow-release theophyllines) fails. Acute severe asthma needs parenteral steroid, parenteral beta 2 agonist, high-dose beta 2 agonist by inhalation, oxygen and hospital admission. Ventilation is increased in the acute severe asthmatic with hypoxia and low PCO2. In 90 asthmatic deaths surveyed in Britain, half had failed to realise the severity.

Ipratropium bromide: a review of its pharmacological properties and therapeutic efficacy in asthma and chronic bronchitis.

Ipratropium bromide is an anticholinergc bronchodilator administered by inhalation. Although producing bronchodilation in most patients with obstructive airways disease, it is somewhat less effective than beta 2-adrenoceptor agonist drugs such as salbutamol or fenoterol in patients with asthma, but is at least as effective as these agents in bronchitis. As with the beta 2-adrenoceptor agonists, the onset of maximum effect with ipratropium (about 1.5 to 2 hours) is slower than with isoprenaline (although significant bronchodilation usually occurs within seconds or minutes of ipratropium inhalation), and the duration of effect (about 4 to 6 hours) is longer. Studies of concomitant use of ipratropium and other agents such as beta 2-adrenoceptor agonists, theophylline, or sodium cromoglycate, have usually shown a greater response in many patients than with single drug therapy, as might be expected from the different mechanisms of action of these groups of drugs. Usual inhaled doses of ipratropium were well tolerated in all studies. Ipratropium thus appears to be a suitable alternative to beta 2-adrenoceptor agonist drugs in patients not fully responding to these agents, and combined therapy with ipratropium and other bronchodilating drugs may prove to be an important area of use in patients failing to respond adequately to a single drug regimen. (nevertheless, in asthma patients in whom a 'non-responsive' state is developing, initiation of corticosteroid therapy should not be delayed). Ipratropium may also be useful in the occasional patient in whom side effects such as palpitations or tremor are troublesome with usual inhaled doses of beta 2-adrenoceptor agonists.