Inhaled anticholinergics and Beta- 2 agonists are frequently combined to achieve optimal bronchodilatation in bronchial asthma. Fixed dose combinations of these agents are being widely used. However, it is unclear whether sequential administration of these drugs is better than simultaneous administration. This study was done to compare the bronchodilatation produced by a fixed dose combination with that produced by the same drugs administered sequentially.
27 consecutive patients with stable bronchial asthma were randomly selected for two spirometry sessions held within a week. In one session, they were given inhaled Ipratropium Bromide (40 μg) followed 30 minutes later by Salbutamol (200 μg ).In the other session, the same drugs in similar dosage were administered through a fixed dose combination. Spirometry was performed at baseline and at 15,30 and 60 minutes post inhalation. The change in Forced Vital Capacity (FVC), Forced Expiration in one second (FEV1), Peak Expiratory Flow Rate (PEFR) and Forced Expiratory Flow (FEF 25–75 ) was measured and compared.
The mean age was 30.5 years. There was no significant difference between the baseline values of FVC, FEV1, PEFR and FEF 25–75 in the two groups. FEV1 increased significantly by a mean of 234.4 ± 40, 329.6 ± 44, and 335.9 ± 45 ml respectively at 15,30 and 60 minutes from baseline in the fixed combination group, and by 202.6 ± 32, 244.8 ± 27 and 204.8 ± 31 ml in the sequential group. A similar trend was noted for the other parameters. However, there was no significant difference in any of these parameters at 15,30 or 60 minutes between the two groups.
Inhalation of a fixed dose combination of an anticholinergic agent and a beta-2 agonist is equally effective in producing bronchodilatation as administering the same drugs in sequential order.
Fixed dose combination inhalers are equally effective and have a better compliance compared to the use of these drugs separately in a sequential manner.
A. Mohan, None.