PURPOSE:This study was conducted in the department of TB & Respiratory Diseases, J. N. Medical College, Aligarh, from Jan. 2006 to Dec. 2007. The fact that smoker asthmatics can behave like COPD patients, one is encouraged to therapeutically exploit the important cholinergic influence in these patients. To clarify the issue for its clinical importance, the present study was aimed at relative bronchodilator response to adrenergic vs. cholinergic agents.
METHODS:Ninety Six patients of asthma, 48 life time non-smokers and 48 current smokers, were given sequential doses of inhaled salbutamol and after achieving maximal therapeutic effect Ipratropium was administered to see the additional bronchodilatation. The sequence in which two drugs were administered was reversed on the next visit of the patient. Spirometric measurements were taken at zero hour, after every sequential dose till plateau and after administering second drug.
RESULTS:After maximal response with salbutamol, improvement in FEV1 was 67.04±12.98% in non-smokers and 60.64±13.6% in smokers. The additional response with Ipratropium was significantly better in smoker asthmatics (9.22±2.08%) than in non-smoker asthmatics (0.13±2.14%). After maximum response with Ipratropium, when given as first drug, improvement in FEV1 was significantly better (41.95±4.57%) in smoker asthmatics than in non-smoker asthmatics (20.06±7.06%). When Salbutamol was given as second drug, the additional improvement was 23.16±5.07% and 19.09±4.9 % respectively in non-smoker and smoker asthmatics.
CONCLUSION:Non-smoker asthmatics showed maximal response with salbutamol alone. Ipratropium did not give any significant additional benefit. In smoker asthmatics, neither of the two drugs was able to fully dilate airways. Both the drugs caused further dilatation when given as second drug. Ipratropium was more effective in smoker asthmatics when given as a sole agent or as a second drug.
CLINICAL IMPLICATIONS:As both adrenergic and cholinergic tones act simultaneously in smoker asthmatics so it is better to use both the drugs for good results in these patients. In non smoker asthmatics, cholinergic agents have very little or no role.
DISCLOSURE:Zuber Ahmad, No Financial Disclosure Information; No Product/Research Disclosure Information