PURPOSE: Combination bronchodilatator therapy for chronic obstructive pulmonary disease (COPD) is available widely throughout the world. The subjects of reversibility to bronchodilatators in COPD has proven to be controversal.The aim of this stady was to determine the acute effect of salbutamol (S), Ipratropium bromide ( IB ), fixed combination Ipratropium bromide + Fenoterol (Berodual), Salbutamol and Ipratropium bromid (S,IB) by nebuliser on lung function in COPD patients.
METHODS: We investigated group of 86 patients hospitalised in our department for acutisation COPD. Pulmonary function tests including FEV1, FVC, FEVl/FVC were performed just before inhalation (during 15 minues) and 30, 60. 180 and 240 minutes of post inhalation.On the four consecutive mornings, patients received the following drugs by nebulisation: 1) salbutamol 0.5mg, 2) Ipratropium bromid 0.25mg, 3) Fenoterol 0.5mg + Ipratropium bromide 0.25mg(BERODUAL), 4) Salbutamol 0.5mg and 20 minutes later Ipratropium bromide 0.25mg.
RESULTS: There was significantly important bronchodilatation (FEV1,FVC) after all drugs.Significant of of improvement was evaluated by variance analysis test.Analysis of forced expiratory volume (FEV1) curves on those test days indicated that combination was superior to either single agent alone in a peak effect, in the effect during the first 6 h after inhalation. The mean peak percent increase in FEV1 over baseline were 38% for Berodual, to 33 % for combination S+IB, to 26% for IB, and 27% for S. The difference between the combination and its component were statistically significant on all test days. Similar changes were noted in the forced vital capacity curves.
CONCLUSION: We concluded that most patients with COPD do have a component of bronchodilatator reversibility. The combination of ipratropium bromide and fenoterol or spalmotil, when given by nebulisation to patients with COPD, is more effective than either of alone. The advantage of the combination is apparent primarily during the first 6 h after inhalation.
CLINICAL IMPLICATIONS: These results confirm that combination of ipratropium and formoterol/salbutamol is superior to either of individual agents alone for identifying reversibility in pulmonary function tests in patients with COPD.
DISCLOSURE: Zorica Lazic, None.