Control of the hypersecretion of vasomotor rhinitis by topical ipratropium bromide

A randomized, double-blind, placebo-controlled trial of ipratropium bromide nasal spray was performed with 25 patients with vasomotor rhinitis. Criteria for selection of patients were (1) clear watery nasal discharge more than 1 hour each day, (2) absent or mild nasal obstruction, (3) no known allergic cause, and (4) no satisfactory response to previous alternative medications. Ipratropium bromide, two sprays (20 micrograms per spray) in each nasal cavity four times daily, for 3 weeks, produced a major reduction in nasal discharge severity and duration (p less than 0.00005 for daytime reduction in both). There was a decreased daily use of nasal tissues (p = 0.0017). At the end of the trial, 21 patients preferred the drug, two preferred placebo, one had no preference, and one patient dropped out for a reason unrelated to symptoms or treatment. This drug preference in favor of active medication was statistically significant at the 0.01 level. Local mild side effects were reported in 21/25 (84%) with ipratropium bromide and 8/25 (32%) with placebo (p = 0.0004). Pulse and blood pressure were not affected. In an ensuing 1-year open trial in which the frequency of use of ipratropium bromide nasal spray was selected by the subjects, the dosage chosen was considerably lower than that used in the controlled trial. There were seven dropouts caused by insufficient benefit or local side effects. Seventeen subjects continued the use of ipratropium bromide for 1 year and reported good results and no side effects. Topical nasal ipratropium bromide is highly effective in the control of the rhinorrhea of vasomotor rhinitis. Drug dosage is a major determinant of local nasal side effects.