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[Anticholinergics as bronchodilators. An action profile].

W T Ulmer1, B Höltmann, E W Schmidt

  • 1Medizinischen Universitätsklinik und Poliklinik der Berufsgenossenschaftlichen Krankenanstalten "Bergmannsheil Bochum," Bochum.

Arzneimittel-Forschung
|October 1, 1987
PubMed
Summary
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This study found that beta 2-sympathomimetics often control more airway obstruction than anticholinergics, with both having additive effects. Complete cholinergic airway obstruction can be blocked by specific inhaled doses of ipratropium bromide (ITB).

Area of Science:

  • Pulmonary Medicine
  • Pharmacology

Background:

  • Airway obstruction involves both reversible and irreversible components.
  • The reversible component can be further classified by responsiveness to bronchodilators like beta 2-sympathomimetics and anticholinergics.

Purpose of the Study:

  • To determine the cholinergic proportion of airway obstruction.
  • To quantify the proportion of airway obstruction responsive to beta 2-sympathomimetics.
  • To compare the efficacy of beta 2-sympathomimetics and anticholinergics in managing airway obstruction.

Main Methods:

  • Three test series involving 107 patients.
  • Assessment of reversible and irreversible airway obstruction.
  • Determination of the proportion of obstruction controllable by beta 2-sympathomimetics and anticholinergics.

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Main Results:

  • A reversible and an irreversible component of increased airway resistance were identified.
  • The reversible component was divisible into portions responsive to beta 2-sympathomimetics and anticholinergics.
  • Both drug classes demonstrated an additive effect on improving airflow resistance.
  • Beta 2-sympathomimetics controlled a larger proportion of airway obstruction than anticholinergics in most cases.
  • Inhaled ipratropium bromide (ITB) at 0.02 mg (0.04 mg aerosol) completely blocked the cholinergic component of obstruction.
  • Cardially recognizable anticholinergic effects were minimal at these doses.
  • Complete cholinergic cardial blockade required higher intravenous doses of ITB (0.25-0.5 mg).

Conclusions:

  • Airway obstruction has distinct components responsive to different bronchodilator classes.
  • Inhaled ipratropium bromide is effective in blocking the cholinergic component of airway obstruction with minimal cardiac side effects.
  • Beta 2-sympathomimetics are often more effective than anticholinergics for reversible airway obstruction.