[Comparative study of anticholinergic and betamimetic agents in the treatment of asthma attacks]

Four regimens of bronchodilatation therapy administered on 2 consecutive days were tested in 4 randomly selected groups of 6 asthmatic patients: 1) intravenous atropine + inhaled oxitropium bromide; 2) intravenous atropine alone; 3) intravenous salbutamol + inhaled salbutamol; 4) intravenous salbutamol alone. On the second day the treatments were crossed over, i.e. the groups which had received the intravenous + inhaled treatment on the first day received the same drug in i.v. form alone and vice versa. The intravenous doses of atropine and salbutamol were 0.5 mg each administered over 1 hour, and those of oxitropium and salbutamol aerosol were 100 mcg hourly for 6 hours. In addition, all patients received methylprednisolone 20 mg i.v. on each day of the study. Peak expiratory flow rate (PEFR), heart rate (HR) and arterial pressure were recorded before treatment, then hourly for 6 hours. All 4 regimes produced significant improvement in PEFR (P less than 0.01). Bronchodilatation was not significantly different in the 4 groups, but improvement was markedly better when intravenous injections were associated with inhalations. No side-effects were recorded with the anticholinergic drugs, whereas a slight but significant increase in HR (P less than 0.05) was observed with the adrenergic drug. This study suggests that anticholinergic agents provide a therapeutic alternative for severe acute asthma when beta 2-adrenergic stimulants cannot be used.