Nebulized bronchodilators for outpatient management of stable chronic obstructive pulmonary disease

The bronchodilator efficacy, safety, and persistence of effect of the anticholinergic agent ipratropium bromide and the beta-adrenergic agonist albuterol, both given by nebulization, were compared in 223 patients with stable, severe chronic obstructive pulmonary disease (COPD). The study was a randomized, double-blind, parallel group trial conducted over 85 days. Patients took the study drugs (either 500 micrograms of ipratropium bromide or 2.5 mg of albuterol) three times daily on an outpatient basis throughout the study. The acute bronchodilator responses to nebulized ipratropium bromide and albuterol were studied on days 1, 43, and 85. The forced expiratory volume in 1 second (FEV1) response was similar for both drugs on day 1 (33% peak increase after ipratropium bromide and 36% peak increase after albuterol). However, albuterol's effect on FEV1 decreased over time. Clinical improvement was noted in both study groups, but the ipratropium bromide group had a greater symptomatic benefit. Patients receiving ipratropium bromide scored higher on a quality-of-life questionnaire evaluating dyspnea, fatigue, emotional function, and mastery. Side effects were relatively infrequent and generally mild for both study drugs. These results show that ipratropium bromide, given by nebulization, is safe and effective in the outpatient treatment of COPD.