OBJECTIVETo evaluate the efficacy of 3 commonly used protocols for management of acute exacerbation of asthma in children.

METHODSTotally 113 asthmatic children were randomized into 3 groups. In group A (53 cases), the children were treated with inhalation of nebulized budesonide suspension plus salbutamol and ipratropium bromide twice daily for 5 days; in group B (41 cases), budesonide plus salbutamol and ipratropium aerosol was administered, and in group C (29 cases), dexathmisone plus aminophylline injection was given once daily for 5 days. All the children received basic treatment with fluid infusion, antibiotics or/and anti-virus medications.

RESULTSThe children in both groups A and C showed effectively controlled asthma attack, with significant differences in the therapeutic effects (P>0.05). In contrast, only a few children showed improvement in group B, suggesting the ineffectiveness of the treatment.

CONCLUSIONNebulized medicine is one of the best means for management of acute asthma exacerbation in children, and inhalation of budesonide suspension plus salbutamol and ipratropium bromide can effectively relieve the asthmatic symptoms in these children with good compliance and convenient administration.

Acute Disease ; Adolescent ; Aerosols ; Albuterol ; administration & dosage ; therapeutic use ; Asthma ; drug therapy ; Bronchodilator Agents ; administration & dosage ; therapeutic use ; Budesonide ; administration & dosage ; therapeutic use ; Child ; Child, Preschool ; Drug Therapy, Combination ; Female ; Humans ; Infant ; Ipratropium ; administration & dosage ; therapeutic use ; Male ; Treatment Outcome

Ipratropium bromide (IP) is a new anticholinergic bronchodilator. To evaluate its effect on bronchial asthma which is still unknown in Korea, a double blind and randomized study was done on all patients of bronchial asthma who visit out-patients clinic of out department from June to September 197 and showed 75 to 100% of FEV1/FVC ratio on prebronchodilator spirometry (pre BD). The selected patients were given 2 puffs of Fenoterol (FE) or Ipratropium inhalator blindly and Spirometry. The repeated results are: 1. In both FE and IP groups, there was a significant bronchodilatory effect on 5 and 60 minutes after administration. 2. One 5 minutes, effect of FE was significantly greater than IP (FVC p<0.05, FEV1 p<0.01). 3. One 60 minutes, effect of IP was slightly less than FE but statistically non-significant. On the basis of above results, we concluded that onset of effect of IP is slower than FE, but its effect is significant and nearly comparable to FE.
Asthma* ; Fenoterol ; Humans ; Ipratropium* ; Korea ; Nebulizers and Vaporizers ; Outpatients ; Spirometry

BACKGROUND AND OBJECTIVE: There has been little clinical data on the treatment outcome of patients with acute asthma attack in Korea. We designed a management protocol of acute asthma, and analyzed clinical p arameters obtained from this protocol. METHOD: A total of 32 cases with acute asthma were treated with oxygen, beta2 agonist, and methylprednisolone. Ipratropium was added in cases of severe attack. After 90 minutes, intravenous aminophylline was given to the patients with poor response. RESULT: Beta2 agonist and methylprednisolone were sufficient for symptom control in 17 cases. Ipratropium and aminophylline were added in 6 and 9 cases, respectively. There was no difference in improvement of PEF, heart rate, respiratory rate, PaO2, PaCO2, and SaO2 at 90 minutes and 8 hours between beta2 agonist inhalation and subcutaneous group. Serum potassium concentration levels significantly decreased in patients treated with ipratropium of aminophylline(n=15, 4.17+/-0.45 vs. 3.99+/-0.35mM/L, p<0.05), compared with patients using only beta2 agonist and methylprednisolone(n=17, 3.89+/-0.30 vs. 4.14+/-0.45mM/L, p>0.05). CONCLUSION: Subcutaneous beta2 agonist may be an alternative to inhalant beta2 agonist for the emergency treatment of acute asthma, and we think a consensus regarding use of aminophylline in the emergency room should be made.
Aminophylline ; Asthma* ; Consensus ; Emergency Service, Hospital ; Emergency Treatment ; Heart Rate ; Humans ; Inhalation ; Ipratropium ; Korea ; Methylprednisolone ; Oxygen ; Potassium ; Respiratory Rate ; Treatment Outcome*

PURPOSE: To examine the clinical effects of two bronchodilator agents, salbutamol and ipratropium bromide, administered by metered-dose inhaler(MDIS) to preterm infants with respiratory distress syndrome(RDS) during mechanical ventilation. METHODS: This study included 8 ventilated preterm infants with RDS, at a postnatal age of 1 week. The effects of single doses of salbutamol(2puffs, 200mcg) and ipratropium bromide(2 puffs, 36mcg) and placebo(2puffs) given by MDIS were examined in eight ventilated preterm infants. The drugs were each given in an open, random design. Blood gases were measured and ventilatory efficiency index(VEI) and arterial/alveolar oxygen tension ratio(PaO2/PAO2) were calculated five minutes before and 30 minutes after administration. Heart rates and mean arterial blood pressure were noted. RESULTS: The mean PaO2 increased by 5.6mmHg and the mean PaCO2 fell by 2.4mmHg, following salbutamol administration. These results of salbutamol administration were significantly greater than those seen with placebo(P<0.017). Salbutamol caused a significant increase in VEI of 10.4%, significantly greater than the fall of 4.3% seen with placebo. Neither salbutamol nor ipratropium bromide resulted in an increase in PaO2/PAO2 and the effect of both drugs did not differ compared with placebo. Ipratropium bromide did not cause any significant changes in PaO2 and PaCO2. Significant tachycardia was not induced in any of the infants for 1 hour after inhalation of both drugs. CONCLUSION: Salbutamol given by MDIS has useful short-term effects in ventilated preterm infants with RDS.
Albuterol ; Arterial Pressure ; Bronchodilator Agents ; Gases ; Heart Rate ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Inhalation* ; Ipratropium ; Nebulizers and Vaporizers* ; Oxygen ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn* ; Tachycardia

PURPOSE: To examine the clinical effects of two bronchodilator agents, salbutamol and ipratropium bromide, administered by metered-dose inhaler(MDIS) to preterm infants with respiratory distress syndrome(RDS) during mechanical ventilation. METHODS: This study included 8 ventilated preterm infants with RDS, at a postnatal age of 1 week. The effects of single doses of salbutamol(2puffs, 200mcg) and ipratropium bromide(2 puffs, 36mcg) and placebo(2puffs) given by MDIS were examined in eight ventilated preterm infants. The drugs were each given in an open, random design. Blood gases were measured and ventilatory efficiency index(VEI) and arterial/alveolar oxygen tension ratio(PaO2/PAO2) were calculated five minutes before and 30 minutes after administration. Heart rates and mean arterial blood pressure were noted. RESULTS: The mean PaO2 increased by 5.6mmHg and the mean PaCO2 fell by 2.4mmHg, following salbutamol administration. These results of salbutamol administration were significantly greater than those seen with placebo(P<0.017). Salbutamol caused a significant increase in VEI of 10.4%, significantly greater than the fall of 4.3% seen with placebo. Neither salbutamol nor ipratropium bromide resulted in an increase in PaO2/PAO2 and the effect of both drugs did not differ compared with placebo. Ipratropium bromide did not cause any significant changes in PaO2 and PaCO2. Significant tachycardia was not induced in any of the infants for 1 hour after inhalation of both drugs. CONCLUSION: Salbutamol given by MDIS has useful short-term effects in ventilated preterm infants with RDS.
Albuterol ; Arterial Pressure ; Bronchodilator Agents ; Gases ; Heart Rate ; Humans ; Infant ; Infant, Newborn ; Infant, Premature ; Inhalation* ; Ipratropium ; Nebulizers and Vaporizers* ; Oxygen ; Respiration, Artificial ; Respiratory Distress Syndrome, Newborn* ; Tachycardia

OBJECTIVETo investigate the effects of inhaled short-acting bronchodilators on diaphragm function and neural respiratory drive in patients with chronic obstructive pulmonary disease (COPD) during maximal isocapnic ventilation (MIV).

METHODSForty-seven patient with moderate to severe COPD were randomized into 4 groups: placebo group (n=12), salbutamol group (n=13), ipratropium group (n=10), and combined group (salbutamol and ipratropium, n=12). Each subject received an initial MIV for 3 min at baseline and inhaled placebo (400 µg), salbutamol (400 µg), ipratropium (80 µg), or both salbutamol and ipratropium, followed 30 min later by another 3 min of MIV. The parameters of diaphragm function and neural respiratory drive were monitored continuously and calculated during MIV.

RESULTSDuring the initial MIV, all the patients experienced a linear increase in root mean square (RMS) of diaphragm electromyogram with a gradual decrease in transdiaphragmatic pressure (Pdi), minute ventilation (VE), and VE/RMS, and these parameters all improved significantly after inhalation of the bronchodilators. Compared with the placebo group at the same time point, the 3 bronchodilator-treated groups showed significantly decreased RMS and Borg score and increased Pdi, VE and VE/RMS; VE/RMS was the highest in the combined treatment group (P<0.05). The Delta Borg was significantly correlated with Delta Pdi, Delta VE, Delta RMS, and Delta VE/RMS (P<0.05).

CONCLUSIONSIn COPD patients, inhaled short-acting bronchodilators can alleviate diaphragm fatigue during MIV, increase lung ventilation, reduce neural respiratory drive, and improve neuro-ventilatory coupling to relieve dyspnoea, and the combination of β-2 agonists and anti-muscarinic antagonists produces a stronger efficacy.

Administration, Inhalation ; Albuterol ; therapeutic use ; Bronchodilator Agents ; therapeutic use ; Diaphragm ; drug effects ; Humans ; Ipratropium ; therapeutic use ; Pulmonary Disease, Chronic Obstructive ; drug therapy ; Respiration

BACKGROUND:The number of elderly people (aged 60 years or over) is expected to double in the next 35 years as a result of decreasing mortality and declining fertility worldwide. The elderly population is at increased risk of being prescribed potentially inappropriate medications (PIM).
OBJECTIVES:To determine the prevalence of PIM prescribed among the geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014.
METHODS:This is a retrospective cross-sectional study on patients who are 65 years and older admitted under Internal Medicine between January 2014 to December 2014. Medical records were reviewed for PIM prescription according to the updated 2012 Beers Criteria.
RESULTS: PIMs were noted in 303 out of of 618 patients.The most common PIMs were insulin sliding scale, digoxin,orphenadrine, ipratropium, ketorolac, clonazepam, clonidine, hydroxyzine, amiodarone and spironolactone.
CONCLUSION:The prevalence of PIM prescription is 49% among geriatric patients admitted in a tertiary teaching hospital in Valenzuela City in 2014. It is recommended to determineprevalence of PIM use in other geriatric care settings, the predictors for PIM use, and the economic burden of PIM use.

Human ; Male ; Female ; Aged 80 And Over ; Aged ; Clonazepam ; Potentially Inappropriate Medication List ; Spironolactone ; Amiodarone ; Clonidine ; Ketorolac ; Orphenadrine ; Digoxin ; Ipratropium ; Insulin ; Hydroxyzine ; Fertility ; Prescriptions ; Patients

OBJECTIVEThe efficacy of bronchodilator in asthmatoid bronchitis remains controversial. This study was designed to investigate the effects of bronchodilators, salbutamo and ipraopium bromide, on the pulmonary function in young children with this disease.

METHODSPulmonary function tests were performed in 20 children with asthmatoid bronchitis (2 months-2.5 years of age) before and 30, 60, and 120 minutes after salbutamo and ipratropium bromide inhalation. The indexes of pulmonary function measured included tidal breathing flow volume (TBFV) loop, percent of tidal volume to peak tidal expiratory flow (%V-PF), terminal flows per peak expiratory flow (25/PF), peak tidal expiratory flow (PTEF), rate of mid-expiratory to mid-inspiratory flow (ME/MI), respiratory rate (RR) and tidal volume per kilogram (TV/kg).

RESULTSBefore drug inhalation, the descending branch of the TBFV loop was depressed. The PTEF shifted forward and %V-PF (0.19 +/- 0.04) and 25/PF (0.42 +/- 0.11) decreased. These changes did not improve and the remaining indexes, RR, ME/MI and TV/kg, 30, 60, and 120 minutes after drug inhalation also remained similar to before inhalation.

CONCLUSIONSSalbutamo and ipratropium bromide inhalation did not improve the airway resistance and ventilation function in children with asthmatoid bronchitis. This suggests that the efficacy of bronchodilator in the treatment of this disease is doubtful.

Administration, Inhalation ; Albuterol ; administration & dosage ; Asthma ; drug therapy ; physiopathology ; Bronchitis ; drug therapy ; physiopathology ; Bronchodilator Agents ; administration & dosage ; Child, Preschool ; Female ; Humans ; Infant ; Ipratropium ; administration & dosage ; Lung ; drug effects ; physiopathology ; Male

BACKGROUND: This study compared the bronchodilator efficacy and safety of tiotropium inhalation capsules (18microgram once daily) with a ipratropium metered dose inhaler (2 puffs of 20microgram q.i.d.) in patients with chronic obstructive pulmonary disease (COPD). METHOD: After the initial screening assessment and a two-week run-in period, patients received either tiotropium 18microgram once daily or ipratropium 40microgram four times daily over a period of 4 weeks in a double blind, double dummy, parallel group study. The outcome measures were the lung function, the daily records of the peak expiratory flow rate (PEFR), the patients' questionnaire, and the use of concomitant salbutamol. The forced expiratory volume in one second (FEV1) and the forced vital capacity (FVC) were measured 5 minutes before inhalation, and 0.5, 1, 2 and 3 hours after inhaling the study drug on days 0, 14 and 28. RESULT: In 16 centers, 134 patients with a mean (SD) age of 66 (7) years and a predicted FEV1 of 42 (12)% were analyzed. The trough FEV1 response was significantly higher in the tiotropium group than in the ipratropium group after a four-week treatment period. The weekly mean morning PEFR of the tiotropium group was consistently higher than that of the ipratropium group during the 4-week treatment period with differences ranging from 12.52 to 13.88 l/min, which were statistically significant. Tiotropium was well tolerated by the COPD patients during the 4-week treatment period and had a similar safety profile to ipratropium. CONCLUSION: This study shows that tiotropium administrated once daily has a superior bronchodilator effect with a similar safety profile in treating COPD patients compared with ipratropium, inhaled four times daily.
Adult* ; Albuterol ; Bronchodilator Agents ; Capsules ; Forced Expiratory Volume ; Humans ; Inhalation ; Ipratropium* ; Lung ; Mass Screening ; Metered Dose Inhalers ; Outcome Assessment (Health Care) ; Peak Expiratory Flow Rate ; Pulmonary Disease, Chronic Obstructive* ; Surveys and Questionnaires ; Vital Capacity ; Tiotropium Bromide

With the establishment of HPLC and LC-MS methods to determine the related substances and the content of active pharmaceutical ingredient (API) in ipratropium bromide aerosol products, several packing material-related impurities were identified, including antioxygen BHT and antioxygen 2246. Results showed that these leachable additives from the packing materials may present at a relative high level in the drug solution, and the low content of API in the drug products is usually due to the adsorption of the packing material as well as the leaking of contents. The current available assay methods for the control of ipratropium bromide aerosol products are often lack of specificity and unable to assure the drug quality effectively. To meet the increasing attention on the regulations of drug packing materials, our research would be a pilot study, indicating that the inappropriate packing materials could cause the migration and adsorption of the active ingredients, and the importance to have compatibility studies between packing materials and drugs.
Aerosols ; Antioxidants ; analysis ; Bronchodilator Agents ; administration & dosage ; chemistry ; Butylated Hydroxytoluene ; analysis ; Chromatography, High Pressure Liquid ; Drug Incompatibility ; Drug Packaging ; Ipratropium ; administration & dosage ; chemistry ; Quality Control ; Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization