Routine Nebulized Ipratropium and Albuterol Together Are Better Than Either Alone in COPD: Conclusion


26 Mar 2014

In our study patients with COPD, maintenance SVN therapy with IB and albuterol provided better bronchodilation than either therapy alone without increasing side effects. Although most patients did well on a three-times-daily regimen, the occasional use of rescue medication by our subjects may indicate that some patients require therapy more often than three times daily. Although many patients can properly use MDIs there continues to be a population of patients who are either incapable or unwilling to use this approach, even for long-term treatment. The use of the combination solution would simplify the treatment routine for many of them.
The role of SVN therapy remains controversial, mainly because MDI treatment is effective and more economical and convenient. In a series of investigations, many COPD patients were found to benefit from home nebulizer therapy. In one study, each patient was randomly given nebulizer therapy for 3 weeks of IB plus fenoterol and 3 weeks of saline solution. Additional 3-week periods before and after nebulizer therapy were used to evaluate usual therapy that included routine MDI treatment. Patients had statistically significantly improved function measured by PEFR and decreased need for “rescue” puffs of inhaler medicine while taking the IB (3-agonist combination by nebulizer. Using these evaluations, the authors concluded that 11 of 20 patients studied would benefit from long-term SVN therapy. In another investigation, patients with chronic asthma or bronchitis were given various types of inhalation therapy. One 2-week period was with terbutaline and IB given with separate MDI inhalers. A spacer (Nebuhaler; Astra Pharmaceuticals Ltd; Kings Langley, UK) was used with other measures to provide maximal therapy with the inhalers. A 1-month trial each of albuterol (5.0 mg), IB (0.5 mg), and the combination was also given by SVN four times daily. Four of 49 subjects did not respond subjectively or objectively to any form of therapy. Five patients responded to the spacer device therapy and were not advanced to nebulizer therapy. Of the patients who were given nebulizer therapy, eight preferred the spacer device therapy and 32 preferred and requested home nebulizer therapy. Based on objective improvement, 28 of the original 49 patients were given home SVN therapy for >1 year and derived subjective and objective benefit from this therapy. Thus, although the role of SVN therapy remains controversial, there are some patients who might benefit from it compared to the routine use of MDI therapy.

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