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


24 Mar 2014

Routine Nebulized Ipratropium and Albuterol Together Are Better Than Either Alone in COPD: DiscussionTo minimize potential adverse effects, the use of submaximal doses of combination therapy of IB and a β-agonist has been advocated by investigators who have studied the response to maximal doses of both types of agents. Subjects were very tolerant to the dose of combination therapy used in the present study. Prior reports of combination therapy also reported a low incidence of side effects, equal to the incidence seen with single-drug therapy at the same dose. Since this was an 85-day study in which the subjects were patients who were being actively treated for their lung disease, it was expected that they would have the large number of episodes of worsening of their respiratory condition as found in this study. Adverse events that were attributed to study medication were rare and consisted of expected side effects of β-agonist (nervousness) and antimuscarinic therapy (dry mouth). Using the frequency of side effects and the well-being of the subjects, the safety of the SVN combination therapy was equal to the safety of the individual drugs. canadian neightbor pharmacy

The lack of significant changes in quality of life assessment, global evaluation, and symptom scores can be explained by the study design. This study was designed to assess the response in terms of pulmonary function. Patients were allowed to continue treatment with their concomitant medications, particularly theophylline, inhaled steroids, and oral steroids throughout the study except on test days. In addition, even the patients who had severe disease, as evidenced by a low mean baseline FEVX percent of predicted, had somewhat mild symptoms. Further, the routine SVN therapy used in this project was given three times daily, whereas most patients who take long-term therapy use four-times-daily therapy. This could have obscured improvements in some patients because of a possible decrease in their clinical status due to changing from their usual routine four-times-daily therapy.

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