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


12 Mar 2014

Routine Nebulized Ipratropium and Albuterol Together Are Better Than Either Alone in COPDHP here are several published reports of the efficacy of the combination of inhaled ipratropium bromide (IB) and various β-agonists in patients with COPD. Short-term studies generally dispensed combination and single-drug therapy at approved doses by metered-dose inhaler (MDI). They report improvement in pulmonary function over either agent alone with the addition of the second drug. Although the short-term studies were on small groups of patients, the improvement with combination therapy was statistically significant in most studies and not significant in only two of the studies. In only one study was the addition of a β-agonist bronchodilator (metaproterenol) of no additional benefit to usual-dose IB. Thus, combination therapy is potentially more effective than singleagent therapy and safer than using higher doses of the components.

In a long-term study, investigators compared the combination and single-drug therapy of IB and albuterol by MDI in 534 patients with COPD. They gave patients with moderately severe COPD either IB, 40 μg, or albuterol sulfate, 120 μg, or the combined drugs four times daily from an MDI over an 85-day period. Over the course of the study, the improvement in pulmonary function, primarily assessed by the change in FEVX following treatment with study medication, was significantly better for the combination than either of the single agents. There was no difference in the small number of adverse events with each of the three treatments. The authors concluded that the long-term administration of combination therapy given by MDI is more effective than single agents with at least equivalent safety to the same doses of single drug.
When inhaled from an MDI, the efficacy of higher doses of either agent in patients with COPD is not significantly improved with the addition of the other drug, but adverse events may be increased. Since the small-volume nebulizer (SVN) doses of these medications are different from those given by MDI, it is important to see if the dose selected for the SVN combination of IB (0.5 mg) and albuterol sulfate (3 mg) is effective and safe. We designed this study to compare the long-term safety and efficacy of the combination IB and albuterol sulfate inhalation solution with that of each separate component using three-times-daily administration in patients with COPD.

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