The Duration of Action of the Combination of Fenoterol Hydrobromide and Ipratropium Bromide in Protecting Against Asthma Provoked by Hyperpnea

doi:10.1378/chest.94.4.709

Chest

Volume 94, Issue 4, October 1988, Pages 709-717

https://doi.org/10.1378/chest.94.4.709 Get rights and content

We compared the duration of the protective effect of two beta-adrenoceptor agonists, fenoterol (200 μg) and salbutamol (200 μg), the anticholinergic agent ipratropium (80 μg), and the combination of fenoterol (200 μg) and ipratropium (80 μg) against challenge by eucapnic voluntary hyperventilation (EVH). Twelve patients with asthma performed EVH for two or four min at 60 percent maximal voluntary ventilation, 30 min, 2 and 4 h after treatment. All treatments (Rx) produced significant bronchodilation after 30 min. The Rx containing a beta-adrenoceptor agonist maintained this bronchodilation for at least 2 h. While all the Rx with a beta-adrenoceptor agonist significantly reduced the fall in forced expiratory volume in one second after EVH at 30 min, only the combination of fenoterol and ipratropium provided significant protection after 2 h. We advise that the duration of protective effect of beta-adrenoceptor agonists is short and patients with moderate to severe exercise-induced asthma may be better controlled by combination therapy. (Chest 1988; 94:709-17)

Section snippets

SUBJECTS AND METHODS

We studied 12 patients with asthma who ranged in age from 13 to 30 years. Their anthropometric details and current medications are given in Table 1. Their medications during the trial, and for four weeks before the trial, remained constant For entry into the trial the following criteria were fulfilled. The subjects had (1) a forced expiratory volume in one second (FEV₁) greater than 1.2 L; (2) well-controlled asthma and could manage without bronchodilators for at least 4 h; (3) no other chronic

ANALYSIS OF RESULTS

The percentage fall in FEV₁ was calculated by subtracting the lowest value for FEV₁, measured after the challenge, from the value measured immediately before each challenge (pre-challenge value), and expressing it as a percentage of the pre-challenge value. When the fall in FEV₁ was less than 10 percent the response was regarded as negative. A fall in FEV₁ between 10 and 25 percent was regarded as a mild response, and a reduction greater than 25 percent, a moderate to severe response. A value

Effect of Treatments on Lung Function at Rest

The patients in this study generally had lung function that was within the normal range (Table 2). For the group, the mean values for FEV₁ on each test day were always greater than 83 percent of the predicted value and the mean maximum difference in FEV₁ between test days was 13.3 ± 6.9 percent. There was no significant difference between the pre-challenge values on each test day (Table 2). Thirty minutes after each active medication had been given, the FEV₁ was significantly higher compared

DISCUSSION

The results of this study show that the anticholinergic agent ipratropium, the beta-adrenoceptor agonists fenoterol and salbutamol, and the combination of fenoterol and ipratropium all induce significant bronchodilatation within 30 min after administration. At this time all the treatments containing a beta-adrenoceptor agonist completely blocked or markedly inhibited the reduction in FEV₁ after challenge with EVH. Although there was a statistically significant inhibition of the response by

ACKNOWLEDGMENTS

Thanks to Boehringer Ingelheim Pty Ltd and Glaxo Australia for providing the active drugs and their placebos.

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View all citing articles on Scopus

Supported by the National Health and Medical Research Council of Australia (C. M. Smith).

Manuscript received December 18; revision accepted March 16.

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Chest

The Duration of Action of the Combination of Fenoterol Hydrobromide and Ipratropium Bromide in Protecting Against Asthma Provoked by Hyperpnea

Section snippets

SUBJECTS AND METHODS

ANALYSIS OF RESULTS

Effect of Treatments on Lung Function at Rest

DISCUSSION

ACKNOWLEDGMENTS

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Chest

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Studies on pulmonary secretions: 1. the over-all chemical composition of pulmonary secretions from patients with cystic fibrosis, bronchiectasis, and laryngectomy

Am Rev Respir Dis

Studies on pulmonary secretions

Am Rev Respir Dis

Effects of temperature, relative humidity and mode of breathing on canine airway secretion

J Appl Physiol Respirat Environ Exercise Physiol

Regional differences in airway surface liquid composition

J Appl Physiol

Intraairway thermal profiles during exercise and hyperventilation in normal man

J Clin Invest

A comparison of the osmotic activation of basophils and human lung mast cells

Am Rev Respir Dis

Mediator release in an isolated airway segment in subjects with asthma

Am Rev Respir Dis

Suppression of exercise-induced asthma by salbutamol, theophylline, atropine, cromolyn, and placebo in a group of asthmatic children

Pediatrics

Exercise-induced asthma: the state of the art

Chest

Inhaled and oral salbutamol in exercise-induced asthma

Am Rev Respir Dis

Arterial plasma histamine levels at rest, during and after exercise in patients with asthma: effects of terbutaline aerosol

Thorax

Influence of albuterol, cromolyn sodium and ipratropium bromide on the airway and circulating mediator responses to allergen bronchial provocation in asthma

Am Rev Respir Dis

Inhaled and oral bronchodilator therapy in exercise-induced asthma

Aust NZ J Med

The protective effect and duration of action of metaproterenol aerosol on exercise-induced asthma

Ann Allergy

Use of serial exercise tests to assess the efficacy and duration of action of drugs for asthma

Thorax

EIA: new thinking and current management

J Respir Dis

Eucapnic voluntary hyperventilation of compressed gas mixture: a simple system for bronchial challenge by respiratory heat loss

Am Rev Respir Dis

Respiratory function tests: normal values at medium altitude and the prediction of normal results

Am Rev Respir Dis