methylatropine and Lung-Diseases--Obstructive

Adrenergic bronchodilators have the potential drawback that they may increase hypoxemia in spite of relieving air-flow obstruction in patients with asthma. Anticholinergic bronchodilators are of interest as alternatives to beta-adrenergic agents, particularly in patients with chronic bronchitis and emphysema, yet little is known of the effects of either class of agent on gas exchange in patients with this diagnosis. We compared their effects on gas exchange in 12 patients with chronic bronchitis and emphysema who also had arterial hypoxemia in a double-blind crossover study. We found that nebulized atropine methonitrate, a quaternary ammonium anticholinergic bronchodilator, resulted in only minor and statistically insignificant effects on gas exchange at all times for as long as 60 min after its inhalation. In contrast, the beta-adrenergic bronchodilator metaproterenol hydrochloride resulted in a statistically significant decrease in the PaO2, the greatest mean decrease being 5.0 +/- 2.5 mm Hg (mean +/- 1 SD). The effects of metaproterenol on arterial blood gases in this population of patients were more prolonged than those previously reported in asthmatic subjects with lesser degrees of hypoxemia. An anticholinergic bronchodilator might be preferable in patients with hypoxemia caused by chronic bronchitis and emphysema in that it does not carry the risk of worsening systemic hypoxemia.

Topics: Aged; Atropine Derivatives; Bronchodilator Agents; Carbon Dioxide; Forced Expiratory Volume; Humans; Hypoxia; Lung Diseases, Obstructive; Metaproterenol; Middle Aged; Oxygen; Pulmonary Gas Exchange

The therapeutic value of 80 micrograms atropine methonitrate delivered per metered aerosol and its combination with 450 micrograms reproterol was investigated in a controlled double-blind cross-over trial in 17 patients with chronic bronchitis and airway obstruction. All patients were atropine responders. According to the parameters of FEV1 and SGaw atropine methonitrate induced a statistically definite and clinically relevant bronchodilation for more than 3 h compared with placebo. The combination of 80 micrograms atropine methonitrate and 450 micrograms reproterol, however, proved to be clearly superior compared with the mono-compound atropine methonitrate.

Topics: Aerosols; Atropine Derivatives; Bronchitis; Bronchodilator Agents; Clinical Trials as Topic; Double-Blind Method; Drug Combinations; Drug Therapy, Combination; Female; Humans; Lung Diseases, Obstructive; Male; Metaproterenol; Middle Aged; Theophylline; Time Factors

Topics: Adult; Albuterol; Atropine Derivatives; Delayed-Action Preparations; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Respiration; Respiratory Function Tests

In order to delineate the clinical profiles which correspond to different patterns of responsiveness to inhaled anticholinergic drugs (i.e. atropine methonitrate, ipratropium bromide), 102 subjects tested with these drugs and with beta 2-adrenergic bronchodilators were classified into three groups, namely: a group with positive skin prick tests (group 1), a group with blood or sputum eosinophilia but negative skin prick tests (group 2), and a group with negative skin prick tests and neither blood nor sputum eosinophilia (group 3). All had reversible airflow obstruction and their clinical profiles closely corresponded to atopic asthma, non-atopic asthma and chronic bronchitis, respectively, but the prevalence of mucus hypersecretion was similar in all three groups. Pharmacologically, group 1 patients were distinguished from the other two groups by their significant impairment of 1-second forced expiratory volume response to the bronchodilator action of anticholinergic drugs. This is the physiological correlate of atopic asthma.

Topics: Adult; Aged; Airway Resistance; Albuterol; Asthma; Atropine Derivatives; Bronchitis; Female; Forced Expiratory Volume; Humans; Ipratropium; Isoproterenol; Lung Diseases, Obstructive; Male; Middle Aged; Parasympatholytics; Respiratory Hypersensitivity

85 subjects with 20% reversibility in FEV1 were classified into the categories of asthma (55 patients) and non-specific airflow obstruction (30 patients), respectively, on the basis of the presence or absence of eosinophilia (in the blood or sputum). Asthmatics were further subdivided into the atopic and non-atopic subgroups, respectively, on the basis of skin prick tests. Clinically, paroxysmal nocturnal wheezing was more significantly associated with asthma than with non-specific airflow obstruction. Atopic asthmatics were distinguished from patients with non-specific airflow obstruction by their younger age at presentation and at onset of obstructive symptoms, by a history of allergic provocation of wheezing, a family history of asthma and other atopic diseases, and by a lower incidence of mucus hypersecretion. The last 3 symptoms also distinguished atopic from non-atopic asthma. Furthermore, unlike patients with non-atopic asthma or patients with non-specific airflow obstruction, atopic asthmatics had a significant impairment of bronchodilator responsiveness to inhaled anticholinergic drugs.

Topics: Adolescent; Adult; Aged; Airway Resistance; Albuterol; Asthma; Atropine Derivatives; Bronchial Provocation Tests; Eosinophilia; Female; Forced Expiratory Volume; Humans; Intradermal Tests; Ipratropium; Isoproterenol; Lung Diseases, Obstructive; Male; Middle Aged; Parasympatholytics; Respiratory Hypersensitivity

The effects of atropine methonitrate and salbutamol delivered by wet nebulisation, separately and in combination, were studied in 22 patients with chronic airways obstruction. Atropine methonitrate 1.5 mg, 3.0 mg and 6.0 mg, salbutamol 2.5 mg, 5.0 mg and 10.0 mg and the intermediate dose of each agent in combination were used. Peak expiratory flow rat (PEFR), forced expiratory volume in 1 S (FEV1.0) and forced vital capacity (FVC) were measured. Improvement in the measured variables were greater after salbutamol, alone or with atropine, up to 3 h after inhalation, after salbutamol with atropine 4 and 6 h after inhalation, and after atropine, alone or with salbutamol, 12 h after inhalation. For all patients together there were no significant differences in the mean maximum PEFR, FEV1.0 or FVC that were achieved following atropine, salbutamol or both together. Salbutamol, 5.0 or 10.0 mg, and atropine methonitrate, 1.5 or 3.0 mg, were maximally effective in most patients and at these doses serious side effects were unusual.

Topics: Adult; Aged; Albuterol; Atropine Derivatives; Drug Combinations; Female; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Peak Expiratory Flow Rate; Vital Capacity