oxitropium and Asthma--Exercise-Induced

Anticholinergic medications have been accepted as an important treatment modality in chronic bronchitis and chronic asthma, but their use in acute asthma is more controversial. A brief historical context of anticholinergics is given. The innervations of the lung that govern bronchoconstriction and bronchodilatation are reviewed. The pharmacological and neurological properties of anticholinergics make them excellent modalities for treatment of asthma. The benefits of anticholinergics in acute asthma, exercise-induced asthma, nocturnal asthma, and psychogenic asthma are reviewed. The use of anticholinergics in anaphylaxis with beta-blockade is examined.

Topics: Adrenergic beta-Antagonists; Adult; Anaphylaxis; Asthma; Asthma, Exercise-Induced; Bronchitis; Bronchoconstriction; Child; Child, Preschool; Cholinergic Antagonists; Chronic Disease; Glycopyrrolate; Humans; Lung; Parasympatholytics; Scopolamine Derivatives; Status Asthmaticus

A vagal mechanism appears to be involved in the development of exercise-induced asthma (EIA), although previous studies have failed to demonstrate a protective effect of anticholinergic drugs against post-exercise bronchoconstriction. To reassess this hypothesis the effect of a new anticholinergic drug, Oxitropium Bromide (OTB) has been studied in ten subjects with documented EIA. There was no change after inhalation of a placebo. Administration of OTB led to bronchodilatation and totally blocked post-exercise bronchoconstriction in 7 patients, and it did so partly in 2. The response to the drug appeared to depend on pretest respiratory function. Thus, the anticholinergic drug OTB may protect against EIA in most patients, confirming the role of a vagal cholinergic mechanism in EIA.

Topics: Adolescent; Adult; Asthma; Asthma, Exercise-Induced; Bronchi; Female; Humans; Male; Parasympatholytics; Scopolamine Derivatives

Oxitropium bromide (Ba 253) is a new inhaled bronchodilating agent with anticholinergic properties. The effect of this compound (100 micrograms) was compared to that of ipratropium bromide (40 micrograms), the beta 2-receptor stimulant fenoterol (400 micrograms) and placebo in 8 patients with exercise-induced asthma. The drugs were administered by metered dose inhalers, after which exercise test were performed on ergometer cycles at the times of the drugs' maximal effects. Forced expiratory volume during 1 S and vital capacity were recorded basally, repeatedly during 20 min after exercise and following the inhalation of isoprenaline (160 micrograms) which was given 20 min after exercise. Fenoterol possessed a very good protective effect against exercise-induced bronchoconstriction in all patients, whereas the other drugs differed very little from placebo. Thus, only 4 patients did benefit from ipratropium bromide, 1 patient from oxitropium bromide and 2 patients from placebo. No side effect occurred. In the doses used the two anticholinergic agents ipratropium bromide and oxitropium bromide were less effective than a beta 2-adrenoreceptor stimulant like fenoterol in protecting against exercise-induced asthma.

Topics: Adult; Asthma; Asthma, Exercise-Induced; Atropine Derivatives; Ethanolamines; Female; Fenoterol; Forced Expiratory Volume; Humans; Ipratropium; Male; Middle Aged; Scopolamine Derivatives; Vital Capacity

The mechanism of exercise-induced bronchoconstriction (EIB) was studied by observing the protective effects of several aerosol agents in a double-blind, randomised trial. Exercise-induced bronchoconstriction was not affected by placebo, but was reduced by each agent used (p less than 0.001). Blocking the parasympathetic system had the weakest effect, while beta 2 adrenergic stimulation produced the strongest effect which was significantly different from the parasympatholytic (p less than 0.02). The effect of the mast cell stabilizer, sodium cromoglycate (SCG) was found to be intermediate. However in some patients SCG had a stronger effect than the beta 2 adrenergic agonist. A relationship was found between EIB and bronchial hyperreactivity induced by histamine (p less than 0.05).

Topics: Adolescent; Asthma; Asthma, Exercise-Induced; Child; Clinical Trials as Topic; Cromolyn Sodium; Double-Blind Method; Ethanolamines; Female; Fenoterol; Forced Expiratory Volume; Humans; Male; Scopolamine Derivatives