oxitropium and Asthma

Inhaled short-acting anticholinergics (SAAC) and short-acting beta₂-agonists (SABA) are effective therapies for adult patients with acute asthma who present to the emergency department (ED). It is unclear, however, whether the combination of SAAC and SABA treatment is more effective in reducing hospitalisations compared to treatment with SABA alone.. To conduct an up-to-date systematic search and meta-analysis on the effectiveness of combined inhaled therapy (SAAC + SABA agents) vs. SABA alone to reduce hospitalisations in adult patients presenting to the ED with an exacerbation of asthma.. We searched MEDLINE, Embase, CINAHL, SCOPUS, LILACS, ProQuest Dissertations & Theses Global and evidence-based medicine (EBM) databases using controlled vocabulary, natural language terms, and a variety of specific and general terms for inhaled SAAC and SABA drugs. The search spanned from 1946 to July 2015. The Cochrane Airways Group provided search results from the Cochrane Airways Group Register of Trials which was most recently conducted in July 2016. An extensive search of the grey literature was completed to identify any other potentially relevant studies.. Included studies were randomised or controlled clinical trials comparing the effectiveness of combined inhaled therapy (SAAC and SABA) to SABA treatment alone to prevent hospitalisations in adults with acute asthma in the emergency department. Two independent review authors assessed studies for inclusion using pre-determined criteria.. For dichotomous outcomes, we calculated individual and pooled statistics as risk ratios (RR) or odds ratios (OR) with 95% confidence intervals (CI) using a random-effects model and reporting heterogeneity (I²). For continuous outcomes, we reported individual trial results using mean differences (MD) and pooled results as weighted mean differences (WMD) or standardised mean differences (SMD) with 95% CIs using a random-effects model.. We included 23 studies that involved a total of 2724 enrolled participants. Most studies were rated at unclear or high risk of bias.Overall, participants receiving combination inhaled therapy were less likely to be hospitalised (RR 0.72, 95% CI 0.59 to 0.87; participants = 2120; studies = 16; I² = 12%; moderate quality of evidence). An estimated 65 fewer patients per 1000 would require hospitalisation after receiving combination therapy (95% 30 to 95), compared to 231 per 1000 patients receiving SABA alone. Although combination inhaled therapy was more effective than SABA treatment alone in reducing hospitalisation in participants with severe asthma exacerbations, this was not found for participants with mild or moderate exacerbations (test for difference between subgroups P = 0.02).Participants receiving combination therapy were more likely to experience improved forced expiratory volume in one second (FEV₁) (MD 0.25 L, 95% CI 0.02 to 0.48; participants = 687; studies = 6; I² = 70%; low quality of evidence), peak expiratory flow (PEF) (MD 36.58 L/min, 95% CI 23.07 to 50.09; participants = 1056; studies = 12; I² = 25%; very low quality of evidence), increased percent change in PEF from baseline (MD 24.88, 95% CI 14.83 to 34.93; participants = 551; studies = 7; I² = 23%; moderate quality of evidence), and were less likely to return to the ED for additional care (RR 0.80, 95% CI 0.66 to 0.98; participants = 1180; studies = 5; I² = 0%; moderate quality of evidence) than participants receiving SABA alone.Participants receiving combination inhaled therapy were more likely to experience adverse events than those treated with SABA agents alone (OR 2.03, 95% CI 1.28 to 3.20; participants = 1392; studies = 11; I² = 14%; moderate quality of evidence). Among patients receiving combination therapy, 103 per 1000 were likely to report adverse events (95% 31 to 195 more) compared to 131 per 1000 patients receiving SABA alone.. Overall, combination inhaled therapy with SAAC and SABA reduced hospitalisation and improved pulmonary function in adults presenting to the ED with acute asthma. In particular, combination inhaled therapy was more effective in preventing hospitalisation in adults with severe asthma exacerbations who are at increased risk of hospitalisation, compared to those with mild-moderate exacerbations, who were at a lower risk to be hospitalised. A single dose of combination therapy and multiple doses both showed reductions in the risk of hospitalisation among adults with acute asthma. However, adults receiving combination therapy were more likely to experience adverse events, such as tremor, agitation, and palpitations, compared to patients receiving SABA alone.

Topics: Adrenergic beta-2 Receptor Agonists; Albuterol; Anti-Asthmatic Agents; Asthma; Atropine; Cholinergic Antagonists; Drug Therapy, Combination; Forced Expiratory Volume; Humans; Ipratropium; Levalbuterol; Metaproterenol; Randomized Controlled Trials as Topic; Scopolamine Derivatives

Inhaled anticholinergics as single agent bronchodilators (or in combination with beta(2)-agonists) are one of the several medications available for the treatment of acute asthma in children.. To determine the effectiveness of only inhaled anticholinergic drugs (i.e. administered alone), compared to a control in children over the age of two years with acute asthma.. The Cochrane Register of Controlled Trials (CENTRAL), and the Cochrane Airways Group Register of trials were searched by the Cochrane Airways Group. The latest search was performed in April 2011.. We included only randomised controlled trials (RCTs) in which inhaled anticholinergics were given as single therapy and compared with placebo or any other drug or drug combinations for children over the age of two years with acute asthma.. Two authors independently selected trials, extracted data and assessed trial quality.. Six studies met the inclusion criteria but were limited by small sample sizes, various treatment regimes used and outcomes assessed. The studies were overall of unclear quality. Data could only be pooled for the outcomes of treatment failure and hospitalisation. Other data could not be combined due to divergent outcome measurements. Meta-analysis revealed that children who received anticholinergics alone were significantly more likely to have treatment failure compared to those who received beta(2)-agonists from four trials on 171 children (odds ratio (OR) 2.27; 95% CI 1.08 to 4.75). Also, treatment failure on anticholinergics alone was more likely than when anticholinergics were combined with beta(2)-agonists from four trials on 173 children (OR 2.65; 95% CI 1.2 to 5.88). Data on clinical scores/symptoms that were measured on different scales were conflicting. Individual trials reported that lung function was superior in the combination group when compared with anticholinergic agents used alone. The use of anticholinergics was not found to be associated with significant side effects.. In children over the age of two years with acute asthma exacerbations, inhaled anticholinergics as single agent bronchodilators were less efficacious than beta(2)-agonists. Inhaled anticholinergics were also less efficacious than inhaled anticholinergics combined with beta(2)-agonists. Inhaled anticholinergic drugs alone are not appropriate for use as a single agent in children with acute asthma exacerbations.

Topics: Acute Disease; Administration, Inhalation; Adolescent; Adrenergic beta-2 Receptor Agonists; Albuterol; Asthma; Atropine; Bronchodilator Agents; Child; Child, Preschool; Cholinergic Antagonists; Drug Therapy, Combination; Fenoterol; Humans; Ipratropium; Metaproterenol; Randomized Controlled Trials as Topic; Scopolamine Derivatives; Treatment Failure

Anticholinergic agents have important uses as bronchodilators for the treatment of obstructive airway diseases, both asthma and, more particularly, chronic obstructive pulmonary disease (COPD). Those in approved clinical use are synthetic quaternary ammonium congeners of atropine, and include ipratropium bromide, oxitropium bromide, and tiotropium bromide, each of which is very poorly absorbed when given by inhalation. Ipratropium and oxitropium have relatively short durations of action (4-8 h). They have been widely used for many years, either alone or in combination with short-acting beta-adrenergic agents such as albuterol and fenoterol, for both maintenance treatment of stable disease and for acute exacerbations of airway obstruction. Tiotropium, which was introduced in the early 2000s, has a duration of action of at least 1-2 days making it suitable for once-daily maintenance treatment of COPD. All of the above agents have a wide therapeutic margin and are safe and well tolerated by patients.

Topics: Asthma; Bronchodilator Agents; Cholinergic Antagonists; Clinical Trials as Topic; Humans; Ipratropium; Pulmonary Disease, Chronic Obstructive; Scopolamine Derivatives; Tiotropium Bromide

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

Studies in both animals and man suggest a role for cholinergically-mediated reflex bronchoconstriction in the airflow limitation of asthma. Muscarinic cholinergic antagonists such as atropine, ipratropium bromide (IB) and oxitropium bromide (OB) when delivered locally to the airways are bronchodilators and antibronchoconstrictors. Although drugs like IB and OB offer advantages over some of the older anticholinergic preparations in terms of pharmacokinetics and therapeutic ratio, they cannot be considered as first line drugs in the therapy of acute asthma. However, when used in combination with other anti-asthma drugs, therapeutic benefit of inhaled IB and OB is obtained by maximising the bronchodilator properties of the individual drugs without attendant systemic side effects. Finally, the removal of the preservatives EDTA and benzylchonium chloride from Atrovent nebulizer solution has removed the risk of paradoxical bronchoconstriction occurring.

Topics: Acute Disease; Administration, Inhalation; Animals; Asthma; Bronchial Provocation Tests; Drug Therapy, Combination; Humans; Ipratropium; Parasympatholytics; Scopolamine Derivatives

The protective effect of inhaled anticholinergic drugs in the methacholine-induced bronchospasm is well-known. The objective of this study was to assess if any possible differences may be found among Ipratropium (IB), Oxitropium (OXI) and Tiotropium (TIO) pre-treatments to obtain the protective effect. Forty-four patients with intermittent bronchial asthma and PD(20)FEV(1) < 200 microg were selected (24 M, 20 F; mean age 32 +/- 8.8). On the baseline, they had mean FEV(1)%: 98.8 +/- 8.54 of theoretical and mean PD(15)FEV(1) 111.8 +/- 61.04 microg. After 72 hours, all patients underwent a second methacholine challenge and were given Ipratropium (40 microg by MDI in 14 pts) or Oxitropium (200 microg by MDI in 14 pts) or Tiotropium (18 microg by Handihaler in 16 pts) sixty minutes before the test. Sixty minutes after the bronchodilator inhalation, the FEV(1)% increase was higher (p < 0.05) in OXI (6.7 +/- 4.83%) and TIO groups (6.11 +/- 2.54%) than in the IB group (3.8 +/- 1.96%). In the IB group PD(15)FEV(1) and PD(20)FEV(1) were obtained in all patients, while in the OXI group they were obtained in 12 and 5 pts respectively and in the TIO group in 14 and 5 pts respectively. Normal hyperreactivity was obtained in 2 patients, in both OXI and TIO groups. In OXI and TIO, the PD(15) obtained after drug pre-medication, was similar (respectively 1628 +/- 955.7 and 1595.5 +/- 990 microg), but higher (p < 0.0001) in comparison to the PD(15) measured in the IB group (532.2 +/- 434.8 microg). Also, the dose-response slope (decline percentage of FEV(1)/cumulative methacholine dose) after PD(15) was similar in both OXI and TIO groups but different in the IB group. A significant relationship (p < 0.01) was found between PD(15)FEV(1) (obtained in 40 pts) and the increase in FEV(1)% obtained 60 minutes after bronchodilator inhalations (r = 0.53). In conclusion, with a standard dose, both Oxitropium and Tiotropium seem to have the same protective effect in bronchial asthma but higher than Ipratropium. It's probable that the best dose of Ipratropium should be a higher one than the usual dose taken.

Topics: Administration, Inhalation; Adult; Analysis of Variance; Asthma; Bronchial Hyperreactivity; Bronchial Provocation Tests; Cholinergic Antagonists; Dose-Response Relationship, Drug; Drug Administration Schedule; Female; Forced Expiratory Volume; Humans; Ipratropium; Male; Methacholine Chloride; Premedication; Probability; Reference Values; Respiratory Function Tests; Scopolamine Derivatives; Sensitivity and Specificity; Severity of Illness Index; Tiotropium Bromide; Treatment Outcome

The interaction between chronic hepatitis C virus (HCV) infection and bronchial asthma is of considerable interest. This study was designed to examine whether differences in airway responses to an inhaled anticholinergic agent exist between asthmatic patients with and without active HCV infection.. Controlled cross-sectional analysis.. University hospital.. Sixteen HCV-negative asthmatic patients and 36 HCV-positive asthmatic patients.. All HCV-positive patients received interferon (INF) therapy for 6 months (INF responders, 16 patients; INF nonresponders, 20 patients). No patient had received INF within 3 years of the start of the study.. Airway hyperreactivity to methacholine (ie, the provocative concentration of methacholine causing a 20% fall in FEV(1) [PC(20)]), maximal increase in FEV(1), and forced expiratory flow between 25% and 75% of FVC (FEF(25-75)) after the administration of oxitropium bromide (200 micro g) were examined. At the start of the study, the groups were well-matched with respect to age, body mass index, and baseline lung function, including methacholine PC(20). The mean (SD) increase in FEV(1) after oxitropium bromide administration was significantly greater in patients with active HCV (95 [7] mL) than in HCV-negative asthmatic patients (68 [12] mL) and asthmatic patients with inactive HCV infection (69 [6] mL; p < 0.001). The increase in FEF(25-75) after oxitropium bromide administration was also significantly greater (250 [90] mL/s vs 170 [90] and 180 [80] mL/s, respectively; p < 0.029).. In patients with asthma, active HCV infection is associated with increased bronchodilator responses to inhaled oxitropium bromide. HCV infection may modulate acetylcholine-mediated airway tone.

Topics: Administration, Inhalation; Asthma; Bronchial Hyperreactivity; Cross-Sectional Studies; Forced Expiratory Volume; Hepatitis C, Chronic; Humans; Interferons; Methacholine Chloride; Middle Aged; Parasympatholytics; Scopolamine Derivatives

International guidelines recommend multiple doses of inhaled beta2-agonists and anticholinergics plus early administration of systemic corticosteroids for acute, severe asthma. This study examined the efficacy of this protocol in adults and analyzed those factors associated with unresponsiveness to the protocol therapy.. Ninety-three consecutive patients 18 to 55 years old presenting for treatment of acute asthma with a peak expiratory flow rate (PEFR) < or = 50% of the predicted value were analyzed.. All subjects received 400 microg of salbutamol every 20 minutes for three doses and 400 microg of oxitropium bromide with each of the three salbutamol doses by means of a metered-dose inhaler with a spacer device, plus intravenously 8 mg betamethasone. PEFR was measured at baseline and at 20, 40, 60, and 120 minutes.. Sixty-nine percent of subjects improved sufficiently to be discharged. In 31% of subjects, the protocol therapy failed. There were no significant differences in age, sex, smoking status, or beta-agonist use within 6 hours between the two groups. Logistic regression analysis demonstrated that a PEFR < 35% of the predicted value at presentation (odds ratio [OR]; 16.3, 95% confidence interval [CI] 4.5 to 59.9), viral respiratory tract infection symptoms > or = 2 days (OR, 4.8, 95% CI 1.3 to 17.1), and asthma hospitalization in the past year (OR, 4.6, 95% CI 1.1 to 19.9) were significantly associated with unresponsiveness to the protocol.. Unresponsiveness to protocol therapy occurs in nearly one-third of individuals presenting with acute, severe asthma. Our findings underscore the need to explore more effective strategies for improving lung function and reducing hospital admission rates.

Topics: Acute Disease; Adolescent; Adrenergic beta-Agonists; Adult; Albuterol; Anti-Asthmatic Agents; Asthma; Betamethasone; Cholinergic Antagonists; Clinical Protocols; Consensus; Female; Humans; Male; Middle Aged; Peak Expiratory Flow Rate; Scopolamine Derivatives; Treatment Failure

The aim of the present study was to assess the reproducibility of changes in forced inspiratory volumes after bronchodilator inhalation. Thirteen patients with chronic obstructive pulmonary disease (COPD) (FEV1, 32-75%pred) and 10 patients with asthma (FEV1, 43-75%pred) inhaled either 200 microg fenoterol or 200 microg oxitropium bromide or placebo, each of them on three occasions, on nine different days in a randomised, cross-over, double-blind fashion. Forced expiratory (FEV1) and inspiratory (FIV1) volumes were measured before and 30 min after inhalation. In patients with COPD, the increase in FEV1 (coefficient of variation) was 221 ml (43%) after fenoterol and 235 ml (33%) after oxitropium; changes in FIV1 were 301 ml (45%) and 360 ml (29%). In patients with asthma, FEV1 improved by 618 ml (26%) and 482 ml (25%), FIV1 by 553 ml (41%) and 475 ml (23%). In less severe COPD or asthma, the reduction in dyspnoea was associated with the improvements in both FIV1 and FEV1, but in severe COPD with the improvement in FIV1 only. The data demonstrate that, at least in terms of relative changes, the reproducibility of bronchodilator responses in terms of FIV1 is similar to that of FEV1 and they underline the assertion of FIV1 being a sensible parameter particularly in severe COPD.

Topics: Adrenergic beta-Agonists; Aged; Asthma; Bronchodilator Agents; Cross-Over Studies; Double-Blind Method; Female; Fenoterol; Forced Expiratory Volume; Humans; Inspiratory Capacity; Male; Middle Aged; Parasympatholytics; Pulmonary Disease, Chronic Obstructive; Reproducibility of Results; Scopolamine Derivatives

The efficacy of combination therapy adding multiple doses of anticholinergics to beta(2)-agonists to improve outcome has not been established in adults with acute severe asthma.. This study was undertaken to compare the outcome of adults with acute severe asthma treated with 4 puffs of salbutamol (100 microg/actuation) every 20 minutes for 3 doses plus 4 puffs of oxitropium bromide (100 microg/actuation) with each of the 3 salbutamol doses versus salbutamol alone administered by means of a metered-dose inhaler with a spacer device.. A randomized, single-blind, placebo-controlled study was performed in 74 patients between 18 and 55 years old presenting to the emergency department (ED) for treatment of acute asthma with a peak expiratory flow (PEF) of 50% or less than the normal predicted value. The primary endpoint was improvement in PEF over the course. The secondary endpoint was the need for additional ED treatment at 120 minutes.. The increase in PEF over the course was significantly greater in the oxitropium plus salbutamol treatment group (P <.0001). The mean absolute difference in PEF at 120 minutes for combination therapy compared with salbutamol alone was 37.8 L/min (P =.001). In addition, the proportion of need for additional ED treatment was less in the combination group than the group receiving salbutamol alone (odds ratio, 0.32; 95% confidence interval, 0.11-0.90).. Adding multiple doses of oxitropium bromide to salbutamol delivered by means of a metered-dose inhaler with a spacer device for acute severe asthma produces a significant improvement in lung function and reduces the need for additional ED treatment.

Topics: Acute Disease; Administration, Inhalation; Adolescent; Adult; Albuterol; Asthma; Drug Delivery Systems; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Nebulizers and Vaporizers; Scopolamine Derivatives; Severity of Illness Index; Therapeutic Equivalency

Although the inhalation of beta2-agonists has frequently been used to relieve acute asthma attacks, the efficacy of anticholinergic agents for acute asthma attacks still remains unclear. This study was designed to compare the inhalation of fenoterol and the inhalation of fenoterol plus oxitropium bromide delivered by a metered-dose inhaler with holding chamber (InspirEase) to relieve acute asthma attacks. To accomplish this, 69 patients who had presented with an acute asthma attack were randomized to receive either fenoterol (1 puff [200 microg/puff] every 1 min for 5 min; total 1000 microg) or fenoterol plus oxitropium bromide (2 puffs [100 microg/puff] every 1 min for 5 min; total 1000 microg). The peak expiratory flow (PEF) and forced expiratory volume in 1 sec (FEV1) values were measured before treatment, and 1, 15, 30, and 60 min after the inhalation therapy. The ratios of improvement, PEF (or FEV1) after treatment divided by PEF (or FEV1) before treatment, were also calculated. Thirty-three patients were evaluated in the combination group and 31 patients were evaluated in the fenoterol group. The PEF value at 60 min after inhalation therapy of the fenoterol plus oxitropium bromide group (261 +/- 18 L/min, mean +/- standard error) was significantly higher compared to that of the fenoterol group (210 +/- 17 L/min). In addition, the ratios of improvement of PEF at 1, 15, 30, and 60 min after inhalation therapy were significantly higher in the fenoterol plus oxitropium bromide group compared with the fenoterol group.

Topics: Acute Disease; Asthma; Bronchodilator Agents; Drug Combinations; Female; Fenoterol; Forced Expiratory Volume; Humans; Male; Middle Aged; Nebulizers and Vaporizers; Peak Expiratory Flow Rate; Scopolamine Derivatives; Treatment Outcome

It has recently been shown that immunoglobulin (Ig)E facilitates the cholinergic bronchoconstrictor pathway in human tissue in vitro. However, whether this occurs in humans in vivo has not been clarified. In this study, the bronchodilator responses were examined to inhalation of a submaximal dose of the anticholinergic agent oxitropium bromide (600 microg) in normal and allergic subjects with various levels of total serum IgE. Values of the forced expiratory volume in one second (FEV1) for all subjects were greater than 80% of predicted, but were negatively correlated with serum IgE levels (p<0.01). Oxitropium bromide inhalation induced an increase in FEV1 that was significantly greater in allergic rhinitis patients with high serum IgE (155+/-20 mL (mean+/-SEM), p<0.05) than in healthy subjects (64+/-21 mL) or those with allergic rhinitis but low serum IgE (82+/-21 mL, p<0.05). In contrast, the effects of the inhaled beta2-adrenergic agent orciprenaline sulphate (2.25 mg) were not significantly different among the three groups. In conclusion, higher serum immunoglobulin E levels were correlated with lower values of the forced expiratory volume in one second, and anticholinergic agents, but not beta2-adrenergic agents, caused more pronounced bronchodilation in subjects with high than in those with low immunoglobulin E levels. These data suggest that serum immunoglobulin E may be one of the factors that determine the airway tone, possibly via cholinergic mechanisms.

Topics: Administration, Inhalation; Adult; Airway Resistance; Asthma; Cholinergic Fibers; Dose-Response Relationship, Drug; Female; Forced Expiratory Volume; Humans; Immunoglobulin E; Male; Parasympatholytics; Rhinitis, Allergic, Perennial; Rhinitis, Allergic, Seasonal; Scopolamine Derivatives; Single-Blind Method

The aim of this study was to evaluate the bronchodilating capacity of nebulized oxitropium bromide (OB) in preschool asthmatic children and to determine an appropriate dose for usage in this age group. The trial enrolled 20 patients with moderate to severe stable asthma aged between 3.2 and 6.2 years (mean 4.7). Applying a placebo controlled, double-blind design, the effect of placebo was compared with three different doses of OB (375, 750 and 1500 micrograms) and with 400 micrograms fenoterol. The three different doses of OB resulted in a highly significant bronchodilation within 15 min after administration. The observed bronchodilation was comparable between the three doses during the first 2 h. However, after 4 h the lowest dose was significantly less powerful than the highest dose. Compared to the additional bronchodilation induced by fenoterol, no difference was found with the degree of bronchodilation of OB which occurred during the first 2 h. Furthermore, after 4 h only the lowest dose of OB was significantly less powerful than fenoterol assessed 10 min following a single 400 micrograms dose.. Oxitropium bromide is a potent and long-acting bronchodilator in preschool children at a dose of 750 micrograms and 1500 micrograms. No side-effects were observed. The exact duration of action remains uncertain, but even 4 h after inhaling 750 or 1500 micrograms of OB no additive bronchodilation induced by fenoterol could be observed.

Topics: Aerosols; Analysis of Variance; Asthma; Bronchodilator Agents; Child; Child, Preschool; Double-Blind Method; Female; Fenoterol; Humans; Male; Parasympatholytics; Scopolamine Derivatives

The short-term and long-term effects of the anticholinergic agent oxitropium bromide (CAS 30286-75-0, OTB) were studied in nine elderly patients with bronchial asthma (8 men and 1 women, age: 69.5 +/- 5.2 years, 3 atopic and 6 (not atopic cases). 2 h after inhalation of 0.8 mg of OTB, forced vital capacity (FVC) had increased from 2.28 +/- 0.22 1 to 2.87 +/- 0.27 1 (p < 0.01), forced expiratory volume in 1 s (FEV1) had increased from 1.22 +/- 0.14 to 1.57 +/- 0.16 1 (p < 0.01), and respiratory resistance (Rrs) had decreased from 5.9 +/- 0.8 cmH2O/l/s to 4.9 +/- 0.7 cmH2O/l/s (p < 0.05). The patients inhaled OTB (0.2 mg t.i.d.) for 6 weeks. Their peak expiratory flow rates, measured each morning and each evening, increased significantly during the first 2 weeks of administration, and the increase was sustained for the entire weeks (p < 0.05). Other pulmonary-function tests were done before drug administration and again at the end of the 6 weeks. By the end of the 6th week of OTB administration, FVC had increased from 2.30 +/- 0.22 1 to 2.99 +/- 0.26 1 (p < 0.01), and FEV1 had increased from 1.25 +/- 0.17 to 1.70 +/- 0.22 1 (p < 0.05). These data indicate that OTB can be useful in the treatment of elderly patients with bronchial asthma.

Topics: Administration, Inhalation; Aged; Airway Resistance; Anti-Asthmatic Agents; Asthma; Cholinergic Antagonists; Female; Forced Expiratory Flow Rates; Humans; Male; Scopolamine Derivatives; Smoking; Vital Capacity

Using a randomized double blind study design, the bronchodilating effect of 200 micrograms inhaled oxitropium bromide (OB) was compared with 200 micrograms inhaled fenoterol (F) after an interval of 20 min, in 20 asthmatic children aged 12.7 years (range: 4.9-15.1 years), suffering from mild bronchoconstriction (mean forced expiratory volume during ls: 73.4%, range: 51%-85%). Both drugs induced a comparable degree of bronchodilatation and no significant differences were found between the OB group and the F group, suggesting equipotency for both drugs after a 20 min interval, at the 200 micrograms dose level. Furthermore, a significant improvement of lung function parameters was detected in both groups after subsequent administration of 400 micrograms F, indicating that inhalation of 200 micrograms of OB or F results in submaximal bronchodilation in asthmatic children suffering from mild bronchoconstriction.

Topics: Adolescent; Asthma; Bronchodilator Agents; Child; Child, Preschool; Double-Blind Method; Female; Fenoterol; Humans; Male; Respiratory Function Tests; Scopolamine Derivatives; Treatment Outcome

The effects of an antimuscarinic agent, oxitropium bromide (200 micrograms), a beta-2 adrenoceptor agonist, fenoterol (200 micrograms), and their combination, were compared in ten patients with chronic obstructive pulmonary disease and ten patients with bronchial asthma, in a placebo-controlled, single blind crossover trial. In patients with chronic obstructive pulmonary disease, oxitropium and fenoterol produced a significant and similar degree of bronchodilatation. The duration of the bronchodilator effect was 3 h after oxitropium and 4 h after fenoterol, respectively. The combination of oxitropium and fenoterol produced a significantly greater degree of bronchodilatation than either drug alone. The duration of bronchodilatation in combination was 7 h and was considerably longer than that of each drug alone. In patients with bronchial asthma, oxitropium and fenoterol also caused bronchodilatation. Their combination produced a significantly greater degree of bronchodilatation than when either drug was used. The duration of the bronchodilator effects were 5 h after oxitropium, 4 h after fenoterol and 5 h after the combination. We conclude that the combination of oxitropium and fenoterol causes greater bronchodilatation in patients with chronic obstructive pulmonary disease and bronchial asthma than when compared to each drug alone. In the former, the duration of bronchodilatation is additionally prolonged. These combination effects may be of value in the clinical management of these common respiratory disorders.

Topics: Aged; Asthma; Bronchodilator Agents; Drug Therapy, Combination; Female; Fenoterol; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Parasympatholytics; Scopolamine Derivatives; Single-Blind Method

The aim of this study was to compare the bronchodilator response of patients with either stable asthma or stable chronic bronchitis to the acute administration of oxitropium bromide and a beta agonist (fenoterol) when given both separately and together in order to determine the responses of these two groups of patients and the optimal doses of these agents when given in combination. The responses of 23 patients with asthma and 25 patients with chronic bronchitis to 400 micrograms of fenoterol, and 200 micrograms of oxitropium given either alone or together with 100, 200 or 400 micrograms of fenoterol was studied. The peak bronchodilator response to oxitropium bromide of the patients with chronic bronchitis was equivalent to the fenoterol response while, in the patients with asthma, the response to oxitropium bromide was approximately 30% of the response to fenoterol. In both groups of subjects the addition of oxitropium bromide to fenoterol significantly increased both the magnitude and the duration of the bronchodilator response without a significant increase in side effects. In both groups of subjects 200 micrograms of oxitropium bromide and 200 micrograms or more of fenoterol gave the optimal response.

Topics: Adult; Asthma; Bronchitis; Chronic Disease; Dose-Response Relationship, Drug; Double-Blind Method; Drug Therapy, Combination; Fenoterol; Humans; Middle Aged; Parasympatholytics; Scopolamine Derivatives

The mechanism of propranolol-induced bronchoconstriction (PIB) remains unclear. Previous uncontrolled studies have suggested that atropine antagonizes PIB in asthma. We conducted a randomized, double-blind, placebo-controlled study of the effect of a new anticholinergic agent, oxitropium bromide, on bronchoconstriction induced by inhaled propranolol in seven subjects with mild asthma 24 to 39 yr of age. Inhaled propranolol induced long-lasting reduction in specific airway conductance (SGaw) in all subjects. This was associated with airway beta-adrenoceptor blockade as demonstrated by a shift in the isoproterenol dose-response curve. Propranolol was less potent than methacholine, with a geometric mean dose causing a 35% fall in SGaw of 4.7 mumol for propranolol compared with 0.48 mumol for methacholine. Pretreatment with oxitropium 200 micrograms completely inhibited the fall in SGaw in response to inhaled propranolol in all subjects. Oxitropium also revealed PIB. Cholinergic receptor blockade by oxitropium inhibits bronchoconstriction induced by inhaled propranolol, supporting involvement of cholinergic mechanisms in PIB.

Topics: Adult; Asthma; Bronchi; Dose-Response Relationship, Drug; Double-Blind Method; Humans; Isoproterenol; Male; Methacholine Chloride; Methacholine Compounds; Parasympatholytics; Propranolol; Pulmonary Ventilation; Random Allocation; Scopolamine Derivatives

The effect of oxitropium bromide on lung mucociliary clearance, pulmonary function and viscoelastic properties of sputum was investigated in 10 asthmatics and 10 chronic bronchitics. A controlled, double-blind, crossover study was performed. Following a baseline (B) measurement the patients were, in a random order, allocated placebo (P) or oxitropium bromide (O; 0.1 mg/puff), administered from metered dose inhalers, which they used for 4 weeks at a dose of 2 puffs t.d.s. This test medication was used in conjunction with their normal medication. At the end of the treatment period the patients were assessed, the treatments were then crossed over and a final assessment made 4 weeks later. The administration of oxitropium bromide resulted in (1) small but statistically significant increases in pulmonary function (less than 10% vs. placebo); (2) increased penetrance of radioaerosol into the lungs (mean +/- SEM alveolar deposition: 35 +/- 3, 26 +/- 3 and 24 +/- 3% for the O, P and B runs respectively; p less than 0.025); (3) no significant change in particle clearance rate from the lungs despite their deeper penetration (mean +/- SEM area under the tracheobronchial clearance curves between 0 and 6 h: 317 +/- 26, 324 +/- 25 and 287 +/- 25%.h for the O, P and B runs respectively; p greater than 0.1); (4) no alteration in sputum production, and (5) no significant changes in apparent viscosity (mean +/- SEM: 640 +/- 162, 446 +/- 79 and 557 +/- 115 mPa.s for the O, P and B runs, respectively; p greater than 0.1) and elasticity (mean +/- SEM: 3,682 +/- 1,383, 1,779 +/- 353 and 2,061 +/- 366 mPa for the O, P and B runs, respectively; p greater than 0.1) of sputum. When the two groups, i.e. the chronic bronchitics and asthmatics, were studied separately, no significant differences in any parameter measured (other than radioaerosol penetrance which was significantly enhanced on oxitropium bromide in chronic bronchitics) were noted between the three assessments.

Topics: Aged; Asthma; Bronchitis; Chronic Disease; Clinical Trials as Topic; Double-Blind Method; Drug Administration Schedule; Humans; Middle Aged; Mucociliary Clearance; Parasympatholytics; Random Allocation; Scopolamine Derivatives

In some animal species substance P and neurokinin A (NKA) cause bronchoconstriction by the release of acetylcholine from postganglionic cholinergic nerve endings. The aim of the present study was to investigate the effect of an anticholinergic drug, oxitropium bromide, on bronchoprovocation with NKA in asthmatics. Eleven mild asthmatics (mean % predicted FEV1 85.5) received on 2 separate days, double blind, in a randomised order, 400 mcg oxitropium bromide or placebo, 90 min before challenge with NKA. NKA was inhaled at 3 concentrations (10(-4), 3.10(-4) and 10(-3) M). Specific airways conductance (sGaw) and forced expiratory volume in 1 s (FEV1) were used as parameters of airway calibre. Compared to the placebo-aerosol, oxitropium bromide caused a significant increase in sGaw and FEV1. On the placebo-treatment day, NKA caused a concentration-dependent decrease in sGaw and FEV1. The percentage changes in sGaw and FEV1 on the oxitropium day were not statistically different from those occurring on the placebo day. We conclude that oxitropium bromide caused a significant bronchodilation but offered no significant protection against NKA-induced bronchoconstriction in mild asthmatic subjects.

Topics: Adult; Asthma; Bronchoconstriction; Female; Humans; Male; Neurokinin A; Parasympatholytics; Scopolamine Derivatives

We have studied the antitussive effects of two anticholinergic agents, oxitropium bromide (200 micrograms) and ipratropium bromide (80 micrograms), and a combined beta-agonist and anticholinergic preparation containing fenoterol hydrobromide (200 micrograms) and ipratropium bromide (80 micrograms), in 16 normal and ten asthmatic volunteers in a double-blind, randomized, placebo-controlled crossover trial. Cough was induced by inhalation of ultrasonically nebulized distilled water and hypotonic saline solution. All treatments significantly reduced the cough response to inhaled distilled water aerosol when compared with placebo (p less than 0.001). There was no difference between oxitropium bromide and ipratropium bromide (p greater than 0.05), but the combination preparation displayed a greater antitussive effect than either oxitropium bromide (p less than 0.05) or ipratropium bromide (p less than 0.025). Cough frequencies in response to hypotonic 0.18 and 0.32 percent saline aerosol were lower than those obtained with distilled water (p less than 0.005) for all treatments. Asthmatic patients coughed less frequently than normal volunteers in response to all solutions when placebo was given (p less than 0.05), but there is no evidence to suggest that the response to treatment was different in the two groups. Our results suggest that inhaled anticholinergic bronchodilators alone or in combination with beta 2-adrenergic agonists might be effective in the treatment of pathologic cough.

Topics: Administration, Inhalation; Adult; Asthma; Atropine Derivatives; Bronchodilator Agents; Cough; Double-Blind Method; Drug Combinations; Drug Evaluation; Drug Synergism; Female; Fenoterol; Humans; Ipratropium; Male; Maximal Expiratory Flow Rate; Random Allocation; Scopolamine Derivatives

The effects of a new inhaled antimuscarinic drug, oxitropium bromide, and of a slow-release theophylline preparation upon nocturnal asthma were compared in a placebo-controlled double-blind study. Two samples were studied: 12 patients received oxitropium at 600 micrograms (6 subjects) or at 400 micrograms t.i.d. (6 subjects) whereas 11 received theophylline at 300 mg b.i.d. Morning dipping, assessed by the fall in peak flow overnight, was significantly reduced in the periods when either active drug was taken, whereas no difference was noticed during the placebo administration. No significant difference was noticed between results obtained with either active drug, as well as with either dosage of oxitropium. No subject reported side effects of oxitropium, as compared to three subjects reporting nausea, vomiting and tremors after theophylline. Oxitropium proves to be a valuable alternative to theophylline in nocturnal asthma, since it is equally potent, safer and does not require the titration of dosage.

Topics: Adolescent; Adult; Asthma; Clinical Trials as Topic; Delayed-Action Preparations; Double-Blind Method; Female; Humans; Male; Middle Aged; Parasympatholytics; Peak Expiratory Flow Rate; Scopolamine Derivatives; Theophylline

In order to determine the duration of action of the inhaled anticholinergic agent oxitropium bromide, a controlled study of the effect of pre-treatment with oxitropium bromide 200 micrograms against cholinergic challenge was carried out in ten asthmatic subjects (6 children, 4 adults). After baseline measurements of lung function (FEV1 and sGaw) and methacholine PC20 (the concentration of methacholine to produce a 20% fall in FEV1) oxitropium bromide or placebo were inhaled double-blind on 2 separate days. Lung function and methacholine PC20 were then measured at 1, 3 and 6 h post dosing. Oxitropium bromide caused significant protection from methacholine challenge for 6 h (p less than 0.05).

Topics: Adolescent; Adult; Asthma; Bronchi; Child; Female; Forced Expiratory Volume; Humans; Male; Methacholine Chloride; Methacholine Compounds; Middle Aged; Parasympatholytics; Parasympathomimetics; Respiratory Function Tests; Scopolamine Derivatives

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

Although the mechanisms of nocturnal asthma are still uncertain, increased vagal cholinergic tone may be contributory factor. To examine this hypothesis, we have studied the effect of an anticholinergic drug, oxitropium bromide, on the early morning fall in peak expiratory flow (PEF) in patients with nocturnal asthma. Eighteen patients (aged 18 to 76 years; seven men) with documented nocturnal asthma were studied in a double-blind randomized cross-over study in which they received either oxitropium bromide (200 micrograms or 400 micrograms) or placebo in a single dose at night for two-week periods. With placebo the mean (+/- SE) fall in PEF (expressed as percentage of evening PEF) was 17.3 +/- 2.0 percent, which was significantly reduced to 10.3 +/- 3.3 percent after oxitropium (400 micrograms) (p less than 0.05; ANOVA). Closer analysis revealed that nine of the 18 patients had responded in a dose-dependent manner, with the mean percentage decreases with placebo, 200 micrograms, and 400 micrograms of oxitropium being 19.1 +/- 3.2, 11.5 +/- 4.4, and 5.0 +/- 4.5 percent, respectively (p less than 0.01 between each treatment). The remaining patients were unaffected by therapy. There were no differences between "responders" and "non-responders" in terms of age, atopic status, duration of asthma, severity of asthma, or bronchodilator response to albuterol (salbutamol). There were no differences in nocturnal symptoms between periods of treatment, and no side effects were recorded. We conclude that anticholinergic drugs may protect against nocturnal asthma in some patients, indicating the involvement of vagal cholinergic mechanisms.

Topics: Administration, Inhalation; Adolescent; Adult; Aged; Asthma; Circadian Rhythm; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Male; Middle Aged; Parasympatholytics; Peak Expiratory Flow Rate; Random Allocation; Scopolamine Derivatives

The bronchodilator effect of a combination of 200 micrograms salbutamol and 200 micrograms oxitropium bromide, given as pressurized aerosols, was compared to that of 200 and 400 micrograms of salbutamol in a controlled experiment on adult patients with asthma. The combined and the high dose salbutamol treatments were equally effective with respect to the response measured 60 minutes after administration, and both were significantly superior to the low dose salbutamol treatment. Bronchodilation persisted longer following the combined treatment than following the low or high dose salbutamol treatment. The results suggest that enhancement of the early bronchodilator response obtained by adding oxitropium bromide to a conventional dose of salbutamol in patients with stable asthma reflects suboptimal dosing of salbutamol rather than differences between the agents in mechanisms of action, whereas enhancement in duration of response is related also to the pharmacological characteristics of oxitropium bromide.

Topics: Adult; Aerosols; Albuterol; Asthma; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Scopolamine Derivatives

Oxitropium bromide is an anticholinergic bronchodilator. In a randomized, controlled, single-dose study with 12 asthmatics we compared 2 metered aerosol doses of salbutamol (200 micrograms and 400 micrograms) with oxitropium bromide (200 micrograms), and the combination of oxitropium bromide (200 micrograms) and salbutamol (200 micrograms). Salbutamol acted more rapidly than oxitropium. There were no differences between the two drugs at 360 min. The combination of both drugs produced a better response than the individual drugs alone, but salbutamol in a dose of 400 micrograms caused the best response throughout the whole follow-up.

Topics: Adult; Albuterol; Asthma; Clinical Trials as Topic; Drug Therapy, Combination; Female; Forced Expiratory Volume; Humans; Male; Maximal Expiratory Flow Rate; Middle Aged; Random Allocation; Scopolamine Derivatives

Oxitropium bromide is a derivative of scopolamine and is an anticholinergic drug. Twenty asthmatics completed the study in which they received, in randomised double-blind fashion, placebo, ipratropium bromide 80 micrograms, and oxitropium bromide 200 micrograms. The patients recorded peak expiratory flow immediately before inhalation and up to 10 h afterwards. PEF were significantly higher than placebo between 10 min and 10 h, for both active treatments. There were no significant differences between values on oxitropium bromide and ipratropium bromide at any time points. Side effects were minimal and oxitropium bromide is an effective bronchodilator in asthma.

Topics: Aerosols; Aged; Asthma; Atropine Derivatives; Clinical Trials as Topic; Double-Blind Method; Female; Humans; Ipratropium; Male; Middle Aged; Peak Expiratory Flow Rate; Random Allocation; Scopolamine Derivatives; Time Factors

Sixteen young adult sufferers from extrinsic paroxysmal asthma with pollen hypersensitivity took part in a therapeutic trial of the synthetic anticholinergic agent oxitropium bromide administered by a metered dose inhaler. The study comprised three 3-week periods. The first, run-in period was carried out to confirm the ability of the patients to maintain a daily record of symptoms. During the second and third periods, the patient received 3 X 2 inhalations of drug or placebo in a cross-over design. The medical staff was blind to the nature of the aerosol (drug or placebo), which was given in random order. The run-in clinical score was high. Asymptomatic days were relatively infrequent and daily drug consumption was high. Functional studies between the cross-over periods showed flow-rate values close to normal, with an increase in residual volume and functional residual capacity. During treatment either with placebo or oxitropium, there was a statistically significant decrease in clinical scores. Results for oxitropium bromide treatment were significantly better than the run-in values (p less than 0.005) and the placebo period (p less than 0.02). There was no significant change in non-trial drug consumption. Functional values showed no difference in terms of flow rate, although oxitropium did cause a significant improvement in the RV/TLC ratio (p less than 0.05). No adverse reactions were reported.

Topics: Administration, Intranasal; Adolescent; Adult; Aerosols; Asthma; Clinical Trials as Topic; Double-Blind Method; Female; Functional Residual Capacity; Humans; Male; Middle Aged; Parasympatholytics; Pulmonary Ventilation; Residual Volume; Scopolamine Derivatives

This paper reviews briefly the place of ipratropium bromide in the treatment of airways obstruction. Oxitropium bromide, a new quaternary ammonium compound derived from scopolamine was shown to be as effective a bronchodilator in a dose of 200 micrograms by inhalation as ipratropium bromide 80 micrograms in 20 patients with atopic asthma.

Topics: Asthma; Atropine Derivatives; Clinical Trials as Topic; Dose-Response Relationship, Drug; Double-Blind Method; Humans; Ipratropium; Parasympatholytics; Peak Expiratory Flow Rate; Scopolamine Derivatives

Topics: Adolescent; Adult; Albuterol; Asthma; Clinical Trials as Topic; Dose-Response Relationship, Drug; Female; Forced Expiratory Volume; Humans; Male; Middle Aged; 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

Two double-blind studies were performed in allergic subjects with bronchial asthma to evaluate the bronchodilator effect and antiallergic protection of oxitropium bromide (OTB), a new antiallergic drug. Study 1, bronchodilator trial: 2 puffs of OTB or provocation tests in 12 subjects each. The bronchodilator effect of FEN was significantly better (between 0 and 30 min after drug administration). At the same time there was an improvement of PaO2 after FEN (before: 62.4 Torr; after: 70.1 Torr), but not after OTB. Study 2, antiallergic protection: OTB or FEN were administered 30 min before bronchial allergen provocation tests in 12 subjects each, complemented by open DSCG controls. All 3 drugs provided significant protection compared with nonmedicated control tests, but only inhibition of FEN was complete. In conclusion, beta 2-adrenergic drugs seem to be superior to anticholinergic drugs in allergic asthma, not only as bronchodilators, but also as prophylactic agents.

Topics: Adult; Asthma; Bronchial Provocation Tests; Bronchodilator Agents; Clinical Trials as Topic; Cromolyn Sodium; Double-Blind Method; Ethanolamines; Female; Fenoterol; Humans; Male; Scopolamine Derivatives

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

The changes in FEV1 and in specific conductance induced by 200 micrograms oxitropium bromide given as pressurized aerosol were measured at 8 time intervals during 7 hours after inhalation in a group of 19 patients with reversible broncho-obstruction. The working of the drug was compared to the functional values observed at the same time intervals after placebo, 40 micrograms ipratropium bromide and 400 micrograms fenoterol. Both oxitropium and ipratropium were definitely and significantly superior to placebo at all time intervals. Oxitropium was superior to ipratropium at the 7th hour. At this time interval the difference was significant At the 7th hour oxitropium gave higher mean results than fenoterol, but this difference was not significant. The drug was also compared to its competitors regarding its subjective and cardiovascular tolerance. No unfavourable side-effects were observed.

Topics: Adrenergic beta-Agonists; Adult; Asthma; Blood Pressure; Bronchitis; Bronchodilator Agents; Fenoterol; Forced Expiratory Volume; Humans; Ipratropium; Male; Placebos; Scopolamine Derivatives; Time Factors

Airway-wall remodelling may result in reduced airway distensibility in bronchial asthma. This study evaluated the baseline airway calibre and distensibility in asthmatic patients by means of high-resolution computed tomography (HRCT).. We studied seven patients (two men, age range 36-69 years) with chronic asthma [forced expiratory volume in the first second (FEV(1)) range: 30%-87% of predicted; FEV1/forced vital capacity (FVC) range 48%-75% of predicted) under stable clinical conditions and six healthy control subjects (three men, age range 29-50 years). In all subjects, HRCT scanning, at suspended end-expiratory volume, was performed at rest and during ventilation with 6 and 12 cmH(2)O by nasal insufflation with continuous positive airway pressure (nCPAP), both at baseline and after inhalation of 200 mug oxitropium bromide metered dose inhaler (MDI). External and lumen diameter (mm) of the right apical upper lobe bronchus were measured in all HRCT scans.. In asthmatics, 12 cmH(2)O insufflation significantly changed baseline lumen (3.3+/-0.7 mm vs. 3.8+/-0.6 mm; p<0.01) and external diameter (6.2+/-0.9 mm vs. 6.7+/-0.8 mm; p<0.05), whereas in healthy controls, both 6 and 12 cmH(2)O insufflation significantly changed baseline lumen diameter (4.0+/-1.6 mm vs. 4.8+/-1.6 mm and 4.7+/-1.7 mm; p<0.01). In asthmatic patients, oxitropium bromide inhalation significantly changed baseline lumen diameter (3.3+/-0.7 mm vs. 4.4+/-0.6 mm; p<0.05), whereas the application of 6 or 12 cmH(2)O insufflation did not modify any bronchial diameters. In healthy controls, oxitropium bromide inhalation significantly changed baseline lumen diameter (4.0+/-.6 mm vs. 5+/-1.5 mm; p<0.05). The application of 12 cmH(2)O but not of 6 cmH(2)O induced a significant change in lumen diameter (5.0+/-1.5 mm vs. 6,0+/-1.6 mm; p<0.05).. Our results show that airway distensibility in asthmatic patients, as assessed by HRCT, can differ compared with that of healthy controls. HRCT can provide useful information on airway distensibility.

Topics: Adult; Aged; Asthma; Bronchi; Bronchography; Continuous Positive Airway Pressure; Female; Forced Expiratory Volume; Functional Residual Capacity; Humans; Image Processing, Computer-Assisted; Insufflation; Lung; Lung Compliance; Male; Metered Dose Inhalers; Middle Aged; Parasympatholytics; Scopolamine Derivatives; Spirometry; Tomography, X-Ray Computed

Topics: Asthma; Bronchitis; Humans; Parasympatholytics; Scopolamine Derivatives

Oxitropium bromide (Tersigat pressurized aerosol) is a new anticholinergic agent. Two puffs of 100 micrograms given in 27 adult patients with asthma produced a 33% mean increase in FEVI, significantly bigger than the 20.9% increase obtained by an intra-muscular injection of theophylline (240 mg) in the same patients.

Topics: Aerosols; Asthma; Bronchodilator Agents; Humans; Parasympatholytics; Scopolamine Derivatives; Theophylline

A marked protective effect of 0.2 mg oxytropium bromide (Ba 253), administered by inhalation, was observed against experimental provocation with a 3% acetylcholine solution. There is no difference between application by means of a metered dose inhaler or by means of powder inhalation. There is no marked protective effect of 0.2 mg oxytropium bromide administered by inhalation (aerosol or powder) against experimental provocation with a 0.3% histamine solution.

Topics: Acetylcholine; Adolescent; Adult; Asthma; Bronchial Provocation Tests; Bronchodilator Agents; Histamine Antagonists; Humans; Male; Parasympatholytics; Scopolamine Derivatives