oxitropium and Bronchial-Hyperreactivity

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