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Query: UMLS:C0010200 (cough)
 23,843 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In a randomized, double-blind, crossover study consisting of three 1-month periods, we compared the effects of ipratropium bromide (IB) 120 micrograms delivered by a metered dose inhaler (MDI) against two different doses of IB (125 micrograms and 500 micrograms) delivered by a gas driven nebulizer. Thirty-two patients (mean age 57.1 years, range 17-78) with severe airflow obstruction (mean PEFR 192 litres/min, range 75-380 litres/min) were recruited to the study. They had a maximum documented reversibility of over 20% (mean 55.2, range 25-200), and an improvement of over 13% (mean 26.3, range 13-56) in the PEFR to a test dose of 120 micrograms IB delivered by a MDI. In the 20 patients who completed the trial no significant differences were found between the treatment periods when comparisons were made of the weekly averages for the morning PEFR, evening PEFR, reversibility, diurnal variation of the PEFR, bronchodilator and steroid usage. The monthly assessments of FEV1, FVC, VC, RV/TLC ratio and the single breath transfer factor showed all three treatments to be better than the base-line assessment (P less than 0.001), but overall there was no significant difference between treatments. The 6-minute walking distance did not show any improvement over the base-line values with any of the treatments. Symptom scores also showed no overall difference between treatments except for cough which was worse on the 500 micrograms nebulizer solution (P less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:A comparison of metered dose inhalers with nebulizers from the delivery of ipratropium bromide in domiciliary practice. 294 67

A multi-center, double-blind, 90-day study compared an ipratropium bromide metered-dose inhaler (40 microgram four times a day) with a metaproterenol metered-dose inhaler (1,500 micrograms four times a day) in 164 patients with asthma; of the 144 patients who completed the study, 71 received ipratropium and 73 received metaproterenol. Our results suggest that both drugs were equally effective bronchodilators. Although the shape of the pulmonary function response curves suggested that ipratropium has different bronchodilator kinetics than metaproterenol (in that it has a slower onset of action and a more prolonged duration), comparison of the areas under the curves for the two drugs showed that there was no statistical difference between ipratropium or metaproterenol. The only significant side effects noted with ipratropium were cough and exacerbation of symptoms; no anticholinergic side effects were noted.
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PMID:Use of ipratropium bromide in asthma. Results of a multi-clinic study. 294 62

The effect of the combination fenoterol-ipratropium bromide (Duovent) as a bronchodilator drug versus salbutamol and placebo was investigated in 20 patients with chronic obstructive lung disease in a random cross-over trial. Our study was performed not only to evaluate the bronchodilator response, but especially to quantify the possibly more prolonged action of Duovent versus salbutamol, based on registration of prevention of asthma attacks, time effects and protective activity, management and tolerance. Each patient received therapy for 3 weeks; in each week only one of the preparations: salbutamol, Duovent or placebo was used. Respiratory function tests were determined every week on the 3rd, 5th and 7th days at the same time exactly at 30 and 60 min after drug inhalation. Additionally we registered, for each patient, daily symptomatology (e.g., asthma attacks, cough, additional daily puff use, adverse reactions) by using a personal clinical diary. The results and analysis of the pulmonary tests (especially FEV1 and peak expiratory flow) confirmed the bronchodilator effect of both drugs, higher for Duovent but not sufficient to reach statistical significance. Clinical condition, regarding number, severity of asthma crises and additional puff use, showed a significant statistical variation for each symptom either as regards advantage of Duovent and salbutamol versus placebo, or advantage of Duovent versus salbutamol. Therefore, the results of this trial reveal an excellent bronchodilator effect of both drugs and confirm a higher clinical efficacy of Duovent if used in long-term treatment, with good tolerability.
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PMID:Protective effect of Duovent versus salbutamol in long-term treatment. 295 14

A group of patients suffering from chronic obstructive lung disease, selected according to clinical criteria and respiratory function, were treated daily for at least 84 days using a metered aerosol containing a combination of a beta 2-agonist (fenoterol) and an atropine-like drug (ipratropium bromide). Every 14 days, respiratory and cardiovascular function was measured and analysed statistically. Information was compiled daily by the patients themselves on dyspnoea, cough, peak flow, any increase in dosage over the recommended dose and any side-effects that might have developed. The results obtained demonstrated that the combination of fenoterol and ipratropium bromide produced clear improvements in respiratory function and symptomatology throughout the observation period. The drug was well tolerated by the majority of patients.
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PMID:Controlled clinical study of a long-term treatment of chronic obstructive lung disease using a combination of fenoterol and ipratropium bromide in aerosol form. 295 16

A special inhalative device is described for reproducible deposition patterns of radioactive aerosols to measure mucociliary and tussive clearance and to evaluate the effect of drugs on the bronchial tree. Additive actions on mucus transport exist between beta 2-agonists and theophylline, but not in combination with inhalative quaternary ammonium compounds (ipatropium and oxitropium bromide). Mucolytics are generally less effective on mucociliary clearance than beta 2-agonists and theophylline, positive, negative and nonresponders are often seen due to the different viscoelastic properties of the mucus. Mucus transport is more than mucociliary clearance. Two-phase gas/liquid movement and coughing are also important transport mechanisms for bronchial mucus. Therefore, bronchodilators enhance mucus transport by increasing airway patency, which increases total and regional air flow and improves cough clearance.
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PMID:Deposition of aerosols and bronchial clearance measurements. 295 9

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.
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PMID:Antitussive properties of inhaled bronchodilators on induced cough. 296 64

In seven normal subjects we investigated whether a nonadrenergic bronchodilator nervous system is demonstrable in humans in vivo. After inhalation of leukotriene D4 (LTD4), respiratory resistance (Rrs) increased by 115 +/- 11% (SE). Subsequent inhalation of 2 nmol of capsaicin induced coughing and a fall in Rrs of 22.1 +/- 2% (P less than 0.01). However, inhalation of the diluent of capsaicin, 10% saline-ethanol, decreased Rrs similarly. These bronchodilator responses were not altered by inhaled ipratropium bromide (120 micrograms) and oral propranolol (80 mg). After ipratropium and propranolol, voluntary coughing alone decreased Rrs by 25 +/- 3% (P less than 0.05). We next investigated whether these bronchodilator responses could be blocked by anesthesia of the airways with inhaled lidocaine. After inhalation of lidocaine and LTD4, capsaicin aerosol induced coughing and a transient increase in Rrs of 18 +/- 6% (P less than 0.05) but no bronchodilation. Inhalation of saline-ethanol (n = 4) and a deep inhalation (n = 6) decreased Rrs by 18 +/- 4% (P less than 0.05) and 34 +/- 3% (P less than 0.001), respectively. We conclude that in normal subjects a nonadrenergic, noncholinergic bronchodilator mechanism exists, which can be activated by inhalation of capsaicin and inhibited by local anesthesia.
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PMID:Nonadrenergic bronchodilator mechanisms in normal human subjects in vivo. 296 70

A placebo-controlled study was performed to compare the effect of the inhalation of ipratropium bromide as a powder (capsule = 40 micrograms) and by pressurized aerosol (two puffs of 20 micrograms; ie, 40 micrograms). Fifteen patients (nine males and six females) with chronic obstructive pulmonary disease were studied in a double-blind crossover comparison of the two different modes of administration. The VC, FEV1 and viscous work of breathing time-response curves were almost identical, indicating bronchodilation. We conclude that in patients with chronic obstructive pulmonary disease, the powder inhalation was not more effective than the pressurized aerosol. It could, however, be offered as an alternative to patients with poor hand-lung coordination. The patients tolerated the two modes of administration without difficulties: no local irritation or coughing was observed.
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PMID:A placebo-controlled comparison between the bronchodilatory effects of ipratropium bromide inhaled as a dry powder and by metered dose inhaler in chronic obstructive pulmonary disease. 297 69

The chemistry, pharmacology, pharmacokinetics, clinical efficacy, adverse effects, and dosage of ipratropium bromide are reviewed. Ipratropium bromide, a synthetic quaternary isopropyl derivative of atropine, interrupts vagally mediated bronchoconstriction by inhibiting the cyclic guanosine 3',5'-monophosphate system at parasympathetic nerve endings. Ipratropium bromide is poorly absorbed after oral and inhaled administration but diffuses rapidly into tissue after i.v. or i.m. administration. The elimination half-life is 3.2-3.8 hours. After inhalation, the drug is eliminated in the urine and feces. The bronchodilatory effect of ipratropium bromide in stable chronic obstructive pulmonary disease appears to be comparable, and may be superior, to that of the beta-sympathomimetic agents. In acute exacerbations, ipratropium bromide is useful but may not be the preferred agent because of a delayed onset of action (within 15 minutes; mean dose-dependent duration of effect, three to five hours). Combination therapy with other bronchodilating drugs has proved useful. Ipratropium bromide may be a useful adjunctive agent in the treatment of asthma. Since the onset of action is delayed, ipratropium bromide should not be used as single-drug therapy in an acute asthmatic exacerbation. Reported adverse effects, including cough, nausea, palpitations, dry mouth, nervousness, gastrointestinal distress, and dizziness, have been mild. The usual dosage is two inhalations (36 micrograms) four times daily, and the maximum number of doses per day should not exceed 12. Although ipratropium bromide is currently indicated only for maintenance therapy in stable chronic bronchitis and emphysema, it may be useful as adjunctive therapy in asthma and in the management of acute exacerbations of chronic bronchitis and asthma. Additional experience in a variety of chronic obstructive pulmonary disorders will help to clarify the role of ipratropium bromide in the treatment of obstructive pulmonary disease.
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PMID:Use of ipratropium bromide in obstructive lung disease. 297 9

The early recognition and appropriate management of EIB can allow children and adolescents to participate fully in physical activities and sport. The diagnosis by history of chest congestion, coughing, and decreasing performance with exercise is helpful but is aided by a more systematic questionnaire that can detect otherwise "normal" people with EIB. The diagnosis is documented by performance of an exercise challenge test such as a treadmill or cycloergometer to verify bronchospasm induced by exercise. The management can be accomplished by nonpharmacologic means such as an early vigorous warm-up, the use of a mask for rebreathing warmed air, and participation in a physical training program to increase anaerobic fitness. Pharmacologic management includes the appropriate use of cromolyn sodium, beta-adrenergic agonists, theophylline, ipratromium bromide, and calcium channel blocking agents. In addition, the antihistamine, terfenadine, can be used to block EIB effectively. These pharmacologic agents can be utilized in both national and international competition when approved by the appropriate national governing body or the U.S. Olympic Committee and the International Olympic Committee.
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PMID:Exercise-induced bronchospasm in children and adolescents. 305 Aug 31


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