In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone

An 85-day multicenter trial

R. Bone, M. Boyars, S. R. Braun, A. S. Buist, S. Campbell, T. Chick, B. M. Cohen, W. Conway, D. W. Cugell, A. DeGraff, M. Friedman, R. B. George, M. Eric Gershwin, J. A. Kram, D. C. Levin, B. Levine, T. L. Petty, S. Rennard, L. Repsher

Research output: Contribution to journalArticle

351 Citations (Scopus)

Abstract

Combination bronchodilator therapy for chronic obstructive pulmonary disease (COPD) is available widely throughout the world except in North America. Previous studies have yielded conflicting results regarding the advantages of combining anticholinergic therapy with sympathomimetic therapy in COPD. We report the results of a 12-week prospective, double-blind, parallel-group evaluation of the use of the following: albuterol, a β- adrenergic agent; ipratropium, an anticholinergic agent; or a combination of the two, administered by metered-dose inhaler to patients with moderately severe stable COPD. Following baseline studies, 534 patients were given one of the three test bronchodilator preparations to be used at home four times daily in addition to oral theophylline and corticosteroids as required. The doses of the latter two drugs were kept stable. Subjects were tested on days 1, 29, 57, and 85. Analysis of 1-s forced expiratory volume (FEV1) curves on those test days indicated that the combination was superior to either single agent alone in peak effect, in the effect during the first 4 h after dosing, and in the total area under the curve of the FEV1 response. The mean peak percent increases in FEV1 over baseline on the four test days were 31 to 33 percent for the combination, 24 to 25 percent for ipratropium, and 24 to 27 percent for albuterol. The differences between the combination and its components were statistically significant on all test days. The AUC0-4 means for the combination were 21 to 44 percent greater than the ipratropium means and 30 to 46 percent greater than the albuterol means. Similar changes were noted in the forced vital capacity curves. Symptom scores did not change over time and did not differ among the treatment groups. We conclude that the combination of ipratropium and albuterol, when given by metered-dose inhaler to patients with COPD, is more effective than either of the two agents alone. The advantage of the combination is apparent primarily during the first 4 h after administration. The availability of combination therapy by metered- dose inhaler should help to improve patient compliance.

Original languageEnglish (US)
Pages (from-to)1411-1419
Number of pages9
JournalChest
Volume105
Issue number5
StatePublished - 1994
Externally publishedYes

Fingerprint

Chronic Obstructive Pulmonary Disease
Multicenter Studies
Ipratropium
Metered Dose Inhalers
Albuterol
Bronchodilator Agents
Cholinergic Antagonists
Therapeutics
Sympathomimetics
Vital Capacity
Forced Expiratory Volume
Theophylline
Patient Compliance
North America
Adrenergic Agents
Area Under Curve
Adrenal Cortex Hormones
Ipratropium Drug Combination Albuterol
Pharmaceutical Preparations

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Bone, R., Boyars, M., Braun, S. R., Buist, A. S., Campbell, S., Chick, T., ... Repsher, L. (1994). In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone: An 85-day multicenter trial. Chest, 105(5), 1411-1419.

In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone : An 85-day multicenter trial. / Bone, R.; Boyars, M.; Braun, S. R.; Buist, A. S.; Campbell, S.; Chick, T.; Cohen, B. M.; Conway, W.; Cugell, D. W.; DeGraff, A.; Friedman, M.; George, R. B.; Gershwin, M. Eric; Kram, J. A.; Levin, D. C.; Levine, B.; Petty, T. L.; Rennard, S.; Repsher, L.

In: Chest, Vol. 105, No. 5, 1994, p. 1411-1419.

Research output: Contribution to journalArticle

Bone, R, Boyars, M, Braun, SR, Buist, AS, Campbell, S, Chick, T, Cohen, BM, Conway, W, Cugell, DW, DeGraff, A, Friedman, M, George, RB, Gershwin, ME, Kram, JA, Levin, DC, Levine, B, Petty, TL, Rennard, S & Repsher, L 1994, 'In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone: An 85-day multicenter trial', Chest, vol. 105, no. 5, pp. 1411-1419.
Bone, R. ; Boyars, M. ; Braun, S. R. ; Buist, A. S. ; Campbell, S. ; Chick, T. ; Cohen, B. M. ; Conway, W. ; Cugell, D. W. ; DeGraff, A. ; Friedman, M. ; George, R. B. ; Gershwin, M. Eric ; Kram, J. A. ; Levin, D. C. ; Levine, B. ; Petty, T. L. ; Rennard, S. ; Repsher, L. / In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone : An 85-day multicenter trial. In: Chest. 1994 ; Vol. 105, No. 5. pp. 1411-1419.
@article{fd0f35f334ef4f4e9e6e2e4fc55b004d,
title = "In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone: An 85-day multicenter trial",
abstract = "Combination bronchodilator therapy for chronic obstructive pulmonary disease (COPD) is available widely throughout the world except in North America. Previous studies have yielded conflicting results regarding the advantages of combining anticholinergic therapy with sympathomimetic therapy in COPD. We report the results of a 12-week prospective, double-blind, parallel-group evaluation of the use of the following: albuterol, a β- adrenergic agent; ipratropium, an anticholinergic agent; or a combination of the two, administered by metered-dose inhaler to patients with moderately severe stable COPD. Following baseline studies, 534 patients were given one of the three test bronchodilator preparations to be used at home four times daily in addition to oral theophylline and corticosteroids as required. The doses of the latter two drugs were kept stable. Subjects were tested on days 1, 29, 57, and 85. Analysis of 1-s forced expiratory volume (FEV1) curves on those test days indicated that the combination was superior to either single agent alone in peak effect, in the effect during the first 4 h after dosing, and in the total area under the curve of the FEV1 response. The mean peak percent increases in FEV1 over baseline on the four test days were 31 to 33 percent for the combination, 24 to 25 percent for ipratropium, and 24 to 27 percent for albuterol. The differences between the combination and its components were statistically significant on all test days. The AUC0-4 means for the combination were 21 to 44 percent greater than the ipratropium means and 30 to 46 percent greater than the albuterol means. Similar changes were noted in the forced vital capacity curves. Symptom scores did not change over time and did not differ among the treatment groups. We conclude that the combination of ipratropium and albuterol, when given by metered-dose inhaler to patients with COPD, is more effective than either of the two agents alone. The advantage of the combination is apparent primarily during the first 4 h after administration. The availability of combination therapy by metered- dose inhaler should help to improve patient compliance.",
author = "R. Bone and M. Boyars and Braun, {S. R.} and Buist, {A. S.} and S. Campbell and T. Chick and Cohen, {B. M.} and W. Conway and Cugell, {D. W.} and A. DeGraff and M. Friedman and George, {R. B.} and Gershwin, {M. Eric} and Kram, {J. A.} and Levin, {D. C.} and B. Levine and Petty, {T. L.} and S. Rennard and L. Repsher",
year = "1994",
language = "English (US)",
volume = "105",
pages = "1411--1419",
journal = "Chest",
issn = "0012-3692",
publisher = "American College of Chest Physicians",
number = "5",

}

TY - JOUR

T1 - In chronic obstructive pulmonary disease, a combination of ipratropium and albuterol is more effective than either agent alone

T2 - An 85-day multicenter trial

AU - Bone, R.

AU - Boyars, M.

AU - Braun, S. R.

AU - Buist, A. S.

AU - Campbell, S.

AU - Chick, T.

AU - Cohen, B. M.

AU - Conway, W.

AU - Cugell, D. W.

AU - DeGraff, A.

AU - Friedman, M.

AU - George, R. B.

AU - Gershwin, M. Eric

AU - Kram, J. A.

AU - Levin, D. C.

AU - Levine, B.

AU - Petty, T. L.

AU - Rennard, S.

AU - Repsher, L.

PY - 1994

Y1 - 1994

N2 - Combination bronchodilator therapy for chronic obstructive pulmonary disease (COPD) is available widely throughout the world except in North America. Previous studies have yielded conflicting results regarding the advantages of combining anticholinergic therapy with sympathomimetic therapy in COPD. We report the results of a 12-week prospective, double-blind, parallel-group evaluation of the use of the following: albuterol, a β- adrenergic agent; ipratropium, an anticholinergic agent; or a combination of the two, administered by metered-dose inhaler to patients with moderately severe stable COPD. Following baseline studies, 534 patients were given one of the three test bronchodilator preparations to be used at home four times daily in addition to oral theophylline and corticosteroids as required. The doses of the latter two drugs were kept stable. Subjects were tested on days 1, 29, 57, and 85. Analysis of 1-s forced expiratory volume (FEV1) curves on those test days indicated that the combination was superior to either single agent alone in peak effect, in the effect during the first 4 h after dosing, and in the total area under the curve of the FEV1 response. The mean peak percent increases in FEV1 over baseline on the four test days were 31 to 33 percent for the combination, 24 to 25 percent for ipratropium, and 24 to 27 percent for albuterol. The differences between the combination and its components were statistically significant on all test days. The AUC0-4 means for the combination were 21 to 44 percent greater than the ipratropium means and 30 to 46 percent greater than the albuterol means. Similar changes were noted in the forced vital capacity curves. Symptom scores did not change over time and did not differ among the treatment groups. We conclude that the combination of ipratropium and albuterol, when given by metered-dose inhaler to patients with COPD, is more effective than either of the two agents alone. The advantage of the combination is apparent primarily during the first 4 h after administration. The availability of combination therapy by metered- dose inhaler should help to improve patient compliance.

AB - Combination bronchodilator therapy for chronic obstructive pulmonary disease (COPD) is available widely throughout the world except in North America. Previous studies have yielded conflicting results regarding the advantages of combining anticholinergic therapy with sympathomimetic therapy in COPD. We report the results of a 12-week prospective, double-blind, parallel-group evaluation of the use of the following: albuterol, a β- adrenergic agent; ipratropium, an anticholinergic agent; or a combination of the two, administered by metered-dose inhaler to patients with moderately severe stable COPD. Following baseline studies, 534 patients were given one of the three test bronchodilator preparations to be used at home four times daily in addition to oral theophylline and corticosteroids as required. The doses of the latter two drugs were kept stable. Subjects were tested on days 1, 29, 57, and 85. Analysis of 1-s forced expiratory volume (FEV1) curves on those test days indicated that the combination was superior to either single agent alone in peak effect, in the effect during the first 4 h after dosing, and in the total area under the curve of the FEV1 response. The mean peak percent increases in FEV1 over baseline on the four test days were 31 to 33 percent for the combination, 24 to 25 percent for ipratropium, and 24 to 27 percent for albuterol. The differences between the combination and its components were statistically significant on all test days. The AUC0-4 means for the combination were 21 to 44 percent greater than the ipratropium means and 30 to 46 percent greater than the albuterol means. Similar changes were noted in the forced vital capacity curves. Symptom scores did not change over time and did not differ among the treatment groups. We conclude that the combination of ipratropium and albuterol, when given by metered-dose inhaler to patients with COPD, is more effective than either of the two agents alone. The advantage of the combination is apparent primarily during the first 4 h after administration. The availability of combination therapy by metered- dose inhaler should help to improve patient compliance.

UR - http://www.scopus.com/inward/record.url?scp=0028318612&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028318612&partnerID=8YFLogxK

M3 - Article

VL - 105

SP - 1411

EP - 1419

JO - Chest

JF - Chest

SN - 0012-3692

IS - 5

ER -