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Evidence summaries

Anti-Cholinergic Bronchodilators Versus Beta2-Sympathomimetic Agents for Acute Exacerbations of Chronic Obstructive Pulmonary Disease

Anti-cholinergic bronchodilatators appear to have similar efficacy as beta-2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease. The combination of these drugs does not appear to increase the effect on FEV1. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 4 studies comparing ipratropium bromide to an inhaled beta-2-agonist, with 137 subjects. Both treatments improved FEV1 after 90 min in the range 150-250 ml. Short-term changes in FEV1 (up to 90 minutes) showed no significant difference between beta2-agonist and ipratropium bromide treated patients. The differences were similar among the studies. There was no significant additional increase in change in FEV1 on adding ipratropium to beta2-agonist: WMD 0.02 liter (95% CI -0.08 to 0.12). Long-term effects (24 hours) of the ipratropium bromide and beta2-agonist treatment combination were similar: WMD 0.05 liters (95% CI -0.14 to -0.05).

Neither of two studies found significant changes in PaO2, either short- or long-term, with ipratropium vs. beta-agonist, although one showed an increase in PaO2 in subjects receiving ipratropium bromide at 60 minutes. Adverse drug reactions included dry mouth and tremor.

Comment: The quality of evidence is downgraded by imprecise results (few patients and wide confidence intervals).

References

  • McCrory DC, Brown CD. Anticholinergic bronchodilators versus beta2-sympathomimetic agents for acute exacerbations of chronic obstructive pulmonary disease. Cochrane Database Syst Rev. 2003;(1):CD003900.

Primary/Secondary Keywords