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Evidence summaries

Ipratropium Bromide Versus Long-Acting Beta-2 Agonists for Stable Chronic Obstructive Pulmonary Disease

Salmeterol and a combination of salmeterol and ipratropium bromide appear to improve morning PEF and FEV1 compared to ipratropium alone, but there is little evidence of benefit in other outcomes. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 7 studies with a total of 2 652 subjects. There was a significantly greater change in favour of salmeterol in morning PEF (MD -10.96, 95% CI -16.09 to -5.83) and FEV1 (MD -0.06 litres, 95% CI -0.11 to 0). There were no significant differences in quality of life, exacerbations, or symptoms. Formoterol appeared to confer some benefits over ipratropium treatment in terms of morning peak flow. There was improvement in post-bronchodilator lung function, supplemental short-acting beta-agonist use and health related quality of life in favour of combination therapy with ipratropium bromide and salmeterol compared with salmeterol alone (8% predicted versus 5% predicted, P < 0.01).

Comment: The quality of evidence is downgraded by indirectness (pulmonary function measurements as end points).

    References

    • Appleton S, Jones T, Poole P, Pilotto L, Adams R, Lasserson TJ, Smith B, Muhammad J. Ipratropium bromide versus long-acting beta-2 agonists for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006;3:CD006101 [Last assessed as up-to-date: 3 July 2008]. [PubMed]

Primary/Secondary Keywords