Acute effects of ipratropium bromide (ITBR, Sch 1000, Atrovent): a review of previous studies.
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Biomedical subjects
Publications and source records attributed to B G Simonsson.
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A total of 121 pleurodeses using instillations of quinacrine (mepacrine) in patients with recurrent pleural effusion were performed. All but three patients suffered from pleural malignancy. A comparison was made between the results achieved by repeated thoracenteses (73 cases) and by simultaneous tube drainage (48 cases). Tube drainage shortened the treatment and lowered the number of painful interventions. There was no difference in the quality of pleurodesis achieved by the two methods. The treatment failed in 12% of patients treated by repeated thoracenteses and in 14% of those treated by tube drainage. Patients with pleurodeses survive longer than non-treated subjects and have a considerably better quality of life.
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Repeated transthoracic intracavitary injections of amphotericin B, nystatin and pimaricine proved a simple and safe method in the treatment of bilateral pulmonary aspergillomas in a patient with large cavities caused by lung disease in ankylosing spondylitis. Both large mycetomas were dissolved by this treatment in combination with peroral corticosteroid medication, and the patient's general condition improved markedly.
A beta2-receptor agonist, terbutaline (Bricanyl), in doses of 2.5 and 5 mg was inhaled by IPPB with a Bird Mark 8 in a double-blind cross-over randomized study on consecutive days in 12 patients with at least 15% reversibility of PEFR or FEV 1.0. One minute after the inhalation of 2.5 mg, PEFR had increased significantly; the greatest effect (+ 34%) was recorded after 120 min. After 5 mg the increase was more marked, with the greatest recorded effect (+ 43%) after 120 min; FEV1 and VC showed similar changes with a tendency towards greater and longer effects after the larger dose. Heart rate did not change. Systolic and diastolic blood pressures decreased at the most with 9 and 5 mmHg respectively, 30 min after 5 mg terbutaline. One patient reported tremor and palpitations 5 min after inhaling 5 mg. Our patients who were treated with beta-adrenergic drugs showed less systemic effects after the same dose of terbutaline than previously non-treated normal subjects in an earlier study. This may support recent findings of drug-induced tolerance to beta-stimulating agents in the heart and skeletal muscles with preservation of good effect on the airway smooth muscles, here shown as having a good residual bronchodilatory effect with clinically non-important effects on heart rate and tremor.
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Dynamic spirometry with flow-volume curves and measurement of static lung volumes in a body plethysmograph were done in 11 patients with reversible airways obstruction before and up to 240 min after inhalation of 20 mug SCH 1000 and of another 40 mug 60 min later. Forced expiratory volume in 1 s (FEV1), vital capacity (VC) and maximal expiratory flow at 50% VC (V 50% VC) increased successively, reaching maximum after 120 min. In a second part of the study 13 patients inhaled 2+4+8 puffs of SCH 1000 (280 mug in all) at 30-min intervals. PEFR increased significantly up to 224 l/min (44% of predicted normal), with increasing number of SCH 1000 inhalations; no further general effect occurred after additional 3 puffs of terbutaline. Heart rate and blood pressure showed no clinically significant changes. No subjective or objective side-effects were noted.