Is an anticholinergic agent superior to a beta 2-agonist in improving dyspnea and exercise limitation in COPD?
OBJECTIVE
To evaluate the impact of a week-long course of inhaled albuterol compared with ipratropium on expiratory peak flow, exercise performance, and dyspnea in patients with stable COPD.


METHODS
A double-blind, two-period, crossover evaluation, wherein the subjects inhaled albuterol, two puffs four times a day (qid) for 7 days, or ipratropium, two puffs quid for 7 days, in random sequence.


METHODS
Outpatients of the Pennsylvania State University Hospital, Lebanon VA Medical Center, and local private office practices.


METHODS
A sample of 15 subjects with stable COPD with FEV1 < 55% predicted.


RESULTS
Variables measured at baseline (no inhaled bronchodilator) and/or on day 7 of each arm included FEV1 (liters), 12-min walk test distance (meters), "rescue" puffs of metaproterenol needed each week, and dyspnea scoring after walking, on the Borg Category Scale (0 to 10 = maximal). There was no significant difference in distance walked in 12 min (mean of 751.0 +/- 55.5 [+/- SE]) vs 755.7 +/- 61.3 m) or perceived dyspnea (mean 2.7 +/- 0.4 vs 3.3 +/- 0.4) during albuterol or ipratropium use. Seven patients preferred ipratropium, seven preferred albuterol, and one had no preference.


CONCLUSIONS
We conclude that the effects of 1 week of albuterol or ipratropium have similar effects on exercise performance and subjective dyspnea in patients with stable COPD.
Blosser
S A
SA
Division of Pulmonary/Critical Care Medicine, Pennsylvania State University, Milton S. Hershey Medical Center, Hershey, USA.
Maxwell
S L
SL
Reeves-Hoche
M K
MK
Localio
A R
AR
Zwillich
C W
CW
D000280:Administration, Inhalation; D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use*; D000368:Aged; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D018592:Cross-Over Studies; D004311:Double-Blind Method; D004417:Dyspnea / Q000517:prevention & control; D017079:Exercise Tolerance / Q000187:drug effects; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000627:therapeutic use*; D008173:Lung Diseases, Obstructive / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D008297:Male; D015999:Multivariate Analysis
D058666:Adrenergic beta-2 Receptor Agonists; D000318:Adrenergic beta-Agonists; D018680:Cholinergic Antagonists; D009241:Ipratropium; D000420:Albuterol