title: Efficacy and safety of eco-friendly inhalers: focus on combination ipratropium bromide and albuterol in chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality and its treatment is critical to improve quality of life, reduce symptoms, and diminish the frequency of COPD exacerbations. Due to the harmful environmental effects of pressurized metered-dose inhalers (pMDIs) containing chlorofluorocarbons (CFCs), newer systems for delivering respiratory medications have been developed.
  
  
  METHODS
  A search of the literature in the PubMed database was undertaken using the keywords "COPD," "albuterol," "ipratropium bromide," and "Respimat® Soft Mist Inhaler™"; pertinent references within the identified citations were included. The environmental effect of CFC-pMDIs, the invention of the Respimat® Soft Mist Inhaler™ (SMI) (Boehringer Ingelheim, Ingelheim, Germany), and its use to deliver the combination of albuterol and ipratropium bromide for the treatment of COPD were reviewed.
  
  
  RESULTS
  The adverse environmental effects of CFC-pMDIs stimulated the invention of novel delivery systems including the Respimat SMI. This review presents its development, internal mechanism, and use to deliver the combination of albuterol and ipratropium bromide.
  
  
  CONCLUSIONS
  CFC-pMDIs contributed to the depletion of the ozone layer and the surge in disorders caused by harmful ultraviolet B radiation. The banning of CFCs spurred the development of novel delivery systems for respiratory medications. The Respimat SMI is an innovative device that produces a vapor of inhalable droplets with reduced velocity and prolonged aerosol duration that enhance deposition within the lower airway and is associated with improved patient satisfaction. Clinical trials have demonstrated that the Respimat SMI can achieve effects equivalent to pMDIs but with lower medication doses. The long-term safety and efficacy remain to be determined. The Respimat SMI delivery device is a novel, efficient, and well-received system for the delivery of aerosolized albuterol and ipratropium bromide to patients with COPD; however, the presence of longer-acting, less frequently dosed respiratory medications provide patients and providers with other therapeutic options.
authors: Pulmonary, Critical Care, and Sleep Medicine Division, Cincinnati Veterans Affairs Medical Center, Cincinnati, OH 45220, USA. ralph.panos@va.gov
authors: Ralph J
authors: RJ
authors: Panos
mesh_terms: D000420:Albuterol / Q000737:chemistry / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000737:chemistry / Q000627:therapeutic use; D017402:Chlorofluorocarbons / Q000009:adverse effects*; D004338:Drug Combinations; D004867:Equipment Design / Q000639:trends; D006801:Humans; D009241:Ipratropium / Q000737:chemistry / Q000627:therapeutic use; D036501:Metered Dose Inhalers / Q000592:standards*; D062966:Ozone Depletion / Q000517:prevention & control*; D017060:Patient Satisfaction; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy; D012138:Respiratory Therapy / Q000295:instrumentation* / Q000379:methods / Q000639:trends; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D017402:Chlorofluorocarbons; D004338:Drug Combinations; D009241:Ipratropium; D000420:Albuterol
keywords: COPD; Respimat® Soft Mist Inhaler™; chlorofluorocarbons; pressurized metered-dose inhaler
references: Int J Chron Obstruct Pulmon Dis. 2009;4:381-90
references: 19888356
references: Treat Respir Med. 2004;3(1):35-44
references: 15174892
references: Respir Med. 2000 May;94(5):490-5
references: 10868713
references: Eur Respir J. 2008 Jan;31(1):204-12
references: 18166598
references: Thorax. 2013 Jan;68(1):5-7
references: 23229813
references: Sci Am. 2008 Aug;299(2):20, 22
references: 18666671
references: Am J Respir Crit Care Med. 2002 Aug 1;166(3):333-9
references: 12153966
references: Cochrane Database Syst Rev. 2002;(1):CD002170
references: 11869627
references: Arch Dermatol. 2010 Mar;146(3):283-7
references: 20231499
references: Respiration. 2000;67(6):672-8
references: 11124651
references: Int J Chron Obstruct Pulmon Dis. 2008;3(1):163-9
references: 18488440
references: Eur Respir J. 2009 May;33(5):1165-85
references: 19407051
references: COPD. 2008 Aug;5(4):235-56
references: 18671149
references: Chest. 1998 Apr;113(4):957-63
references: 9554631
references: Philos Trans R Soc Lond B Biol Sci. 2006 May 29;361(1469):769-90
references: 16627294
references: Chest. 2010 Jan;137(1):13-9
references: 19363211
references: Int J Pharm. 2004 Sep 28;283(1-2):1-9
references: 15363496
references: Mayo Clin Proc. 2012 Apr;87(4):328-34
references: 22469345
references: Proc Natl Acad Sci U S A. 2007 Mar 20;104(12):4814-9
references: 17360370
references: J Pharm Sci. 1996 Sep;85(9):960-4
references: 8877887
references: Chest. 2005 Jan;127(1):335-71
references: 15654001
references: Science. 1990 Oct 19;250(4979):370
references: 17793009
references: Thorax. 2013 Jan;68(1):114-6
references: 22764216
references: Expert Opin Drug Metab Toxicol. 2010 Mar;6(3):381-92
references: 20163324
references: Lancet. 2009 Feb 28;373(9665):705-6
references: 19249618
references: Cochrane Database Syst Rev. 2012 Jul 11;(7):CD009285
references: 22786525
references: Int J Chron Obstruct Pulmon Dis. 2009;4:225-32
references: 19554196
references: Thorax. 1981 Jan;36(1):52-5
references: 7292382
references: Int J Chron Obstruct Pulmon Dis. 2011;6:129-39
references: 21468167
references: Treat Respir Med. 2005;4(1):41-52
references: 15725049
references: Respir Care. 2005 Sep;50(9):1201-8
references: 16122403
references: Chest. 2012 Aug;142(2):305-311
references: 22871756
references: Health Technol Assess. 2001;5(26):1-149
references: 11701099
references: Respir Med. 2010 Aug;104(8):1179-88
references: 20172704
references: Ann Allergy Asthma Immunol. 1997 Jul;79(1):85-8
references: 9236507
references: Arch Dermatol. 1996 Apr;132(4):436-43
references: 8629848
references: J Aerosol Med. 2004 Summer;17(2):129-39
references: 15294063
references: J Aerosol Med. 2005 Fall;18(3):273-82
references: 16181002
references: Thorax. 2013 Jan;68(1):48-56
references: 23042705
references: Int J Cardiol. 2012 Jul 12;158(2):279-84
references: 22386700
references: Med Devices (Auckl). 2011;4:145-55
references: 22915941
references: J Aerosol Med Pulm Drug Deliv. 2009 Sep;22(3):271-83
references: 19466904
references: Respir Care. 2005 Sep;50(9):1177-90
references: 16122401
references: Chest. 1985 Aug;88(2 Suppl):152S-160S
references: 3893925
references: Chemosphere. 2005 Dec;61(11):1539-47
references: 15936055
references: Respiration. 2008;75(2):224-38
references: 18042978
references: JAMA. 2008 Sep 24;300(12):1439-50
references: 18812535
references: J Aerosol Med. 2005 Fall;18(3):264-72
references: 16181001
references: Treat Respir Med. 2005;4(1):53-61
references: 15725050
references: Respir Med. 2004 May;98(5):387-97
references: 15139567
references: Clin Pediatr (Phila). 2009 Mar;48(2):131-4
references: 19015282
references: Int J Chron Obstruct Pulmon Dis. 2008;3(4):763-70
references: 19281091
references: COPD. 2008 Apr;5(2):133-8
references: 18415812
references: N Engl J Med. 2005 Aug 4;353(5):487-97
references: 16079372