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Routine Nebulized Ipratropium and Albuterol Together Are Better Than Either Alone in COPD*
The COMBIVENT Inhalation Solution Study Group i
Study objective: We compared the long-term safety and efficacy of the combination ipratropium bromide (IB) and albuterol sulfate (ALB) inhalation solution with that of each separate component using three-times-daily administration.
Design: Using a parallel design, we randomized patients to receive 3.0 mg ALB, 0.5 mg IB, or the combination by small-volume nebulizer (SVN) for 85 days. Subjects were allowed to use up to two extra doses of study medication daily for control of symptoms on an as-needed basis. The main efficacy evaluation was the acute pulmonary function response to an aerosol of the maintenance study medication over the course of the investigation. Physician global evaluation, subject quality of life assessments, COPD symptom scores, and twice-daily peak expiratory flow rate (PEFR) were also assessed over the study period.
Setting: Twenty-five centers participated in the investigation.
Patients: We studied 652 patients with moderate to severe COPD.
Measurements and results: Over the course of the study, the acute spirometric response and evening PEFR values with the SVN combination of IB plus ALB were statistically significantly better compared to ALB or IB alone. The quality of life scores, physician global evaluations, symptom scores, and morning PEFR scores were unchanged over the duration of the study in all treatment groups. There was no significant difference in adverse events in the three treatment groups.
Conclusions: In patients with COPD, maintenance SVN therapy with IB and ALB provides better bronchodilation than either therapy alone without increasing side effects. (CHEST 1997; 112:1514-21)
Abbreviations: AUC=area under the response-time curve; FEF2s 75=forced expiratory flow between 25% and 75% of the FVC; IB=ipratropium bromide; MDI=metered-dose inhaler; PEFR=peak expiratory flow rate; SVN=smallvolume nebulizer
here are several published reports of the efficacy of the combination of inhaled ipratropium bromide (IB) and various [3-agonists in patients with COPD.1-13 Short-term studies generally dispensed combination and single-drug therapy at approved doses by metered-dose inhaler (MDI). They report improvement in pulmonary function over either agent alone with the addition of the second drug. Although the short-term studies were on small groups of patients, the improvement with combination therapy was statistically significant in most studies1-9 and not significant...