Assessment of the clinical usefulness of nebulised ipratropium bromide in patients with chronic airflow limitation.

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Abstract
Effect of adding nebulized ipratropium bromide to bronchodilator treatment was studied in 20 patients with severe chronic airflow limitation. Maintenance theophylline with or without a steroid preparation was continued and comparison made between placebo, nebulized salbutamol, and a combination of nebulized salbutamol and ipratropium. Although the mean FEV1 [1-s forced expiratory values] showed the combination to produce a small but significant increase in peak bronchodilatation over the effect of salbutamol alone, there were 8 patients in whom no clinically useful improvement occurred. The remaining 12 patients did obtain clinically useful improvement in the magnitude or the duration of bronchodilatation (or both) as a result of the added ipratropium. Individual patients with chronic airflow limitation responded to the addition of nebulized ipratropium bromide in a variable way. Patients who could obtain additional benefit from ipratropium need to be identified by an appropriate reversibility study before its inclusion in their bronchodilator treatment.