The effect of ipratropium bromide on intraocular pressure in patients with chronic obstructive pulmonary disease: an open-label study

Background: After smoking cessation, bronchodilation with anticholinergics and beta₂-agonists is the keystone of pharmacologic therapy for symptomatic chronic obstructive pulmonary disease (COPD). For patients who fail to get relief from a drug delivered via a metered-dose inhaler (MDI) plus spacer, or for acute exacerbations in patients who are unable to use an MDI, a nebulized solution (NS) usually is preferred. Although ipratropium bromide (IB) has a low incidence of adverse events, anticholinergic drugs are known to produce side effects such as urinary retention, constipation, drying of secretions, and precipitation of glaucoma.Objective: In this open-label study, we aimed to assess the acute effects of IB on intraocular pressure (IOP) and tolerability of administration of IB by MDI and NS in patients with COPD and baseline values of IOP that were within normal limits.Methods: Eligible patients were aged >40 years and had a cigarette smoking history of >20 pack-years (ie, packs/d × years of smoking), a clinical history of COPD, and a ratio of forced expiratory volume in 1 second to slow vital capacity (FEV₁/VC) <89% predicted value. After baseline pulmonary function testing (PFT), IOP measurements by Goldmann applanation tonometry were performed. PFT measurements were repeated at 15 and 120 minutes after drug inhalation, and IOP measurements were repeated 120 minutes after drug inhalation. Doses were administered on 3 consecutive mornings: placebo on day 1, MDI IB 40 μg on day 2, and NS IB 250 μg on day 3.Results: Measurements are expressed as mean ± SD. Twenty-one stable patients with COPD (all men; mean age, 60.95 ± 7.90 years; mean smoking history, 47.24 ± 17.62 pack-years) were selected from a university hospital outpatient population. On MDI and NS test days (days 2 and 3), respectively, mean baseline FEV₁ measurements were 1.30 ± 0.62 L (42.74% ± 20.11% predicted value) and 1.23 ± 0.58 L (41.16% ± 18.51% predicted value); mean baseline IOPs for the MDI group were 14.24 ± 2.61 mm Hg and 14.00 ± 2.51 mm Hg (right and left eyes, respectively) and for the NS group were 14.57 ± 2.52 mm Hg and 14.00 ± 2.63 mm Hg (right and left eyes, respectively). Although improvements in forced VC, FEV₁, and maximal mid-expiratory flow rate were significant at 15 and 120 minutes for both delivery methods (P < 0.01 for both delivery methods at both times), no significant increase in IOP was found.Conclusion: The single-dose administration of MDI and NS formulations of IB at doses producing bronchodilation had no significant effect on IOP in this study population.