Bronchodilating effect of ipratropium bromide inhalation powder and aerosol in children and adolescents with stable bronchial asthma

Ulrik CS, Backer V, Bach-Mortensen N. Bronchodilating effect of ipratropium bromide inhalation powder and aerosol in children and adolescents with stable bronchial asthma. The purpose of this study was to compare the bronchodilating effect of ipratropium bromide (IB) administered by a conventional Ingelheim powder device system (IPI) and by a metered dose inhaler (MDI) in children and adolescents with stable bronchial asthma. Seventy patients, aged 7 to 16 years, with stable bronchial asthma from our outpatient clinic were tested for bronchial responsiveness to inhaled IB. Fifteen (21%) of the 70 subjects were found to have a substantial bronchial response to inhalation of 40 γg IB, i.e. at least 15% increase in FEV₁ 30 min after inhalation; the remaining 55 subjects had <15% increase in FEV₁. No relationship between severity of asthma, age or sex and bronchial responsiveness to inhaled IB was found. Among the 15 subjects who had substantial bronchial response to IB, the increase in FEV₁ after inhalation of fenoterol tended to be greater than the response to inhaled IB, although this did not reach statistical significance. Responders, i.e. subjects who had at least 15% increase in FEV₁ after inhalation of IB, took part in a double-blind, cross-over study of the bronchodilating effect of 40 γg IB delivered by IPI and MDI. We found no significant differences in the bronchodilating effect during a 6-h follow-up. Maximum bronchodilating effect of IB was reached after 30 min and the maximum response lasted for 90 min. No side or adverse effects were observed following inhalation of IB. We conclude that before starting treatment with ipratropium bromide for bronchial asthma in children and adolescents, the patients should be tested for bronchial responsiveness to inhaled IB to find out whether they are responders or nonresponders; and further that, among responders, inhalation of powder is as effective as inhalation from a dosis-aerosol.