Ipratropium bromide versus short acting beta-2 agonists for stable chronic obstructive pulmonary disease

Ipratropium bromide appears to be slightly more effective than short-acting beta-agonists in improving lung function and quality of life, and in decreasing the need for oral steroids.

A Cochrane review included 11 studies with a total of 3912 subjects. Small benefits of ipratropium over a short-acting beta-2 agonist were demonstrated on lung function outcomes. There were small benefits in favour of ipratropium on quality of life (HRQL), as well as a reduction in the requirement for oral steroids (4 studies, OR 0.52, 95% CI 0.37 to 0.74, NNT = 15). Combination therapy with ipratropium plus a short-acting beta-2 agonist conferred clinically and statistically significant benefits over a short-acting beta-2 agonist alone in terms of post-bronchodilator lung function, and reduced the requirement for oral steroids (4 studies, OR 0.69, 95% CI 0.5 to 0.94, NNT = 20).

Comment: The quality of evidence for the combination treatment is downgraded by the possibility of publication bias suggested by the funnel plot, and for ipratropium bromide alone for borderline statistical and clinical significance.

Ədəbiyyat

1. Appleton S, Jones T, Poole P, Pilotto L, Adams R, Lasserson TJ, Smith B, Muhammad J. Ipratropium bromide versus short acting beta-2 agonists for stable chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2006;(2):CD001387 [Last assessed as up-to-date: 3 July 2008].