Bronchodilator effects of ipratropium bromide and albuterol sulfate among subjects with tetraplegia

The Journal of Spinal Cord Medicine, 2018 · DOI: 10.1080/10790268.2016.1235753 · Published: January 1, 2018

Spinal Cord Injury Pharmacology Pulmonology

Simple Explanation

This study investigates the effectiveness of two bronchodilators, ipratropium bromide (IB) and albuterol sulfate (AS), in individuals with tetraplegia. People with tetraplegia often experience breathing difficulties due to lung volume restriction and airway obstruction. The study compares the effects of IB and AS on airway function using various measurements like spirometry, body plethysmography, and impulse oscillation system (IOS). IOS is a non-invasive method that assesses respiratory impedance during normal breathing. The findings suggest that both IB and AS improve airway function in tetraplegic individuals, but IB may have a greater bronchodilatory effect, particularly in the larger central airways. This supports the idea that there is an overriding cholinergic airway tone in tetraplegia.

Study Duration

Not specified

Participants

12 subjects with chronic tetraplegia

Evidence Level

Not specified

Key Findings

1
Both ipratropium bromide (IB) and albuterol sulfate (AS) elicit significant bronchodilation in subjects with tetraplegia, as demonstrated by improvements in spirometry and specific airway conductance.
2
IB tended towards greater bronchodilation than AS, as indicated by a larger percentage increase in specific airway conductance (sGaw) post-bronchodilator.
3
Impulse oscillation system (IOS) measurements revealed a greater reduction in central airway resistance (R20) following IB compared to AS, suggesting that IB primarily acts on the larger central airways.

Research Summary

This study evaluated the bronchodilator effects of ipratropium bromide (IB) and albuterol sulfate (AS) in subjects with tetraplegia using spirometry, body plethysmography, and impulse oscillation system (IOS). The results showed that both IB and AS significantly improved airway function, but IB tended to have a greater bronchodilatory effect, particularly in the central airways. The findings support the theory of overriding cholinergic airway tone in tetraplegia and suggest that IB's predominant site of action is on the larger central airways.

Practical Implications

Potential Therapeutic Benefit

IB might be particularly beneficial for tetraplegic patients with recurrent atelectasis or pneumonia, as it may facilitate pulmonary clearance and maximize lung function.

Combination Therapy

Co-administration of IB and AS might confer greater bronchodilation than either agent alone due to their different sites of action along the airway.

Further Research Needed

Larger studies are necessary to determine if maintenance therapy with bronchodilators like IB can reduce pulmonary complications, improve quality of life, or alleviate pulmonary symptoms in individuals with higher-level spinal cord injury.

Study Limitations

1
Small sample size may limit the generalizability of the findings.
2
The clinical implications of the observed bronchodilator effects are not yet fully understood.
3
The study primarily involved healthier individuals with spinal cord injury, and it is unclear if similar benefits would be observed in a sicker cohort at higher risk for pulmonary complications.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury