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Objectives: Failure to effectively manage acute exacerbations early with bronchodilator therapy is a major cause of mortality and morbidity in chronic obstructive pulmonary disease (COPD). In our study, we aimed to compare the effect of salbutamol + ipratropium bromide, an established treatment for acute exacerbations, with that of the newer agent levalbuterol + ipratropium bromide on FEV1, FVC, and heart rate (HR) in COPD.
Methods: Forty-five stable COPD patients classified as group D based on the 2017 GOLD guidelines were included in the study. The patients were instructed not to take long-acting b2 agonist + inhaler corticosteroid for 12 hours and long-acting anticholinergic treatment for 24 hours before baseline assessments. After confirming that the patients had not used short-acting bronchodilator treatment for the past 12 hours, pulmonary function tests (PFT) and electrocardiogram (ECG) were performed. On day 1, PFT and ECG were repeated at 15 and 45 minutes after inhaling short-acting salbutamol + ipratropium bromide (40/200 mcg). The same treatment and assessment procedure was repeated 72 hours later using levalbuterol + ipratropium bromide (40/100 mcg). Changes in FEV1 and FVC values and HR on ECG were evaluated.
Results: Statistically significant ΔFEV1 and ΔFVC were observed at 15 and 45 minutes after inhalation compared to baseline values (p<0.001). Comparison of ΔFEV1 and ΔFVC values at 15 and 45 minutes after levalbuterol + ipratropium bromide and were significantly greater than those observed after salbutamol + ipratropium bromide (p=0.017 and p=0.022, respectively). Similarly, ΔHR at 15 and 45 minutes after treatment was significant greater with salbutamol + ipratropium bromide (p=0.04).
Conclusion: Levalbuterol + ipratropium bromide caused relatively greater improvements in FEV1 and FVC with relatively smaller increase in heart rate. Therefore, this combination can be used in place of salbutamol + ipratropium bromide in the treatment of COPD exacerbations.