Acute medicamenteuze bronchusverwijding bij CARA: bij astma betere reactie op salbutamol en bij chronische bronchitis op ipratropium (bromide)

– Earlier Dutch reports show that β₂-adrenergic drugs are prescribed five times more often by general practitioners and chest physicians than anticholinergics. However, so far it is not clear which patients respond better to which drug. Therefore we investigated the acute bronchodilating responses to 400 µg salbutamol and 80 µg ipratropium bromide in 188 patients with chronic bronchitis (n = 113) or asthma (n = 75) who had mild to moderate airflow obstruction. The diagnosis of asthma or chronic bronchitis was based on internationally accepted criteria. The study had a cross-over design. The mean increase in FEV₁ (forced expiratory volume in one second) in the subjects with asthma was significantly higher after salbutamol (0.37 l or 18 of the prebronchodilator value) than after ipratropium bromide (0.26 l or 13). In chronic bronchitis there was no difference between the increase in FEV₁ after salbutamol (0.16 l or 7) and after ipratropium bromide (0.19 l or 8). Asthmatic patients in general responded better to salbutamol, whereas patients with chronic bronchitis in general responded better to ipratropium bromide (p < 0.005). The response pattern was also related to allergy and age, allergic patients and patients under 60 in general responded better to salbutamol than non-allergic patients and older patients, who benefited more from ipratropium bromide (p < 0.005).