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Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Discussion

Ipratropium bromide appeared to have no significant effect either on cardiac vagal tone or on heart rate (the inverse of cardiac IBI) among young asthmatic adults. Cardiac IBI and vagal tone increased during testing (iie, the direction opposite to the predicted effects of IB). Canadian family pharmacy online more It is possible that this reflects relaxation and psychologic habituation to the experimental situation. Previous research has demonstrated that cardiac vagal tone increases during relaxation and sleep.’ Ipratropium bromide did not significantly affect this habituation phenomenon, although there was a nonsignificant tendency for RSA to decrease after IB, when IB was presented in the first session (ie, where the psychologic habituation effect was smallest).

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Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Asthma Severity

Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Asthma SeverityAsthma tended to be mild on the day of testing with IB or placebo (Table 1). Of the 12 subjects tested with methacholine, 5 had FEVi reductions of at least 20 percent after one to three doses (severe asthma), 6 after four to six doses (moderate asthma), and 1 after seven doses (mild asthma). The mean tolerance was four methacholine doses.
Airway Response to IB
The MANOVA revealed a significant (p<0.003) interaction between DRUG and PRETEST/POSTTEST, using Wilks’ lambda statistic. This interaction reflected an increase in all measures after IB, but no change after the placebo.
The MANOVA was followed by univariate analyses of variance for each spirometry variable separately. Canadian health & care mall this As can be seen in Tables 2 and 3, subjects improved significantly PRE to POST after IB, relative to placebo, on all three measures of pulmonary function. No significant effects for ORDER were found.
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Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Methacholine Challenge Tests

Subjects received two metered-dose inhalations, either of IB or from an identically appearing canister of placebo (saline solution). (At the time of testing, two puffs was the common periodic dosage of IB. Since that time, higher periodic doses of IB, up to six puffs, have been recommended for the clinical treatment of patients with chronic obstructive lung disease.) The IB and placebo canisters were supplied by the manufacturer (Boehringer-In-gelheim Inc) and the procedure was performed by the pulmonary physician. For each puff, the physician held the inhaler 5 cm from the subject’s open mouth, and the subject was instructed to breathe normally more buy proventil. At end-tidal volume, the inhaler was activated and, simultaneously, the patient was instructed to breathe slowly and deeply to total lung capacity. This breath was held for 5 s. Compliance with this technique was confirmed by the testing physician.
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Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Setting and Experimenters

Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Setting and ExperimentersThis statistic was originally described in the patent for the device, and has subsequently been described by others. The formula and equipment for assessing and computing V was derived from studies using cross-spectral analysis to determine the proportion of the periodic fluctuations in heart period that occur within the expected respiratory frequencies for an adult human population.
Spirometry testing and the administration of medication were performed by a board-certified pulmonary physician. Doubleblind procedures were used, such that neither the physician nor the patient was told whether active drug or placebo was being administered in any given session.
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Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Equipment

Twelve subjects had previously, within 2 months of testing, completed methacholine challenge tests that confirmed the presence of asthma. Two of these subjects were included in the present study despite normal spirometry findings on the day of testing. The value of methacholine challenge testing in the diagnosis of asthma has been previously described.
Subjects were excluded for any of the following reasons: a history of chronic bronchitis or sinusitis, history or physical findings consistent with emphysema or nonasthma respiratory disease, a history of smoking cigarettes within the past 2 years, presence of cardiovascular or neurologic disease, or psychiatric disorders requiring the administration of psychoactive medication.
Subjects refrained from using bronchodilator medication for 12 h before screening spirometry and avoided caffeine on the day of testing. Buy proventil Link Informed consent was obtained at the beginning of the first session, after each subject was provided with written and verbal descriptions of all procedures and all anticipated drug effects. The procedures were approved by the committee for protection of human subjects of Robert Wood Johnson Medical School.
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Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: Methods

Effects of Aerosol Ipratropium Bromide on Cardiac Vagal Tone: MethodsIpratropium bromide (IB) is a parasympathetic blocking agent whose properties as a bronchodi-lator have been well established. When taken in aerosol form, it is generally considered to act locally on the airways of the lung without systemic effect. However, the evaluation of systemic effects of IB has previously been limited to its effect on heart rate. Heart rate may be relatively insensitive to central effects of a parasympathetic blocking agent, because heart rate is under sympathetic as well as parasympathetic influence.
A more sensitive measure of vagal tone may be respiratory sinus arrhythmia (RSA), the variation in heart rate that occurs during the respiratory cycle. Changes in vagus nerve activity induced by pharmacologic agents, electrical stimulation, surgery, and various disease processes are all proportionately reflected by changes in amplitude of RSA.” This study examined the effect of conventional clinical doses of IB on RSA among individuals with asthma, a group among whom elevations in RSA have previously been reported and for whom IB commonly may be prescribed.
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The Effect of High Doses of Inhaled Salbutamol and Ipratropium Bromide in Patients With Stable Cystic Fibrosis: Finally

The Effect of High Doses of Inhaled Salbutamol and Ipratropium Bromide in Patients With Stable Cystic Fibrosis: FinallyEaston and coworkers compared the bronchodilating effects of albuterol and IB given by aerosol either alone or in sequence. They administered 120 \Lg of IB and 800 jig of albuterol over a 30-min period. When used alone, both bronchodilators significantly increased airflow and relieved hyperinflation, and there was no significant difference between the two drugs. After the improvement with the initial bronchodilator, the subsequent effect of a second inhaled bronchodilator was not greater than that of placebo. Our results in a group of young patients with chronic lung disease due to CF are similar to the results presented by Easton and coworkers. We did not find any beneficial bronchodilator effect of multidrug therapy when high doses were used. Although the patients did not have side effects with the doses administered, it is possible that in some patients, regular doses of p-adrenergic combined with anticholinergic agents may be a better therapeutic approach to avoid side effects.

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The Effect of High Doses of Inhaled Salbutamol and Ipratropium Bromide in Patients With Stable Cystic Fibrosis: Conclusion

Hordvik and coworkers found that bronchodilator responsiveness in CF decreases during acute pulmonary exacerbations. Our patients were in stable condition, with no history of admission to hospital for the previous 3 months, and no pulmonary exacerbation up to 4 weeks prior to the study. Fattishal studied the response to bronchodilators in CF patients in a longitudinal and cross-sectional manner by using pulmonary function data over an 8-year period. A proportion of patients (40 percent) presented a positive response to inhaled adrenergic agents; however, there was a lack of consistent response. Zinman and coworkers found a mean of 8 percent increase in FEVX after isoeth-arine (p2-sympathomimetic) in a group of 12 CF patients, but also found an increase in the degree of non-homogeneous lung emptying after the inhalation of the drug. Van Haren et al recently found, in a group of 20 adult CF patients, that both inhalation of terbu-taline and IB caused dose-related bronchodilation.
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The Effect of High Doses of Inhaled Salbutamol and Ipratropium Bromide in Patients With Stable Cystic Fibrosis: Discussion

The Effect of High Doses of Inhaled Salbutamol and Ipratropium Bromide in Patients With Stable Cystic Fibrosis: DiscussionThe efficacy of bronchodilator therapy in patients with CF has been discussed previously by several authors. Zach et al showed that in a proportion of CF patients, increased bronchial smooth muscle tone mechanically compensated for structural damage; therefore, inhaled bronchodilators may induce airway compression during forced expiratory maneuvers. Our subjects were selected because they had a positive response to bronchodilators in the past, and during the protocol the individual improvement in FEVj from baseline was variable but at least 8 percent. Eggleston and coworkers studied the response to inhaled S in two groups of CF patients classified according to their response to inhaled methacholine. Among those who responded to methacholine, daily peak expiratory flow rate (PEFR) measurements improved significantly more with albuterol than with placebo.

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The Effect of High Doses of Inhaled Salbutamol and Ipratropium Bromide in Patients With Stable Cystic Fibrosis: Results

Analysis of variance was used to compare quantitative variables at baseline and after the different treatments for each subject and to compare the percentage of change after each drug (S and IB). Paired t tests (two-tailed) were applied to compare the values after the additive treatment doses. A p value ^0.05 was considered to be significant.
Baseline characteristics of the patients as well as baseline pulmonary function measurements (PFTs), oxygen saturation, and heart rate are presented in Table 1. All patients had previous evidence of a positive response to inhaled S on at least 1 occasion in the previous 2 years. There was no difference in the average baseline PFT between the 2 days of the protocol.
There was a significant improvement in FEV\ and a decrease in Raw after inhalation of high doses of S during sequence A or IB during sequence В compared with baseline (Table 2). The improvement in midex-piratory flows was not statistically significant. Lung volume measurements (RV and FRC) were decreased by 10 and 5 percent vs 12 and 7 percent after S200 + S400 in sequence A compared to after IBW, in sequence B. However, these decreases were not significantly different from baseline. There was no significant further improvement in expiratory flows, lung volumes, and Raw when IB was given after high doses of S (sequence A) or when S was given after a high dose of IB (sequence B) (Table 2). The PFTs at 4 and 8 h from baseline showed a significant increase in FEVt (p<0.05) and a decrease in Raw (p<0.01) compared with baseline with either sequence. Expiratory flows and lung volume measurements were not significantly different from baseline. canadian family pharmacy online

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