Heart failure: ipratropium bromide may improve lung function.

Clinical bottom line (level 2b)

  1. Patients with heart failure who were given ipratropium bromide, may have a higher total lung capacity after treatment than at admission.
  2. Patients given ipratropium bromide, may have a small increase in FEV 1 after treatment than at admission.
Rolla et al: European Respiratory Journal 1993; 6: 1492-1495
Expires October 2003

The study

Double-blinded ?concealed randomised cross-over trial with intention-to-treat
Setting: University hospital, Italy

10 patients (aged mean 67 years, 60% male) exacerbation of dyspnoea caused by chronic heart failure

Excluded if
  • previous diagnosis of chronic obstructive pulmonary disease
  • smoked >10 pack-years
  • occupational history at risk for respiratory diseases
  • positive results to any of the 6 allergen tests performed
  • suspected myocardial infarction


    • Control Group: (n = 10, 10 analysed): placebo
    Experimental Group: (n = 10, 10 analysed): inhaled ipratropium, 60 µ g
    Following preliminary investigations, the patients underwent intensive treatment with increased diuretics, angiotensin-converting-enzyme inhibitors, antiarrhythmic drugs, when appropriate, for a period from 7-10 days. Following this, when clinical assessment had clearly improved, chest X-rays, lung function and arterial blood gas analysis were repeated.
    100% followed for ? weeks

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    total lung capacity (control=at admission; experiment=after therapy) 4.50
    (0.50)     		5.00
    (0.50)     		-0.50
    (-0.97 to -0.03)
    FEV 1 1.47
    (0.18)     		1.69
    (0.19)     		-0.22
    (-0.69 to 0.25)

    Comments

    1. Excluding heavy smokers (>10 pack years) implies a probably greater benefit among the general population with heart failure.
    2. Until a clinically important benefit can be demonstrated, it is unlikely that Ipratropium will become part of the standard management of heart failure.

    Citation

    1. Rolla G, Bucca C, Brussino L, et al: Bronchodilating effect of ipratropium bromide in heart failure. European Respiratory Journal 1993; 6: 1492-1495
    Contributor: Clare Wotton and Musab Hayatli, October 1999
    Reviewer: Peter Wark

    Clinical Question.
    Patient heart failure
    Intervention or Exposure ipratropium bromide
    Comparison placebo
    Outcome bronchodilation