Fg. Hayden et al., EFFECTIVENESS AND SAFETY OF INTRANASAL IPRATROPIUM BROMIDE IN COMMON COLDS - A RANDOMIZED, DOUBLE-BLIND, PLACEBO-CONTROLLED TRIAL, Annals of internal medicine, 125(2), 1996, pp. 89
Objective: To determine the tolerability and clinical effectiveness of
intranasal ipratropium bromide for the treatment of symptoms of commo
n colds. Design: Multicenter, double-blind, randomized trial. Setting:
3 university student health services. Patients: 411 previously health
y persons 14 to 56 years of age who had cold symptoms that had lasted
for no more than 36 hours, rhinorrhea subjectively judged to be of at
least moderate severity, and documented nasal discharge of at least 1.
5 g over a 1-hour observation period. Intervention: Either 1) ipratrop
ium bromide nasal spray 0.06% in buffered salt solution, two 42-mu g s
prays per nostril administered by metered pump spray; 2) control nasal
spray, which consisted of buffered salt solution; or 3) no treatment.
Treatments were self-administered three or four times daily during wa
king hours for 4 days. After receiving their morning dose, patients st
ayed at the study center for 6 hours on study day 1 and 3 hours on stu
dy day 2; symptom severity was recorded and nasal mucus discharges wer
e collected and weighed hourly during these periods. Results: Ipratrop
ium recipients had 26% less nasal discharge than controls (P = 0.0024)
and 34% less nasal discharge than untreated patients (P = 0.0001). Se
verity of rhinorrhea as judged subjectively was reduced in ipratropium
recipients by 31% compared with controls and by 78% compared with unt
reated patients (P = 0.0001 for both comparisons). in addition to bein
g associated with reductions in daily assessments of the severity of r
hinorrhea (P less than or equal to 0.003), ipratropium was associated
with reduced sneezing on study days 2 (20% difference; P = 0.03) and 4
(30% difference; P = 0.02) but not with reduced nasal congestion comp
ared with the control spray. Ipratropium was generally well tolerated
but was associated with higher rates of blood-tinged mucus (16.8% in t
he ipratropium group compared with 3.6% in the control group; P = 0.01
) and nasal dryness (11.7% in the ipratropium group compared with 3.6%
in the control group; P = 0.021) than the control spray. Patient asse
ssments off the overall effectiveness of treatment were more favorable
for ipratropium than for the control spray (P less than or equal to 0
.026) or for no treatment (P less than or equal to 0.002) on each day
of inquiry; (study days 1, 2, and 5). Conclusions: Intranasal ipratrop
ium bromide provides specific relief of rhinorrhea and sneezing associ
ated with common colds.