BRONCHODILATING EFFECT OF IPRATROPIUM BROMIDE IN HEART-FAILURE

The aim of this study was to test the hypothesis that lung oedema caus es an obstructive airway impairment, due to an increase in cholingeric bronchial tone in patients with chronic heart failure (CHF). Ten pati ents with CHF were tested by inhalation of ipratropium bromide and pla cebo, given in sequential randomized order, in double-blind fashion, a fter assessment of baseline lung function, both during acute cardiac d ecompensation and after 8-10 days of adequate treatment. The decrease in lung oedema was associated with a significant increase in vital cap acity (VC) (from 70+/-4.4 to 83+/-5.4% pred), forced expiratory volume in one second (FEV1) (from 59+/-3.6 to 72+/-4.6% pred), FEV1/VC (from 61+/-2.8 to 64+/-2.3%) and residual volume (RV) (from 94+/-7.9 to 99/-6.8% pred). Ipratropium bromide produced a far better bronchodilatat ion during acute decompensation when FEV1 increased from 59+/-3.6 to 7 0+/-3.7% pred, than after intensive treatment for heart failure, when FEV1 increased from 72+/-4.6 to 76+/-4.8% pred. The maximum absolute i ncrease in FEV1 induced by ipratropium bromide was 286+/-32 ml at admi ssion and only 111+/-15 ml after In conclusion, in chronic heart failu re, airway obstruction is partially reversible after inhalation of an anti-muscarmic drug, when lung oedema is present, supporting the hypot hesis that lung oedema increases cholinergic bronchial tone.