ABNORMALITIES OF PULMONARY-FUNCTION IN PATIENTS WITH CONGESTIVE-HEART-FAILURE, AND REVERSAL WITH IPRATROPIUM BROMIDE

Patients with congestive heart failure (CHF) have baseline restrictive and obstructive abnormalities in pulmonary function. Thus, improvemen t of respiratory parameters may provide a new method for the treatment of CHF. Ipratropium is an inhaled anticholinergic bronchodilator with no reported cardiac or systemics effect. A pilot study was performed to investigate the acute effects of a 72 mu g inhaled dose of ipratrop ium bromide on pulmonary function and pulmonary artery pressures in 18 nonsmokers and 11 smokers with severe (New York Heart Association cla ss 2 or 3), stable CHF who were referred for orthotopic cardiac transp lantation. An unmatched group of 10 healthy subjects (5 men and 5 wome n, mean age 36.8 +/- 1.8 years) were studied with pulmonary function t esting alone. Forced expiratory volume in 1 second (FEV(1)) in 15 of 1 8 nonsmokers with CHF showed a favorable response with a mean improvem ent of 5.1% (2.74 +/- 0.20 to 2.89 +/- 0.19 liter after drug treatment ; p = 0.0026). Forced expiratory flow between 25 and 75% of the forced vital capacity (FEF(25-75)) improved by 19% (2.50 +/- 0.25 to 3.09 +/ - 0.28 liter/s; p = 0.0013). Eight of 11 smokers with CHF responded wi th a 9.5% increase in FEV(1) (2.32 +/- 0.21 to 2.54 +/- 0.19 liter; p = 0.0006) and a 23.2% increase in FEF(25-75) (1.82 +/- 0.38 to 2.37 +/ - 0.46 liter/s; p = 0.0029). Pulmonary artery pressures, cardiac outpu t, systemic arterial pressures, and cardiac rate and rhythm were unaff ected by administration of the drug. All normal subjects responded to ipratropium bromide. FEV(1) increased by 3.8% (4.14 +/- 0.3 to 4.29 +/ - 0.3 liter; p = 0.0002), and FEF(25-75) increased by 15.2% (4.28 +/- 0.39 to 4.94 +/- 0.41 liter/s; p = 0.0005). It is concluded that the a irway response to ipratropium bromide in patients with CHF is highly s ignificant. Further study is needed to determine whether chronic thera py with ipratropium bromide in selected patients with CHF will lead to improvements in exertional breathlessness and effort tolerance.