COMBINED INTRANASAL IPRATROPIUM BROMIDE AND OXYMETAZOLINE IN EXPERIMENTAL RHINOVIRUS INFECTION

The topical anticholinergic ipratropium bromide and topical decongesta nt oxymetazoline were tested to determine whether oxymetazoline alone and the combination were well tolerated and reduced rhinorrhea and mid dle ear pressure abnormalities during experimental rhinovirus infectio n. The study was double-blind, placebo-controlled and double dummy ill design. Healthy volunteers (n = 109) with low serum neutralizing anti body titer (less than or equal to 1:2) were. Treatments inoculated wit h rhinovirus (type 39 or Hank's strain) and randomized to treatment wi th ipra-tropium bromide 0.06% two sprays per nostril (84 mu g per trea tment) and oxymetazoline 0.05% two sprays per nostril, oxymetazoline a lone, or placebo. Treatments were self administered twice daily for 5 days beginning 1 day after rhinovirus inoculation. The overall infecti on rate was 83% and of those infected, 88% felt that they had a cold. During the 3-hour period after nosing, the increase in nasal discharge was significantly lower in the combined ipratropium and oxymetazoline (0.13 +/- 0.17 gm/3 hr; mean +/- SE) than after oxymetazoline alone ( 0.60 +/- 0.18 gm/3 hr) or vehicle (0.73 +/- 0.18 gm/3 hr). Over the 5- day observation period total daily nasal discharge also tended to be l ower in the ipratropium plus oxymetazoline group (3.67 +/- 0.70 gm/24 hr; mean +/- SE) compared to oxymetazoline (5.61 +/- 0.73; 35% reducti on) or the vehicle (5.04 +/- 0.73: 27% reduction) recipients, but the differences were not statistically significant. Subjective assessments of rhinorrhea indicated that the severity of rhinorrhea was significa ntly better among patients receiving oxymetazoline alone or with iprat ropium compared to the vehicle. No significant difference in the cumul ative frequencies of middle ear pressure abnormalities (27-31%) were f ound among the treatment groups. Oxymetazoline does not consistently s timulate or decrease nasal mucus production, and ipratropium added to oxymetazoline is well tolerated and reduces rhinorrhea during experime ntal rhinovirus infection.