Improved delivery of ipratropium bromide using Respimat (R) (a new soft mist inhaler) compared with a conventional metered dose inhaler: cumulative dose response study in patients with COPD

Respimat(R) (RMT) is a reusable, propellant-free, soft mist inhaler (SMI), a novel device for inhalation therapy. We conducted a three-period cross-ov er study to evaluate the safety and efficacy of cumulative doses of ipratro pium bromide inhaled from RMT (Two dose levels) or from a pressurized meter ed dose inhaler (MDI), in 36 patients with chronic obstructive pulmonary di sease (COPD). The bronchodilator effect of ipratropium bromide was greater when administered via RMT (10 or 20 mu g per puff. given double-blind withi n device, to total doses of 160 or 320 mu g) than via MDI (20 mu g per puff ; total dose 320 mu g). The bronchodilator effects of the 160 and 320 mu g doses delivered via RMT were similar. Cumulative ipratropium bromide doses of 320 mu g given via MDI or RMT and 160 mu g given via RMT produced simila r safety profiles. Between 45 min after the first drug inhalation and 45 mi n after the final dose, greater bronchodilatory effect was obtained from ha lf the cumulative dose of ipratropium (RMT 10 pg per puff) when compared wi th the MDI (20 mu g per puff). Therefore, ipratropium bromide delivered by RMT is as safe as, and can be more effective than. the MDI on acute adminis tration in patients with COPD.