Rebuck AS et al, 1987, Canada | 51 patients with an acute exacerbation of COPD (148 asthmatics also recruited) | PRCT | FVC, FEV1, MMEFR, PEFR, cardiovascular markers at 45 min | No significant difference | No sample size calculation. |
| | | | | Small groups in each of the treatment arms, thus small differences may go undetected. |
| Ipratropium v fenoterol v both (all nebulised). | | FVC, FEV1, MMEFR, PEFR, cardiovascular markers at 90 min | No significant difference | |
O'Driscoll BR et al, 1989, UK | 47 patients with COPD (an asthmatic group also recruited) | PRCT | PEFR on arrival and at one hour | No difference in improvement (p>0.55) | No sample size calculation, small groups in each treatment arm, thus important effects can be overlooked. No defined inclusion or exclusion criteria. 20 patients admitted, excluded from study. |
| Salbutamol v salbutamol plus ipratropium bromide | | | | |
| | | | | No actual figures given. |
Shrestha M et al, 1991, USA | 55 COPD patients with an acute exacerbation (FEV1 <40% of predicted) | PRCT | Times to discharge from ED | Time to discharge 91 minutes less in the salbutamol plus ipratropium group (p<0.05) | No sample size calculation. |
| | | | | Small numbers. Inhaled therapy |
| Isoetharine plus placebo v isoetharine plus ipratropium bromide (inhaled) | | FVC, FEV1 | No difference | |
Moayyedi P et al, 1995, UK | 62 COPD patients with an acute exacerbation | PRCT | Length of hospital stay | No significant difference | Power study retrospectively completed |
| | | Duration of nebuliser therapy | No significant difference | |
| Salbutamol v salbutamol plus ipratropium bromide (nebulised) | | FVC, FEV1 | No significant difference | |
| | | Subjective improvement on days 1, 3, 7 and 14 | No significant difference | |
Koutsogiannis Z and Kelly A-M, 2000, Australia | 50 patients presenting to ED with an acute exacerbation of COPD. | PRCT | Absolute and percentage change in FEV1 at 90 min | No difference between the 2 groups. | No sample size calculation. |
| | | | | Groups are small thus any differences may be overlooked. |
| | | | (p=0.36 for absolute change, p=0.56 for % change) | |
| All patients started with salbutamol and ipratropium nebulisers and then salbutamol v ipratropium v salbutamol plus ipratropium. | | | | All patients had both drugs initially. |