O1.1.3 Short-acting bronchodilator combinations

For combination therapy with ipratropium bromide and short-acting beta2-agonists, there was no significant difference in pre-drug spirometry compared to ipratropium bromide alone (Appleton 2006a). There was a significant benefit for the combination in post-drug spirometry measurements; weighted mean difference = 70 mls (95% CI 50 to 90) for FEV1 and 120mls (95% CI 80 to 160) for FVC. There was no significant difference between interventions for quality of life or adverse drug effects, but combination treatment decreased the need to add or increase oral corticosteroids compared to ipratropium bromide alone, Number Needed to Treat = 20 (95% CI 12 to 108).

In summary, short-acting bronchodilators, either beta2-agonists or ipratropium bromide, significantly increase lung function measurements in COPD. Ipratropium bromide has a significantly greater effect on lung function compared to beta2-agonists alone; in addition to improving quality of life and decreasing need for oral corticosteroid treatment. These benefits occurred with a decreased risk of adverse drug effects. Combining two classes of bronchodilator may provide added benefits without compounding adverse effects.