RESUMO
Mammals airways are extensively innervated by the vagus nerve, which controls the airway diameter and bronchial tone. However, very few studies described the respiratory function and lung morphology after vagal section. In the present study, we evaluated the respiratory mechanics after aerosolization of vehicle (to obtain control values), a muscarinic agonist (methacholine), a ß2-adrenergic agonist (salbutamol) or a muscarinic antagonist (ipratropium bromide) in intact (Vi) and bilaterally vagotomized (Vx) Swiss male mice. Different group was established for morphometric analyze. The total lung resistance, airway resistance, elastance, compliance, lung tissue damping, lung tissue elastance, and morphological parameters (collagen and elastic fibers) were significantly different in the Vx group compared to the Vi group. Bronchoconstrictor and bronchodilators change the respiratory function of the Vx group. In conclusion, the vagus nerve modulates the lung function in response to bronchoconstriction and bronchodilation, as well as lung architecture of mice.
Assuntos
Agonistas de Receptores Adrenérgicos beta 2/farmacologia , Broncoconstritores/farmacologia , Broncodilatadores/farmacologia , Pulmão/efeitos dos fármacos , Pulmão/fisiologia , Antagonistas Muscarínicos/farmacologia , Mecânica Respiratória/efeitos dos fármacos , Mecânica Respiratória/fisiologia , Vagotomia , Nervo Vago/fisiologia , Albuterol/farmacologia , Animais , Colágeno , Tecido Elástico , Ipratrópio/farmacologia , Pulmão/ultraestrutura , Masculino , Cloreto de Metacolina/farmacologia , Camundongos , Agonistas Muscarínicos/farmacologiaRESUMO
This study aimed to investigate the role of M3 acetylcholine receptor (M3-AChR) expression in airway remodeling. Additionally, we aimed to evaluate the effects of ipratropium bromide solution inhaled in an early phase of asthma on airway remodeling in ovalbumin (OVA)-sensitized and challenged mice. Thirty BALB/c mice were divided into three groups, namely, control group (saline sensitized/challenged mice), asthma group (OVA sensitized/challenged mice), and treatment group (OVA sensitized/challenged mice treated by ipratropium bromide). Pathological changes were detected by histological staining in the bronchopulmonary tissue of mice. WAt/Pbm (the airway wall area /basement membrane perimeter) ratio of the asthma group (25.37 ± 4.25) increased significantly (P < 0.05) when compared with that of the control (12.89 ± 1.71) and treatment group (15.82 ± 2.91). WAm/Pbm (smooth muscle wall area / basement membrane perimeter) ratio of the asthma group (7.58 ± 2.16) increased significantly (P < 0.05) when compared with that of the control (2.55 ± 0.72) and treatment group (3.36 ± 1.69). M3-AChR concentration increased in the treatment group (29.24 ± 3.59) and was significantly different (P < 0.05) from that of the control group (25.50 ± 1.83). During asthma treatment, SAMA can alleviate airway remodeling in murine model by lessening the thickness of bronchial walls and inhibiting the proliferation of smooth muscle cells. There were no obvious changes in M3-AChR density in the murine model of asthma characterized by airway remodeling. However, ipratropium bromide may up-regulate the expression of M3-AChR in bronchial walls of asthmatic murine model.
Assuntos
Remodelação das Vias Aéreas , Asma/metabolismo , Brônquios/metabolismo , Receptores Colinérgicos/metabolismo , Animais , Antiasmáticos/farmacologia , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/patologia , Brônquios/efeitos dos fármacos , Brônquios/patologia , Feminino , Ipratrópio/farmacologia , Ipratrópio/uso terapêutico , Camundongos , Camundongos Endogâmicos BALB C , Miócitos de Músculo Liso/efeitos dos fármacos , Miócitos de Músculo Liso/metabolismo , Receptores Colinérgicos/genéticaRESUMO
OBJECTIVE: This work was aimed to investigate the pharmacodynamic interactions between gnaphaliins A and B with ipratropium bromide (IBR) and salbutamol (SAL) using the guinea pig trachea model through application of the combination index (CI)-isobologram equation. METHODS: The guinea pig trachea rings in isolated chamber with Krebs-Henseleit solution (37°C) were contracted with carbachol (3 µm), and then, concentration-relaxant effect curves were constructed for individual drugs and in combination at fixed constant ratios (1 : 1, 3 : 1 and 1 : 3). Median effect and combination index (CI)-isobologram equations were used for determining interactions. KEY FINDINGS: Gnaphaliin A and gnaphaliin B showed clear synergistic interaction with salbutamol, reducing the dose of salbutamol more than sevenfolds to produce the same relaxant effect. However, the combination of either flavonoids with ipratropium bromide showed no interaction. CONCLUSIONS: Applying the combination index-isobologram method, we determined that gnaphaliin A and gnaphaliin B have synergistic effect with salbutamol due probably to their inhibitory effect on phosphodiesterases to maintain high levels of cAMP in the tracheal smooth muscle. However, these compounds did not show any effect with ipratropium.
Assuntos
Albuterol/farmacologia , Broncodilatadores/farmacologia , Flavonoides/farmacologia , Interações Ervas-Drogas , Ipratrópio/farmacologia , Relaxamento Muscular/efeitos dos fármacos , Músculo Liso/efeitos dos fármacos , Traqueia/efeitos dos fármacos , Animais , Relação Dose-Resposta a Droga , Sinergismo Farmacológico , Cobaias , Técnicas In Vitro , MasculinoRESUMO
BACKGROUND: Expiratory flow limitation and lung hyperinflation promote cardiocirculatory perturbations that might impair O(2) delivery to locomotor muscles in patients with chronic obstructive pulmonary disease (COPD). The hypothesis that decreases in lung hyperinflation after the inhalation of bronchodilators would improve skeletal muscle oxygenation during exercise was tested. METHODS: Twelve non- or mildly hypoxaemic males (forced expiratory volume in 1 s (FEV(1))=38.5+/-12.9% predicted; Pao(2)>60 mm Hg) underwent constant work rate cycle ergometer exercise tests (70-80% peak) to the limit of tolerance (Tlim) after inhaled bronchodilators (salbutamol plus ipratropium) or placebo. Muscle (de)oxygenation (approximately fractional O(2) extraction) was determined in the vastus lateralis by changes (Delta) in the deoxyhaemoglobin/myoglobin signal ([HHb]) from near-infrared spectroscopy, and cardiac output (QT) was monitored by impedance cardiography. RESULTS: Bronchodilators reduced lung hyperinflation and increased Tlim compared with placebo (454+/-131 s vs 321+/-140 s, respectively; p<0.05). On-exercise kinetics of QT and pulmonary O(2) uptake V(o(2))were accelerated with active treatment; Delta[HHb] dynamics, however, were delayed by approximately 78% and the signal amplitude diminished by approximately 21% (p<0.01). Consequently, the ratio between V(o(2)) and Delta[HHb] dynamics decreased, suggesting improved microvascular O(2) delivery (tau-V(o(2))/MRT-Delta[HHb]=4.48+/-1.57 s vs 2.08+/-1.15 s, p<0.05). Of note, reductions in lung hyperinflation were related to faster QT kinetics and larger decrements in tau-V(o(2))/MRT-Delta[HHb] (p<0.01). CONCLUSIONS: Decreases in operating lung volumes after the inhalation of bronchodilators are associated with faster 'central' cardiovascular adjustments to high-intensity exercise with beneficial consequences on muscle oxygenation in patients with moderate to severe COPD.
Assuntos
Broncodilatadores/farmacologia , Músculo Esquelético/fisiopatologia , Consumo de Oxigênio/efeitos dos fármacos , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Agonistas Adrenérgicos beta/farmacologia , Agonistas Adrenérgicos beta/uso terapêutico , Idoso , Albuterol/farmacologia , Albuterol/uso terapêutico , Brasil , Broncodilatadores/uso terapêutico , Antagonistas Colinérgicos/farmacologia , Antagonistas Colinérgicos/uso terapêutico , Estudos Cross-Over , Método Duplo-Cego , Teste de Esforço/métodos , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Ipratrópio/farmacologia , Ipratrópio/uso terapêutico , Perna (Membro)/fisiopatologia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Capacidade Vital/efeitos dos fármacosRESUMO
Exercise-induced bronchospasm (EIB) is the transient narrowing of the airways that follows vigorous exercise. Ipratropium bromide may be used to prevent EIB, but its effect varies among individuals. We hypothesized that time of administration of ipratropium interferes with its action. This was a prospective, double-blind, cross-over study carried out to evaluate the bronchoprotective and bronchodilatory effect of ipratropium at different times of day. The study consisted of 4 exercise challenge tests (2 at 7 am and 2 at 6 pm). In the morning, one of the tests was performed after placebo administration and the other one after ipratropium (80 microg) and the two tests (placebo and ipratropium) were repeated in the evening. Twenty-one patients with severe or moderate asthma and previous confirmation of EIB were enrolled in this prospective trial. The bronchodilatory effect of ipratropium was 0.25+/-0.21 L or 13.11+/-10.99% (p=0.001 compared to baseline values) in the morning, and 0.14+/-0.25 L or 7.25+/-11.37% (p>0.05) in the evening. In the morning, EIB was 0.58+/-0.29 L on the placebo day and 0.38+/-0.22 L on the treatment day (p=0.01). In the evening, EIB was 0.62+/-0.28 L on the placebo day and 0.51+/-0.35 L on the treatment day (p>0.05). We suggest that the use of ipratropium for the treatment of asthma and EIB should take into consideration the time of administration.
Assuntos
Asma Induzida por Exercício/tratamento farmacológico , Broncodilatadores/uso terapêutico , Ipratrópio/uso terapêutico , Adulto , Asma Induzida por Exercício/fisiopatologia , Broncodilatadores/farmacologia , Ritmo Circadiano , Estudos Cross-Over , Método Duplo-Cego , Esquema de Medicação , Teste de Esforço , Feminino , Humanos , Ipratrópio/farmacologia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Testes de Função Respiratória , Fatores de TempoRESUMO
BACKGROUND: The six minute walk test (6 MW) elicits dynamic hyperinflation (DH) in severe COPD patients, which can be evaluated by reductions in inspiratory capacity (IC). Although IC is currently used to determine the effects of bronchodilators on DH during exercise tests on a cycle ergometer, its usefulness during a walking test has not been evaluated. AIM: To study the acute effects of ipratropium bromide (IB) on forced expiratory volume at l second (FEV1) and IC at rest and on DH during exercise assessed by the 6 MW. SUBJECTS AND METHODS: Fifteen stable COPD patients were randomly allocated in a double-blind, placebo-controlled, crossover fashion to 2 treatment periods using a single dose of nebulized IB 500 mg or placebo. Spirometry, including IC, and 6 MW were measured at baseline and after IB and placebo. IC was also measured 15 min after exercise. Dyspnea, oxygen saturation (SpO2) and heart rate were assessed at the end of exercise. RESULTS: After IB, 8/15 patients exhibited a clinically significant increase in IC (> or = 10% predicted). A similar increase in FEV1 was observed in only one patient. No changes were observed with placebo. A significant increase in 6 MW from baseline (p = 0.007) was found after IB (45 +/- 14 m) compared to placebo (0.5 +/- 9 m), whereas dyspnea was significantly lower. Inspiratory capacity fell after 6 MW with both treatments, but it reached their baseline values at 15 min after exercise only with IB. CONCLUSIONS: Our results demonstrate that IC provides additional information to conventional spirometry on the acute effects of bronchodilators and confirm its value to assess DH during a walking test.
Assuntos
Broncodilatadores/farmacologia , Teste de Esforço/efeitos dos fármacos , Ipratrópio/farmacologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Idoso , Método Duplo-Cego , Feminino , Volume Expiratório Forçado/efeitos dos fármacos , Humanos , Capacidade Inspiratória/efeitos dos fármacos , Masculino , Pessoa de Meia-Idade , Descanso , Espirometria , CaminhadaRESUMO
BACKGROUND: The six minute walk test (6 MW) elicits dynamic hyperinflation (DH) in severe COPD patients, which can be evaluated by reductions in inspiratory capacity (IC). Although IC is currently used to determine the effects of bronchodilators on DH during exercise tests on a cycle ergometer, its usefulness during a walking test has not been evaluated. AIM: To study the acute effects of ipratropium bromide (IB) on forced expiratory volume at l second (FEV1) and IC at rest and on DH during exercise assessed by the 6 MW. SUBJECTS AND METHODS: Fifteen stable COPD patients were randomly allocated in a double-blind, placebo-controlled, crossover fashion to 2 treatment periods using a single dose of nebulized IB 500 mg or placebo. Spirometry, including IC, and 6 MW were measured at baseline and after IB and placebo. IC was also measured 15 min after exercise. Dyspnea, oxygen saturation (SpO2) and heart rate were assessed at the end of exercise. RESULTS: After IB, 8/15 patients exhibited a clinically significant increase in IC (> or = 10 per cent predicted). A similar increase in FEV1 was observed in only one patient. No changes were observed with placebo. A significant increase in 6 MW from baseline (p = 0.007) was found after IB (45 +/- 14 m) compared to placebo (0.5 +/- 9 m), whereas dyspnea was significantly lower. Inspiratory capacity fell after 6 MW with both treatments, but it reached their baseline values at 15 min after exercise only with IB. CONCLUSIONS: Our results demonstrate that IC provides additional information to conventional spirometry on the acute effects of bronchodilators and confirm its value to assess DH during a walking test.
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Broncodilatadores/farmacologia , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Ipratrópio/farmacologia , Teste de Esforço/efeitos dos fármacos , Caminhada , Capacidade Inspiratória/efeitos dos fármacos , Descanso , Espirometria , Método Duplo-Cego , Volume Expiratório Forçado/efeitos dos fármacosRESUMO
OBJECTIVE: To determine whether the addition of repeated doses of nebulized ipratropium bromide (IB) to a standardized inpatient asthma care algorithm (ACA) for children with status asthmaticus improves clinical outcome. STUDY DESIGN: Children with acute asthma (N = 210) age 1 to 18 years admitted to the ACA were assigned to the intervention or placebo group in randomized double-blind fashion. Both groups received nebulized albuterol, systemic corticosteroids, and oxygen according to the ACA. The intervention group received 250 microg IB combined with 2.5 mg albuterol by jet nebulization in a dosing schedule determined by the ACA phase. The placebo group received isotonic saline solution substituted for IB. Progression through each ACA phase occurred based on assessments of oxygenation, air exchange, wheezing, accessory muscle use, and respiratory rate performed at prescribed intervals. RESULTS: No significant differences were observed between treatment groups in hospital length of stay (P =.46), asthma carepath progression (P =.37), requirement for additional therapy, or adverse effects. Children >6 years (N = 70) treated with IB had shorter mean hospital length of stay (P =.03) and more rapid mean asthma carepath progression (P =.02) than children in the placebo group. However, after adjustment was done for baseline group differences, the observed benefit of IB therapy in older children no longer reached statistical significance. CONCLUSION: The routine addition of repeated doses of nebulized IB to a standardized regimen of systemic corticosteroids and frequently administered beta-2 agonists confers no significant enhancement of clinical outcome for the treatment of hospitalized children with status asthmaticus.
Assuntos
Agonistas Adrenérgicos beta/uso terapêutico , Albuterol/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Broncodilatadores/uso terapêutico , Antagonistas Colinérgicos/uso terapêutico , Hospitalização , Ipratrópio/uso terapêutico , Estado Asmático/tratamento farmacológico , Doença Aguda , Administração por Inalação , Adolescente , Agonistas Adrenérgicos beta/farmacologia , Fatores Etários , Albuterol/farmacologia , Algoritmos , Anti-Inflamatórios/farmacologia , Broncodilatadores/farmacologia , Criança , Pré-Escolar , Antagonistas Colinérgicos/farmacologia , Procedimentos Clínicos , Método Duplo-Cego , Quimioterapia Combinada , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Ipratrópio/farmacologia , Tempo de Internação/estatística & dados numéricos , Masculino , Nebulizadores e Vaporizadores , Troca Gasosa Pulmonar , Estado Asmático/diagnóstico , Estado Asmático/metabolismo , Estado Asmático/fisiopatologia , Esteroides , Resultado do TratamentoRESUMO
La respuesta clínica y funcional a dos broncodilatadores, bromuro de ipratropio y teofilina en enfermedad pulmonar obstructiva crónica fue evaluada en 62 pacientes, procedentes del programa de enfermedades bronquiales obstructivas del Instituto Nacional del Tórax. Conjuntamente se describen las características clínicas, radiológicas y de laboratorio de los 62 pacientes. El estudio duró 6 meses y los pacientes recibieron bromuro de ipratropio 40 mg 4 veces al día por vía inhalatoria o teofilina oral 200 mg 2 veces al día. Por distribución aleatoria se dividieron en dos series : ipratropio (n=30) y teofilina (n=32) realizándose cambio de terapia a los 3 meses. Los pacientes fueron sometidos mensualmente a un seguimiento clínico y funcional durante el tiempo de duración del estudio. Al final del período de tratamiento, la disnea mejoró solo durante el período con ipratropio (p<0,01), aunque no se apreció cambios significativos en la función pulmonar con ninguno de los dos medicamentos. Durante el período con ipratropio se presentó una menor frecuencia de reacciones adversas severas (p < 0,05)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Ipratrópio/farmacologia , Pneumopatias Obstrutivas/tratamento farmacológico , Teofilina/farmacologia , Administração por Inalação , Dispneia/tratamento farmacológico , Ipratrópio/administração & dosagem , Ipratrópio/efeitos adversos , Fatores de Risco , Sinais e Sintomas , Fumar/efeitos adversos , Teofilina/administração & dosagem , Teofilina/efeitos adversosRESUMO
El bromuro de ipratropio (BI) asociado con un agente beta 2 agonista en aerosol producido por inhalador de dosis medida (IDM) es frecuentemente empleado en lactantes y niños con obstrucción bronquial. En este estudio se evaluó el efecto broncodilatador de dos dosis diferentes (2 y 4 puffs) de una mezcla de BI más salbutamol (S) en IDM (Combivent) en 28 niños con asma leve a moderada. El estudio fue aleatorio, cruzado, controlado con placebo y simple ciego. La CVF, VEF1 y FEF25-75 se midieron en condiciones basales, antes y después de placebo y de cada una de las dosis empleadas. El análisis estadístico se realizó mediante pruebas no paramétricas para muestras pareadas. No hubo diferencias significativas en ninguno de los índices espirométricos descritos al usar 2 o 4 "puffs" de BI+S. Sin embargo, en los pacientes que tuvieron un aumento del VEF1 > o igual 15 por ciento con cualquiera de las 2 dosis de BI+S, el aumento del FEF25-75 fue significativamente mayor al usar 4 "puffs". Lo anterior sugiere que 2 "puffs" de BI+S serían igualmente efectivos para producir broncodilatación en niños asmáticos. Sin embargo, en aquellos pacientes que presentan un mayor grado de obstrucción bronquial, o como en este estudio, una reversibilidad bronquial más alta al broncodilatador, el empleo de 4 "puffs" de BI+S podría ser más eficiente para obtener una mejor broncodilatación
Assuntos
Humanos , Masculino , Feminino , Albuterol/farmacologia , Asma/tratamento farmacológico , Ipratrópio/farmacologia , Albuterol/administração & dosagem , Broncodilatadores/uso terapêutico , Relação Dose-Resposta a Droga , Fluxo Expiratório Forçado/efeitos dos fármacos , Volume Expiratório Forçado/efeitos dos fármacos , Ipratrópio/administração & dosagem , Capacidade Vital/efeitos dos fármacosRESUMO
Se evalúa la respuesta clínica a diferentes broncodilatadores en 100 lactantes con síndrome bronquial obstructivo que, por la intensidad de éste requerían hospitalización, mediante un estudio prospectivo doble ciego, en el que se asignaron 25 niños menores de lactantes por grupo. Los niños del grupo I recibieron ipratropio (I), los del grupo II cloruro de sodio 9 por ciento (NaCI), en el grupo III se empleó fenoterol-ipratropio (FI) y en el grupo IV salbutamol (S), en todos los casos por nebulización. La calificación de Tal era similar al ingreso en los 4 grupos (día 0). Al día 1 del tratamiento era significativamente menor (p<0,05) en FI, como también el día 2 (p<0,01): (promedios día 1: 4,6 (I); 4,5 (NaCI); 3,8 (FI); 4,6 (S); día 2: 3,8 (I) 4,1 (NaCI); 2,1 (FI); 3,9 (S); día 3: 3,0 (I); 3,4 (NaCI); 1,6 (FI); 3,2 (S). El promedio de días estada fue I: 4,64 ñ 1,29; NaCI: 5,44 ñ 1,61; FI: 3,08 ñ 1,28; S: 5,28 ñ 1,69; p<0,001 a favor de FI. Los niños tratados con NaCI requirieron con mayor frecuencia terapia adicional con broncodilatadores (p<0,05) en claro contraste con los manejados con FI, que requirieron menos broncodilatadores adicionales que el resto (p<0,01) desde el día 1 del ingreso. No se registraron efectos secundarios indeseables con los diferentes regímenes aplicados
Assuntos
Humanos , Masculino , Feminino , Lactente , Administração Intranasal , Bronquite/tratamento farmacológico , Broncodilatadores/farmacologia , Nebulizadores e Vaporizadores , Albuterol/efeitos adversos , Albuterol/farmacologia , Evolução Clínica , Protocolos Clínicos , Quimioterapia Combinada/farmacologia , Fenoterol/efeitos adversos , Fenoterol/farmacologia , Ipratrópio/efeitos adversos , Ipratrópio/farmacologia , Pneumopatias Obstrutivas/tratamento farmacológico , Estudos Prospectivos , Cloreto de Sódio/efeitos adversos , Cloreto de Sódio/farmacologia , Resultado do TratamentoRESUMO
1. The effects of phenthonium and related compounds on the spontaneous release of acetylcholine (ACh) were investigated with electrophysiological and radiolabelled techniques to correlate the prejunctional effect with their cholinolytic activities and to determine the structure-activity relationship. 2. Phenthonium and endophen are N-(4-phenyl)-phenacyl derivatives of l-hyoscyamine in "exo" and "endo" conformation, respectively. Tropol is N-(4-phenyl) phenacyl tropan-3-ol whereas ipratropium is 8-isopropyl-noratropine. 3. Only phenthonium increased the frequency of miniature endplate potentials and the resting efflux of spontaneous [3H]-ACh in rat diaphragm muscles. 4. The rank order of the antimuscarinic potency was: ipratropium > atropine > phenthonium = endophen > tropol. The rank order of the antinicotinic activity was: phenthonium = endophen > tropol > atropine > ipratropium. 5. It is concluded that the prejunctional facilitatory effect of phenthonium is associated with the N-phenyl-phenacyl group at "exo" conformation but the effect is unrelated to its cholinolytic properties.
Assuntos
Acetilcolina/metabolismo , Derivados da Atropina/farmacologia , Antagonistas Colinérgicos/farmacologia , Junção Neuromuscular/efeitos dos fármacos , Junção Neuromuscular/metabolismo , Animais , Feminino , Cobaias , Íleo/efeitos dos fármacos , Íleo/inervação , Técnicas In Vitro , Ipratrópio/farmacologia , Cinética , Potenciais da Membrana/efeitos dos fármacos , Placa Motora/efeitos dos fármacos , Placa Motora/fisiologia , Antagonistas Muscarínicos/farmacologia , Contração Muscular/efeitos dos fármacos , Contração Muscular/fisiologia , Bloqueadores Neuromusculares/farmacologia , Ratos , Ratos Wistar , Relação Estrutura-Atividade , TrítioAssuntos
Masculino , Feminino , Criança , Corticosteroides/farmacologia , Asma/terapia , Cromolina Sódica/farmacologia , Inflamação/tratamento farmacológico , Ipratrópio/farmacologia , Teofilina/efeitos adversos , Albuterol/uso terapêutico , Asma/prevenção & controle , Fenoterol/uso terapêutico , Terbutalina/uso terapêuticoRESUMO
O objetivo deste trabalho é fazer uma análise crítica do brometo de ipratrópio (BI), discutindo suas propriedades farmacológicas, comparaçöes e combinaçöes com outras drogas broncodilatadoras e seu papel na terapêutica de patologias broncopulmonares