Ipratropium in the Management of Chronic Obstructive Pulmonary Disease - Research Paper Example

? The Pharmacological Effects of Ipratropium in the Management of Chronic Obstructive Pulmonary Disease The Pharmacological Effects of Ipratropium in the Management of Chronic Obstructive Pulmonary Disease Introduction Chronic Obstructive Pulmonary Disease is a pathology that alters the normal respiratory function of an individual. It is an issue of concern owing to the rising number of sufferers of this pathology. The most common cause that has been associated with Chronic Obstructive Pulmonary Disease is smoking. Pharmacological interventions are available for the treatment of this condition. Ipratropium is a pharmacological treatment modality which is prescribed to patients suffering from Chronic Obstructive Pulmonary Disease. This paper will serve to analyze what Chronic Obstructive Pulmonary Disease is and the pharmacological actions of ipratropium. It will emphasize upon the pharmacological effects of ipratropium in the management of Chronic Obstructive Pulmonary Disease. What is Chronic Obstructive Pulmonary Disease? Chronic Obstructive Pulmonary Disease is a pathological condition which results owing to the combination of three disease states which include chronic bronchitis, chronic bronchiolitis as well as emphysema. Systemic manifestations in patients may also be present which include loss of appetite which results in the reduction in weight and the functional capacity of the muscles may also reduce. Chronic Obstructive Pulmonary Disease as the name implies is the blockage in the airways. The changes that occur due to this condition cannot be restored to the initial normal physiological state. In the United Kingdom, the condition is known to affect 1 to 2 percent of the population and more than 30,000 people die due to this condition. It has been marked to be the sixth highest reason of mortality in the United Kingdom. The situation is similar in the United States where Chronic Obstructive Pulmonary Disease is an issue of concern and it is ranked as the fifth highest reason of severe life hampering disease and death amongst the patients. The global increase in the number of people suffering from Chronic Obstructive Pulmonary Disease is due to the alarming rise in the number of people who smoke cigarettes. Cigarette smoking has been marked to be the most important reason for the occurrence of this condition. An inflammatory process ensues in the airways and the cascade of events results in the narrowing of the airways. The condition is mostly seen in people above the age of 40 years. Patients with continuous cough which is accompanied with sputum and loss of breath may be checked to exclude the diagnosis of Chronic Obstructive Pulmonary Disease. A chest X-ray along with the Forced Expiratory Volumes and Forced Vital Capacity may be helpful in the diagnosis of the condition. Symptomatic treatment of Chronic Obstructive Pulmonary Disease is available which results in the betterment of the health status of the patients (Colledge et al 2010; Kumar et al 2005). Pharmacology of Ipratropium Ipratropium is made from isopropyl and the parent compound from which it is derived is atropine. It was discovered in the year 1976 by scientists working in Boehringer Ingelheim which is a pharmaceutical organization located in Germany. It is a quaternary ammonium compound which primarily functions towards the dilatation of the bronchioles. It is an anti-cholinergic agent. Anti-cholinergic agents which were derived naturally from Dhatura were used for the treatment of airway disease since hundreds of years. But the invention of ipratropium served as a breakthrough as this drug did not produce systemic side effects (George 2005; Ravina 2010). Mechanism of Action Ipratropium is a non-selective agent that acts on the muscuranic receptors of acetylcholine and thus prevents the action of acetycholine from taking place. It antagonizes the effect of acetylcholine on these receptors. The action of acetylcholine on these muscuranic receptors of the airways results in the generation of cGMP within the cells of the smooth muscles. This further leads to constricting the airways. Ipratropium particularly acts on these muscuranic receptors that lie in the airways and leads to relaxing the smooth muscles of the bronchi by preventing this acting of acetylcholine. The effect is the dilatation of the airways. This results in a ten percent enhancement in the forced expiratory volume. Ipratropium acts mainly on its target site that is the airways and does not act on other muscuranic receptors of the body. This is because the drug has a poor systemic absorption (Crain et al 2010; Saeb-Parsy 1999; Waller et al 2001). Pharmacokinetics Ipratropium is a drug which is given by nebulizers or aerosols and thus it is administered by inhalational methods. The drug does not get absorbed from the gastrointestinal tract and unlike atropine it does not hinder the mucociliary function. The drug starts its function after 60 to 90 minutes of administration and it stays in the body for 6 to 8 hours. The half life of the drug ranges to approximately 4 hours. Therefore, ipratropium starts working at a slower rate but its functioning persists for a longer time. The optimal dose for ipratropium for adults ranges from 40 to 80 micrograms. The dosage may be increased to as high as 125 micrograms according to the health status of the patient (Crain et al 2010; Siafakas 2004; Waller et al 2001). Contraindications Ipratropium should not be prescribed to patients who are allergic to ipratropium bromide. Patients who have hypersensitivity to atropine or soya lecithin should also not be advised ipratropium. It should also not be prescribed to patients who have glaucoma (Pollak 2008; Siafakas 2004). Adverse Effects Ipratropium is known to be very bitter and this may result in altered taste sensation of the mouth. It can also result in altering the normal visual capacity and lead to blurring. Ipratropium can lead to palpitations and it can worsen the condition of hypertensive patients by further increasing the blood pressure. It can cause drying and burning of the nasal passages associated with bleeding from the nose. It can affect the eyes and result in inflammation of the conjunctiva. Its contact with the throat can result in pharyngitis and hoarseness of voice. Cough may become worsened owing to the use of ipratropium. Other adverse effects of the drug include headache, complaint of dizziness and nervousness by the patient (Pollak 2008; Siafakas 2004). Chronic Obstructive Pulmonary Disease and Ipratropium Chronic Obstructive Pulmonary Disease occurs due to the narrowing of the airways owing to the ongoing inflammatory response. The airways become constricted and thus the patient presents with difficulty in breathing, cough and sputum. Ipratropium works as an anticholinergic on the walls of the smooth muscle of the airways and works towards their relaxation for providing relief for the patients of Chronic Obstructive Pulmonary Disease. Ipratropium relieves the bronchoconstriction of these patients (Siafakas 2004). There are five major symptoms of Chronic Obstructive Pulmonary Disease where the action of bronchodilators is considered crucial. Dyspnea is one of these symptoms and the patients present with loss of breath and they may complain of having difficulty with normal breathing. Restriction of the capacity to exercise is also a symptom of Chronic Obstructive Pulmonary Disease as the patient may complain of being unable to complete exercises like walking. The quality of life of patients is altered as they may complain of having difficulty while sleeping and having episodes of breathlessness during their sleep. Furthermore, they may complain of sputum which occurs due to the hypersecretion of mucus from the airways and due to the inflammation of the air passages. There is a reduction in the forced expiratory volume and the total lung volume as well (Hanania et al 2007). The assessment of the pharmacological actions of ipratropium in the management of Chronic Obstructive Pulmonary Disease can be done by assessing the action of the drug on these five major symptoms. Ipratropium that is mainly delivered by either metered dose inhalers or by nebulised solutions is termed as a short acting anticholinergic. The drug has been beneficial for increasing the forced expiratory volume of these patients. It also leads to a subsequent increase in the lung volume which shows another benefit of the usage of ipratropium. Ipratropium also results in the relief of dypnea of the patients. Furthermore the capacity to exercise also improves with the administration of ipratropium (Hanania et al 2007). The effects of ipratropium on sleep have been analyzed by a research that was conducted by Martin and his colleagues. The research comprised of thirty six subjects who were suffering from Chronic Obstructive Pulmonary Disease and their forced expiratory volume was less than 65 percent. The major cause of sleep disruption in Chronic Obstructive Pulmonary Disease is the reduction in the saturation of arterial oxygen. This is mainly due to the increased action of acetylcholine. The patients in the research were given ipratropium bromide over a period of four weeks and they were then assessed for their quality of sleep. It was analyzed that the saturation of arterial oxygen improved during the sleep time and the patients also expressed of betterment in the quality of their sleep. Furthermore, the duration of the rapid eye movement sleep also improved in the patients. The forced vital capacity before going to sleep was also considerably better in the patients. Thus the research indicated a clear association and improvement in sleep owing to the use of ipratropium in patients suffering from Chronic Obstructive Pulmonary Disease (Martin et al 1999). The muscuranic receptors, M1 and M3 are present in the airway passages. The parasympathetic action on these receptors leads to contractility of smooth muscle, release of mucus in greater amounts and the working of the cilia also increases. The M2 receptors are found on the postganglionic parasympathetic nerves. They can work towards reducing the release of acetylcholine if acted upon by particular drugs. The rise in acetylcholine is mainly responsible for the pathology of Chronic Obstructive Pulmonary Disease. Ipratropium possesses the capability of acting on all of the three muscuranic receptors. Its action on M1 and M3 receptor produces a direct effect on the airways and by acting on M2; it indirectly reduces the amount of acetylcholine. Another function of ipratropium as an anti-cholinergic has also been identified by the assistance of studies. It has been put forward by a research that the inflammatory process of the airways in Chronic Obstructive Pulmonary Disease results owing to the production of ERK1/2-dependent leukotriene B4 owing to the activation of this pathway by acetylcholine. Ipratropium may act pharmacologically to reduce this inflammatory process by reducing the production of acetylcholine (Hanania et al 2007). Studies have demonstrated the fact that for patients who have stable Chronic Obstructive Pulmonary Disease, ipratropium bromide is very beneficial in treating the symptoms of dyspnea and the exchange of gases increases appropriately as well. But further research has been done to see the effect of ipratropium on patients having acute episodes of Chronic Obstructive Pulmonary Disease. Rebuck and his colleagues carried out a research to analyze the effect of ipratropium on patients having an acute episode of Chronic Obstructive Pulmonary Disease. Their research demonstrated the fact that ipratropium was beneficial for these patients whose forced expiratory volume showed good improvement after 40 to 90 minutes of the inhalation of the drug. A similar research was carried out by Karper and his colleagues. This research also put forward the fact that ipratropium was helpful in treating acute episodes of Chronic Obstructive Pulmonary Disease. This was seen as the patients showed a mean rise of 25 percent in the forced expiratory volume and a mean rise of 22 percent in forced vital capacity (Siafakas 2004). A research was conducted to analyze the effect of ipratropium as well as metaproterenol on patients having acute episodes of Chronic Obstructive Pulmonary Disease. The research indicated the fact that though both the drugs served to increased the forced expiratory volume; metaproterenol resulted in a reduction in the partial pressure of oxygen after thirty minutes. On the other hand, ipratropium led to an increase in this partial pressure. This research upheld the fact that ipratropium was safer for patients having acute episodes of Chronic Obstructive Pulmonary Disease as it did not alter the partial pressure of oxygen and it increased it (Karpel 1990). Chronic Obstructive Pulmonary Disease is a pathological state of the respiratory system which results in blocking the airway passages. It leads to contraction of the bronchial smooth muscles and increased secretion of mucus. This results in difficulty in breathing, reduction in exercise tolerance and reduced forced expiratory volume and forced vital capacity. Ipratropium is a very useful drug that produces many positive effects on improving the health status of the patients suffering from Chronic Obstructive Pulmonary Disease. References Colledge, N. R., Davidson, L. S. P., Ralston, S. H., & Walker, B. R. (2010). Davidson's principles and practice of medicine. Edinburgh: Churchill Livingstone/Elsevier. Crain, E. F., & Gershel, J. C. (2010). Clinical manual of emergency pediatrics. Cambridge: Cambridge University Press. George, R. B. (2005). Chest medicine: Essentials of pulmonary and critical care medicine. Philadelphia, PA: Lippincott Williams & Wilkins. Hanania, N. A., & Donohue, J. F. (January 01, 2007). 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(2010). The evolution of drug discovery: From traditional medicines to modern drugs. Weinheim: Wiley-VCH. Saeb-Parsy, K. (1999). Instant pharmacology. Chichester: Wiley. Siafakas, N. M. (2004). Acute exacerbations of chronic obstructive pulmonary disease. New York: M. Dekker. Waller, D., Renwick, A. G., & Hillier, K. (2001). Medical pharmacology and therapeutics. Edinburgh: W.B. Saunders. Read More