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Randomized Controlled Trial
. 2011:6:637-46.
doi: 10.2147/COPD.S21917. Epub 2011 Nov 28.

Functional imaging using computer methods to compare the effect of salbutamol and ipratropium bromide in patient-specific airway models of COPD

L A De Backer  1 , W G Vos, R Salgado, J W De Backer, A Devolder, S L Verhulst, R Claes, P R Germonpré, W A De Backer
Affiliations
Randomized Controlled Trial

Functional imaging using computer methods to compare the effect of salbutamol and ipratropium bromide in patient-specific airway models of COPD

L A De Backer et al. Int J Chron Obstruct Pulmon Dis. 2011.

Abstract

Background: Salbutamol and ipratropium bromide improve lung function in patients with chronic obstructive pulmonary disease (COPD). However, their bronchodilating effect has not yet been compared in the central and distal airways. Functional imaging using computational fluid dynamics offers the possibility of making such a comparison. The objective of this study was to assess the effects of salbutamol and ipratropium bromide on the geometry and computational fluid dynamics-based resistance of the central and distal airways.

Methods: Five patients with Global Initiative for Chronic Obstructive Lung Disease Stage III COPD were randomized to a single dose of salbutamol or ipratropium bromide in a crossover manner with a 1-week interval between treatments. Patients underwent lung function testing and a multislice computed tomography scan of the thorax that was used for functional imaging. Two hours after dosing, the patients again underwent lung function tests and repeat computed tomography.

Results: Lung function parameters, including forced expiratory volume in 1 second, vital capacity, overall airway resistance, and specific airway resistance, changed significantly after administration of each product. On functional imaging, the bronchodilating effect was greater in the distal airways, with a corresponding drop in airway resistance, compared with the central airways. Salbutamol and ipratropium bromide were equally effective at first glance when looking at lung function tests, but when viewed in more detail with functional imaging, hyporesponsiveness could be shown for salbutamol in one patient. Salbutamol was more effective in the other patients.

Conclusion: This pilot study gives an innovative insight into the modes of action of salbutamol and ipratropium bromide in patients with COPD, using the new techniques of functional imaging and computational fluid dynamics.

Keywords: chronic obstructive pulmonary disease; computational fluid dynamics; computed tomography; imaging; ipratropium; salbutamol.

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Figures

Figure 1
Figure 1
Changes in airway volume based an segmented airways from the CT scan (iVtot) in a patient (upper figures) mainly responsive to salbutamol (B) and less to ipratropium bromide (A), and in a patient (lower figures) more responsive to ipratropium bromide (C) and less responsive to salbutamol (D).
Figure 2
Figure 2
Changes in FEV1, VC, Raw and sRaw after salbutamol and ipratropium in five COPD patients (GOLD III). All changes are significant (P < 0.05) except the changes in FEV1 after salbutamol and VC after ipratropium. Abbreviations: FEV1, forced expiratory volume in 1 second; VC, vital capacity; SE, standard error; SD, standard deviation.
Figure 3
Figure 3
Changes after salbutamol and ipratropium bromide in total (iVtot), central (iVcentr) and distal airway volume (iVdist) based on images of segmented airways and corresponding resistance (iRawtot, iRawcentr and iRawdist) using computational fluid dynamics, in five COPD patients (GOLD ST III). All changes are significant (P < 0.05) except for iVawcentr after salbutamol and iRawcentr after both salbutamol and ipratropium bromide. Abbreviations: SD, standard deviation; SE, standard error.
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