/:*-..= S Evid Based Med: first published as 10.1136/ebm.1996.1.205 on 1 December 1996. Downloaded from

Intranasal ipratropium bromide reduced rhinorrhea and improved cold symptoms

Hayden FG, Diamond L, Wood PB, 0.06% in a buffered salt solution (P = 0.003). {This 17% absolute dif- KortsDC, Wecker MT. Effectiveness (2 sprays/nostril [84 u,g] 3 times/d ference in improvement between the and safety of intranasal ipratropium for 4 d) (n = 137), the same nasal ipratropium and placebo groups bromide in common colds. A ran- spray without ipratropium in = 137), means that 6 patients (95% CI, 4 to domized, double-blind, placebo- or no medication (n = 137). No cold 16) would need to be treated with controlled trial. Ann Intern Med. medications other than analgesics ipratropium (rather than placebo) for 1996JullS;12S:89-91. and antitussives were allowed. 4 days to result in improvement for 1 additional patient; the relative risk Main outcome measures improvement was 26%, CI 9% to Objective 47%* }. Rates of nasal dryness (12% To determine whether intxanasal ipra- The main outcome measure was a vs 4%), blood-tinged mucus (17% vs tropium bromide is effective and safe global assessment of overall improve- 4%), and headache (9% vs 2%) were for reducing common cold symptoms. ment (report by patients of being better or much better). Rhinorrhea greater in the ipratropium group than Design was monitored in the clinic hourly in the placebo group. 6-day, randomized, double-blind, for the first 6 hours on day 1 and Conclusion placebo-controlled trial. hourly for 3 hours on day 2. Symp- toms were monitored for 4 days. Patients who used nasal sprays that Setting contained ipratropium bromide re- 3 U.S. university health services. Main results ported improved cold symptoms and less rhinorrhea but had more adverse Patients Analysis was by intention to treat. Ipratropium reduced rhinorrhea effects than did patients who re- 411 adults (mean age 22 y, 91% white) ceived placebo or no treatment. with at least moderate rhinorrhea and (P < 0.01), weight of nasal discharge documented nasal discharge (for < 36 (P < 0.001), and sneezing (P < 0.05) Source of funding: Boehringer Ingelbeim Pharmaceutical, Inc. hours) associated •with a cold. Exclu- but not nasal congestion. Overall http://ebm.bmj.com/ sion criteria included asthma, chronic improvement was reported at day 1 in For article reprint: Dr. EG. Hayden, Box 87% of the ipratropium group, 73% 47$, Department of Internal Medicine, respiratory disease, allergic rhinitis, University of Virginia Health Sciences fever, or probable bacterial infection. of the placebo group, and 57% of the untreated group. At day 5, 81% of the Center, Charlottesville, VA 22908, USA. Intervention ipratropium group, 65% of the place- "Numbers calculated from data in article. bo group, and 18% of the untreated Patients were allocated to nasal Abstract and Commentary also published in on September 24, 2021 by guest. Protected copyright. spray with ipratropium bromide, group reported overall improvement AC? Journal Chili. 1996; 125:73.

Commentary (continued from page 204) them as they were spontaneously reported. suits, but it would be more convincing to tion of zinc lozenges (but perhaps not other On the other hand, Mossad and colleagues see the results replicated in other settings. preparations) reduced the duration of colds used both an open-ended question and cat- The benefits of zinc lozenges and ipra- by nearly half when they were started egorical responses to identify the specific tropium nasal spray are clinically impor- within 24 hours of the onset of symptoms; side effects of the zinc lozenges. Not sur- tant but are tempered by their adverse S lozenges should be dissolved in the prisingly, patients reported more side effects effects (unpleasant taste and nausea with mouth daily until symptoms resolve. To re- when asked specifically about adverse effects zinc lozenges and nasal drying with duce the sneezing and rhinorrhea associ- of the zinc lozenges than when asked to re- ipratropium nasal spray). We do not know ated with the common cold, ipratropium spond to an open-ended question. what the economic and epidemiologic ef- nasal spray can be used, but patients should Compared with the placebo group, pa- fects of these treatments will be. Will they be told to titrate the number of sprays to tients using this particular zinc gluconate- reduce work and school absenteeism or prevent excessive nasal drying. glycine complex had fewer days with complications of colds? Will they affect Peter S. Millard, MD, PhD cough, headaches, hoarseness, throat transmission of cold viruses? Eastern Maine Medical Center symptoms, nasai congestion, and nasal Ipratropium nasal inhalers for treating Bangor, Maine, USA drainage. Previous clinical trials of zinc cold symptoms are now available by pre- lozenges in the treatment of the common scription at local pharmacies in the Reference cold have shown conflicting results, which United States. 1 of 2 local health-food 1. Godfrey J, Conant Sloane B, Smith DS, may be partly attributable to the different stores that I called stocked the zinc glu- et al. Zinc gluconate and the common cold: formulations and doses used in the vari- conate lozenges. a controlled clinical study. J Intern Med Res. ous studies. One other study (1) that used What do we tell our patients? If asked, I SW2;2 0:2 34-46. the same formulation showed similar re~ will tell mine that one particular formula-

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