Ipratropium bromide nasal spray safe and effective treatment for rhinorrhea in non-allergic rhinitis: Study

Intranasal ipratropium bromide significantly reduced the duration and severity of rhinorrhea. The therapy was determined to be beneficial by both physicians and patients and led to a better quality of life.

Rhinitis is a global problem defined as at least one of the following: nasal obstruction, itching, sneezing, rhinorrhea, and congestion. The two major classifications are nonallergic and allergic rhinitis. Nonallergic rhinitis is when rhinorrhea and obstruction occur concerning noninfectious, nonallergic triggers such as weather change, exposure to cigarette smoke or caustic odours, barometric pressure differences, etc. Allergic rhinitis occurs by the triggering of nasal symptoms by an allergen.

The anticholinergic IB is available in a nasal form and blocks the parasympathetic signalling that leads to watery rhinorrhea and effectively controls this specific symptom. Topical anticholinergics such as ipratropium bromide nasal spray effectively treat rhinorrhea symptoms. There are little to no side effects.

Against the above background, Patrick El Khoury, Saint Joseph University, Beirut, Lebanon, and colleagues aimed to compare the effectiveness of intranasal ipratropium bromide to placebo in reducing nasal symptoms, particularly rhinorrhea, and enhancing the quality of life in nonallergic rhinitis patients in a systematic review and meta-analysis.

For this purpose, the researchers conducted a comprehensive literature review on Embase, Medline, and Cochrane libraries. RCTs (randomized controlled trials) and non-randomized comparative parallel group trials were included comparing ipratropium bromide nasal spray to placebo.

The study revealed the following findings:

• Five RCTs assessed 472 participants with a diagnosis of nonallergic rhinitis.
• IB nasal spray 0.03% was used across all studies. IB impacts rhinorrhea reduction better than the placebo, with a standardized mean difference (SMD) of 0.93.
• The mean change in rhinorrhea severity was 85% and I^2 26%.
• IB outperformed the placebo in reducing the symptom's duration/day, as revealed by an SMD of 0.35.
• Within the first week, the difference between treatments was noticeable and remained consistent throughout the treatment.
• Patients who were administered ipratropium bromide experienced a substantially more significant improvement in mental and physical outcomes.
• Nasal adverse events with IB were generally brief and intermittent.

"Compared with a placebo, ipratropium bromide nasal spray is effective and safe in treating NAR-associated rhinorrhea," the researchers wrote. "IB significantly reduces the duration and severity of rhinorrhea."

"The therapy was determined to be beneficial by both patients and physicians and led to a better quality of life," they conclude.

Reference:

El Khoury P, Abou Hamad W, Khalaf MG, El Hadi C, Assily R, Rassi S, Khoueir N. Ipratropium Bromide Nasal Spray in Nonallergic Rhinitis: A Systematic Review and Meta-Analysis. Laryngoscope. 2023 Apr 17. doi: 10.1002/lary.30706. Epub ahead of print. PMID: 37067019.