Background Anticholinergic medications such as ipratropium improvethe pulmonary function of patients with acute exacerbationsof asthma, but their effect on hospitalization rates is uncertain.
Methods We conducted a randomized, double-blind, placebo-controlledstudy of 434 children (2 to 18 years old) who had acute exacerbationsof moderate or severe asthma treated in the emergency department.All the children received a nebulized solution of albuterol(2.5 or 5 mg per dose, depending on body weight) every 20 minutesfor three doses and then as needed. A corticosteroid (2 mg ofprednisone or prednisolone per kilogram of body weight) wasgiven orally with the second dose of albuterol. Children inthe treatment group received 500 µg (2.5 ml) of ipratropiumbromide with the second and third doses of albuterol; childrenin the control group received 2.5 ml of normal saline at thesetimes.
Results Overall, the rate of hospitalization was lower in theipratropium group (59 of 215 children [27.4 percent]) than inthe control group (80 of 219 [36.5 percent], P=0.05). For patientswith moderate asthma (indicated by a peak expiratory flow rateof 50 to 70 percent of the predicted value or an asthma scoreof 8 to 11 on a 15-point scale), hospitalization rates weresimilar in the two groups (ipratropium: 8 of 79 children [10.1percent]; control: 9 of 84 [10.7 percent]). For patients withsevere asthma (defined as a peak expiratory flow rate of <50percent of the predicted value or an asthma score of 12 to 15),the addition of ipratropium significantly reduced the need forhospitalization (51 of 136 children [37.5 percent], as comparedwith 71 of 135 [52.6 percent] in the control group; P=0.02).
Conclusions Among children with a severe exacerbation of asthma,the addition of ipratropium bromide to albuterol and corticosteroidtherapy significantly decreases the hospitalization rate.
Source Information
From the Division of Pediatric Emergency Medicine (F.Q., P.D.), the Department of Clinical Outcomes (J.P.), and the Department of Pediatrics (A.Z.), Children's Hospital of the King's Daughters, Eastern Virginia Medical School, Norfolk.
Address reprint requests to Dr. Qureshi at Pediatric Emergency Medicine, Children's Hospital of the King's Daughters, 601 Children's Ln., Norfolk, VA 23507.
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