Efficacy of frequent nebulized ipratropium bromide added to frequent high-dose albuterol therapy in severe childhood asthma☆,☆☆,★,★★
Section snippets
METHODS
The study design was a double-blind, randomized, placebo-controlled trial with three study groups: all patients received three nebulizations of albuterol in combination with either no ipratropium, one dose of ipratropium, or three doses of ipratropium. The study took place in the emergency department of the Hospital for Sick Children, Toronto, between October 1991 and December 1993. Included in the study were children with an acute asthma attack who were 5 through 17 years of age and were able
RESULTS
During the study period (Oct. 15, 1991, to Dec. 12, 1993) 1586 children more than 5 years of age with asthma were seen in our ED; 435 of these arrived while the nurse was on duty (usually between 2 and 10 PM). The exclusions comprised 204 patients with baseline FEV1 50% of the predicted value or greater, 33 patients previously enrolled in this study, 21 with coexistent medical problems, 32 children who did not perform the pulmonary function test satisfactorily, 15 whose condition was unstable
DISCUSSION
Our study shows a significant benefit of the addition of repeated doses of nebulized ipratropium to frequent high-dose albuterol therapy in children with severe acute asthma. This benefit seems especially marked in children with very severe baseline status, in whom this regimen also resulted in lower hospitalization rates.
Ipratropium is an acetylcholine antagonist. Although parasympathetic fibers occur primarily in the larger airways,17 ipratropium may have a generalized action throughout the
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Cited by (0)
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From the Divisions of Emergency, Clinical Pharmacology, and Chest, the Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
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Supported by the Ontario Ministry of Health (Emergency Medical Services) and Boehringer Ingelheim.
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Reprint requests: Suzanne Schuh, MD, Emergency Department, Hospital for Sick Children, 555 University Ave., Toronto, Ontario M5G 1X8, Canada.
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0022-3476/95/$3.00 + 0 9/25/62808