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Ipratropium bromide added to asthma treatment in the pediatric emergency department
J J Zorc1, M V Pusic, C J Ogborn
1Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
Insights
Adding ipratropium bromide to emergency department (ED) asthma treatment for children significantly reduced treatment time and the number of nebulizer treatments before discharge. Hospitalization rates remained similar between groups.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Acute asthma exacerbations are a common reason for pediatric emergency department (ED) visits.
- Standard ED treatment involves nebulized albuterol and oral corticosteroids.
- The role of ipratropium bromide as an adjunct therapy in pediatric asthma remains an area of investigation.
Purpose of the Study:
- To evaluate the efficacy of adding ipratropium bromide to standard ED asthma treatment.
- To assess the impact on time to discharge, number of nebulizer treatments, and hospitalization rates.
Main Methods:
- A randomized controlled trial was conducted with pediatric patients (>12 months) presenting with acute asthma.
- Participants received standardized albuterol and oral corticosteroid treatment.
- Subjects were randomized to receive either ipratropium bromide or normal saline with the first three nebulized albuterol doses.
Main Results:
- The ipratropium group showed a 13% reduction in ED treatment time (185 vs. 213 minutes).
- Fewer total albuterol doses were administered in the ipratropium group (median 3 vs. 4).
- Hospital admission rates were not significantly different between the ipratropium (18%) and control (22%) groups.
Conclusions:
- Adding ipratropium bromide to an ED asthma protocol can decrease treatment duration and albuterol use.
- This adjunct therapy may improve efficiency in managing pediatric asthma exacerbations in the ED.
- Further research may explore optimal dosing and patient selection for ipratropium use in pediatric asthma.
Objective:
To determine if the addition of ipratropium bromide to the emergency department (ED) treatment of childhood asthma reduces time to discharge, number of nebulizer treatments before discharge, and the rate of hospitalization.
Methods:
Patients >12 months of age were eligible if they were to be treated according to a standardized ED protocol for acute asthma with nebulized albuterol (2.5 mg/dose if weight <30 kg, otherwise 5 mg/dose) and oral prednisone or prednisolone (2 mg/kg up to 80 mg). Subjects were randomized to receive either ipratropium (250 microg/dose) or normal saline (1 mL/dose) with each of the first three nebulized albuterol doses. Further treatment after the first hour was determined by physicians blinded to subject group assignment. Records were reviewed to determine the length of time to discharge home from the ED, number of doses of albuterol given before discharge, and the number of patients admitted to the hospital.
Results:
Four hundred twenty-seven patients were randomized to ipratropium or control groups; these groups were similar in all baseline measures. Among patients discharged from the ED, ipratropium group subjects had 13% shorter treatment time (mean, 185 minutes, vs control, 213 minutes) and fewer total albuterol doses (median, three, vs control, four). Admission rates did not differ significantly (18%, vs control, 22%).
Conclusions:
The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge.
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