Related Experiment Video
Updated: Mar 24, 2026
Dry Powder and Nebulized Aerosol Inhalation of Pharmaceuticals Delivered to Mice Using a Nose-only Exposure System
Published on: April 6, 2017
Response to nebulized salbutamol versus combination with ipratropium bromide in children with acute severe asthma
Bilquis Naeem Memon1, Arit Parkash1, Khalid Mahmood Ahmed Khan1
1National Institute of Child Health (NICH), Karachi, Pakistan.
Insights
In children with acute severe asthma, nebulised salbutamol combined with ipratropium bromide showed no significant improvement over salbutamol alone. This finding suggests salbutamol monotherapy may be sufficient for treating acute asthma exacerbations in pediatric patients.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Emergency Medicine
Background:
- Acute severe asthma is a common pediatric emergency requiring prompt and effective treatment.
- Current treatment guidelines often recommend inhaled bronchodilators such as salbutamol.
- The role of adding anticholinergic agents like ipratropium bromide to salbutamol in severe pediatric asthma exacerbations requires further clarification.
Purpose of the Study:
- To compare the efficacy of nebulised salbutamol alone versus the combination of nebulised salbutamol and ipratropium bromide in treating acute severe asthma in children.
- To evaluate the impact of adding ipratropium bromide on clinical severity scores in pediatric patients with acute severe asthma.
Main Methods:
- A randomized controlled trial involving 200 children with acute severe asthma.
- Patients were randomized into two groups: Group A received nebulised salbutamol alone, and Group B received nebulised salbutamol plus ipratropium bromide.
- Asthma severity was assessed using the Bentur Modification clinical score, with efficacy measured by the change in score after treatment.
Main Results:
- Both treatment groups showed improvement in clinical asthma severity scores.
- 93% of children in the combination group (salbutamol + ipratropium) improved compared to 84% in the salbutamol alone group.
- The difference in clinical improvement between the two groups was not statistically significant (p>0.05).
Conclusions:
- The addition of ipratropium bromide to nebulised salbutamol did not demonstrate superior efficacy compared to salbutamol alone in managing acute severe asthma in children.
- These findings suggest that salbutamol monotherapy may be a sufficient treatment option for acute severe asthma exacerbations in the pediatric population.
- Further research could explore specific subgroups or varying severity levels where combination therapy might offer benefits.
Objective:
To compare the efficacy of nebulised salbutamol alone and in combination with ipratropium bromide in acute severe asthma in children.
Methods:
The randomised controlled trial was conducted at the National Institute of Child Health, Karachi, from October 2012 to March 2013, and comprised patients with acute severe asthma who were randomised into two equal groups. Group A patients received 3 doses of nebulised salbutamol alone (0.03 ml/kg/dose) at 15-minute intervals and Group B received 3 similar doses of salbutamol along with ipratropium (250 ug/dose). Acute severe asthma was categorised as serve exacerbation (clinical score >10) and moderate (5-10 score) based on Bentur Modification. Efficacy was measured after 5minutes of the last dose by change in severity score from severe exacerbation (baseline) to low score. SPSS 10 was used for statistical analysis.
Results:
There were two groups of 100(50%) patients each. The mean age in Group A was 9.1±3 years and 9.3±2.8 years in Group B. Male-Female ratio in Group A was 1.5:1 and in Group B it was 1.2:1. In Group B, 93(93%) children showed improvement in clinical score (<10 score) while it was 84(84%) in Group A. There was better response in clinical score in Group A than Group B, but it was not significant (p>0.05).
Conclusions:
The combination of nebulised salbutamol along with ipratropium bromide in the treatment of acute asthma exacerbation was not superior to salbutamol alone.
Related Concept Videos
01:23Inhaled Medications
01:25Antiasthma Drugs: β2-Adrenoceptor Agonists
One class of bronchodilators includes β2-adrenoceptor agonists. These agents target the β2-adrenoceptors located on bronchial smooth muscle cells. By stimulating these receptors, β2-agonists induce...
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:20Antiasthma Drugs: Muscarinic Receptor Antagonists
Antimuscarinic agents compete with ACh for the same binding site on the muscarinic receptors. By binding to these receptors, they inhibit the downstream effects of ACh and block the parasympathetic...
01:25Antiasthma Drugs: Inhaled Corticosteroids and Glucocorticoids
ICS work through a multifaceted mechanism of action. They suppress the inflammatory response caused by the proliferation of TH cells. They also reduce the transcription of the IL-2 gene, which is involved in the...
01:26COPD: Management Using Bronchodilators and Corticosteroids