Ipratropium bromide and airways obstruction in childhood

Although our information on the pharmacological effects of ipratropium bromide in childhood has increased, its role has yet largely to be defined. Studies indicate that in children over the age of 2 to 3 years the optimal dose is probably 250 micrograms. For children under this age the maximum dose should probably be 125 micrograms delivered as a nebulized solution. In pre-term babies doses in excess of 20 micrograms are likely to produce side effects. Studies indicate that ipratropium bromide is effective in some pre-term babies who have airways obstruction following positive pressure ventilation but it can be a useful agent in the first 18 months of life, when beta 2-stimulants are rarely effective. Approximately 40% of children with recurrent attacks of airways obstruction obtain very useful benefit. Its place in the management of older children with asthma has yet to be defined. Although there have been a number of recent studies on the role of ipratropium bromide in childhood, information remains relatively sparse.