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Metered-dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non-randomized,

Osamu Nomura1,2, Takateru Ihara1, Yoshihiko Morikawa3

  • 1Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical , Tokyo, Japan.

Pediatrics International : Official Journal of the Japan Pediatric Society
|January 14, 2020
PubMed

Insights

Metered-dose inhaler ipratropium bromide (IB) did not reduce hospital admissions for severe pediatric asthma exacerbations. This delivery method may be less effective than nebulizers for ipratropium bromide inhalation.

Area of Science:

  • Pediatric Emergency Medicine
  • Respiratory Medicine
  • Pharmacology

Background:

  • Ipratropium bromide (IB) with beta-agonists reduces pediatric asthma hospitalizations.
  • Metered-dose inhalers (MDIs) may shorten emergency department (ED) stays compared to nebulizers.
  • Effectiveness and safety of MDI-delivered IB with spacers in children are not well-established.

Purpose of the Study:

  • To evaluate the effectiveness and safety of metered-dose inhaler (MDI) administered ipratropium bromide (IB) in pediatric patients with acute asthma exacerbation.

Main Methods:

  • Prospective, non-randomized, observational study of pediatric patients (≥4 years) with severe asthma exacerbation.
  • Patients received IB via MDI with a spacer three times at 20-minute intervals.
  • Propensity score matching was used to control for confounding factors.

Main Results:

  • No significant difference in admission rates between the IB group (25.9%) and the non-IB group (31.5%).
  • Similar post-treatment modified pulmonary index scores in both groups.
  • One patient (1.0%) in the IB group experienced mild vomiting.

Conclusions:

  • MDI-delivered ipratropium bromide was ineffective in reducing pediatric asthma admission rates.
  • Potential for reduced efficacy compared to nebulized ipratropium bromide.
  • Further research needed to compare MDI and nebulizer delivery for IB in pediatric asthma.
Abstract

Keywords:
acute asthma exacerbationchildrenipratropium bromidemetered-dose inhalerpropensity score matching

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