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Utilization of intranasal ipratropium bromide in the prevention of recurrent croup events: Is it effective?
Brian P Anderson1, Holly P Shifman2, Michael S Haupert3
1Department of Otolaryngology - Head and Neck Surgery, Ascension Macomb-Oakland Hospital, Madison Heights, MI, USA.
Insights
Intranasal ipratropium bromide (IB) may reduce recurrent croup (RC) episodes and improve symptoms in children. This study found IB treatment led to fewer croup occurrences and less need for steroid medication, suggesting it as a novel therapeutic option.
Area of Science:
- Pediatric Otolaryngology
- Respiratory Medicine
- Pharmacology
Background:
- Recurrent croup (RC) is a common pediatric condition.
- Current management strategies for RC can be limited.
- Intranasal ipratropium bromide (IB) is theorized to reduce subglottic inflammation and edema.
Purpose of the Study:
- To determine the effectiveness of intranasal IB in managing symptoms of recurrent croup.
- To assess if IB reduces the need for alternative treatments for RC.
Main Methods:
- Retrospective chart review and survey data from pediatric patients diagnosed with RC (2018-2020).
- Comparison of treatment outcomes between patients receiving IB and those receiving other medications.
- Inclusion criteria: pediatric patients under 10 years old with RC.
Main Results:
- Patients treated with IB experienced 1.83 fewer croup episodes annually (p=0.046).
- IB treatment resulted in a 0.5-point improvement in child symptom scores (p=0.017) and 1.3 fewer steroid doses yearly (p=0.018).
- Significantly more patients receiving IB reported symptom improvement (p<0.01).
Conclusions:
- Intranasal IB shows promise as a novel therapeutic option for reducing RC events.
- IB may improve patient symptoms and decrease corticosteroid utilization in managing RC.
- Further prospective studies are warranted to confirm the benefits of intranasal IB for RC.
Objective:
Recurrent croup (RC) is a common problem in the pediatric population. We theorize that reduced rhinorrhea and post-nasal drip as well as suppressed cough receptor activity by the anticholinergic, intranasal ipratropium bromide (IB), may lead to reduced inflammation and edema of the subglottis, decreasing RC symptoms. The aim of this study is to determine the effectiveness of IB in improving symptoms of RC and in reducing the need for alternative forms of management.
Method:
A retrospective chart review combined with survey data of patients with RC was conducted to assess demographic data, comorbidities, and treatment outcomes. Pediatric patients less than 10 years of age diagnosed with RC through the department of pediatric otolaryngology between 2018 and 2020 were included. Results were compared between one group treated with IB for RC and a second group treated with medications other than IB.
Results:
Among the 67 patients treated for RC, 34 completed survey data and were included in the study. Overall, patients who were treated with IB for RC had 1.83 less croup episodes per year (p = 0.046), a 0.5-point improvement in child symptoms (p = 0.017) and 1.3 fewer doses of steroids per year than the patients not treated with IB (p = 0.018). Patients treated with IB were significantly more likely to answer "yes," that the use of medication helped improve symptoms (p < 0.01).
Conclusion:
Intranasal IB is a novel therapeutic option that may reduce RC events, improve patient symptoms and reduce steroid use. Further prospective studies are needed to definitively characterize the benefits of IB in the treatment of RC.
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