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Effect of nebulized ipratropium on the hospitalization rates of children with asthma
F Qureshi1, J Pestian, P Davis
1Division of Pediatric Emergency Medicine, Children's Hospital of the King's Daughter, Eastern Virginia Medical School, Norfolk 23507, USA.
Insights
Adding ipratropium bromide to standard asthma treatments significantly reduced hospitalizations in children with severe asthma exacerbations. This finding highlights ipratropium
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Anticholinergic medications, like ipratropium, are used for asthma exacerbations.
- Their impact on hospitalization rates in children remains unclear.
- Standard treatment includes albuterol and corticosteroids.
Purpose of the Study:
- To evaluate the efficacy of adding ipratropium bromide to standard therapy for acute asthma exacerbations in children.
- To determine the effect on hospitalization rates.
Main Methods:
- A randomized, double-blind, placebo-controlled trial involving 434 children (2-18 years) with moderate to severe asthma exacerbations.
- Participants received nebulized albuterol and oral corticosteroids.
- The treatment group received ipratropium bromide with albuterol doses, while the control group received a placebo.
Main Results:
- Overall hospitalization rates were lower in the ipratropium group (27.4%) compared to the placebo group (36.5%).
- For children with moderate asthma, hospitalization rates were similar between groups.
- In children with severe asthma, ipratropium significantly reduced hospitalization rates (37.5% vs. 52.6%).
Conclusions:
- Adding ipratropium bromide to albuterol and corticosteroid therapy significantly decreases hospitalization rates in children with severe asthma exacerbations.
- Ipratropium may be a beneficial addition for managing severe pediatric asthma attacks.
Background:
Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma, but their effect on hospitalization rates is uncertain.
Methods:
We conducted a randomized, double-blind, placebo-controlled study of 434 children (2 to 18 years old) who had acute exacerbations of moderate or severe asthma treated in the emergency department. All the children received a nebulized solution of albuterol (2.5 or 5 mg per dose, depending on body weight) every 20 minutes for three doses and then as needed. A corticosteroid (2 mg of prednisone or prednisolone per kilogram of body weight) was given orally with the second dose of albuterol. Children in the treatment group received 500 microg (2.5 ml) of ipratropium bromide with the second and third doses of albuterol; children in the control group received 2.5 ml of normal saline at these times.
Results:
Overall, the rate of hospitalization was lower in the ipratropium group (59 of 215 children [27.4 percent]) than in the control group (80 of 219 [36.5 percent], P=0.05). For patients with moderate asthma (indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale), hospitalization rates were similar in the two groups (ipratropium: 8 of 79 children [10.1 percent]; control: 9 of 84 [10.7 percent]). For patients with severe asthma (defined as a peak expiratory flow rate of <50 percent of the predicted value or an asthma score of 12 to 15), the addition of ipratropium significantly reduced the need for hospitalization (51 of 136 children [37.5 percent], as compared with 71 of 135 [52.6 percent] in the control group; P=0.02).
Conclusions:
Among children with a severe exacerbation of asthma, the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate.