β-agonists have been identified as primary therapy for acute asthma and adjunctive therapy with anticholinergic agents has yielded variable results. This study evaluates the addition of ipratropium to β-agonist in the treatment of acute asthma.
A double-blind study of 434 children (2–18 years) with acute asthma.
All patients received a weight appropriate dose of inhaled albuterol (2.5 to 5.0 mg) every 20 minutes. At the second dose 2 mg/kg of prednisolone was administered. The treatment group was administered 500 μg ipratropium bromide with doses number 2 and 3 and the control group was given placebo.
Overall, the hospitalization rate was lower in the group given ipratropium. This was particularly evident in the patients where the initial PEFR was <50% and the asthma symptom score was elevated. The addition of ipratropium resulted in a hospitalization rate that decreased from 52% to 38% in the most severely affected patients.
In a study published in the Journal of Pediatrics in the same month, no effect was discerned with the addition of ipratropium 250 μg to two dosing ranges of albuterol. There appears to be an inconsistent additive effect when ipratropium is added to albuterol. Patients who have more severe airway obstruction and who do not respond to initial β-agonist therapy are more likely to respond to combined therapy.