Objective. To ascertain whether the addition of repeated doses of nebulized ipratropium bromide (IB) to standardized inpatient asthma care for children with status asthmaticus would improve clinical outcome.
Study Population. A total of 210 children 1 to 18 years old admitted with acute asthma.
Methods. This was randomized, double-blind, placebo-controlled trial in which children with acute asthma were assigned to receive either ipratropium or placebo in addition to standard therapy consisting of nebulized albuterol, systemic steroids, and oxygen. The intervention group received 250 μg IB combined with each albuterol treatment by jet nebulization in a dosing schedule as determined an algorithm. The placebo group received isotonic saline instead of IB.
Results. There were no significant differences between the therapeutic groups in hospital length of stay (P = .46) asthma care pathway progression (P = .37) the need for additional therapy, or adverse effects. Children greater than 6 years (N = 70) treated with IB had a shorter mean hospital length of stay (P = .03) and progressed more rapidly in the asthma care pathway (P = .02) than children in the placebo group, although these differences were no longer significant after data were adjusted for baseline differences.
Conclusion. The addition of repeated doses of nebulized IB to a standardized regimen of systemic steroids and albuterol offers no significant advantage in terms of clinical outcome for the treatment of hospitalized children with acute asthma.
Reviewer’s Comments. The literature on IB in acute asthma remains unclear. Emergency room studies have yielded conflicting results, with some showing shorter lengths of stay and reduced rates of hospitalization and others showing no effect. This is an excellent study of inpatient asthma that demonstrates little effect, although there was a trend toward more effect in older children. There are likely to be individual patients who respond more to IB than others although it has not yet been possible to identify those patients before the initiation of treatment. It still seems reasonable to use IB in patients showing little response to their first β-agonist treatments to determine if that individual patient may benefit from its use.
- Copyright © 2002 by the American Academy of Pediatrics