Meta-analysis of the effects of ipratropium bromide in adults with acute asthma: The reply (original) (raw)

2000, The American Journal of Medicine

To determine whether inhaled ipratropium bromide provides additional benefits to adults with acute asthma, who are being treated with beta-agonists in an emergency department. Searching MEDLINE was searched from 1978 to April 1999 using the following MeSH terms: 'N-isopropylatropine' or 'ipratropium bromide', and 'adult', 'acute asthma' or status asthmaticus'. Searches of Current Contents, the Science Citation Index, and review articles were also performed. Studies were limited to those published in the English language. Details of additional published and unpublished studies were obtained by contacting experts (pulmonologists and emergency physicians) and the manufacturer of ipratropium bromide (Boehringer Ingelheim), and by searching the Medical Editors Trial Amnesty. Study selection Study designs of evaluations included in the review Randomised, double-blind controlled trials (RCTs) were eligible for inclusion. Specific interventions included in the review Studies comparing the addition of inhaled ipratropium bromide to treatment with beta-agonists in an emergency department were eligible. The dosing regimes of ipratropium were: once only; twice every 45 minutes to 2 hours; or continuously. The dosing regimes of the beta-agonists were: for fenoterol, once or twice every 30 minutes; and for salbutamol, once or twice every 45 minutes to 2 hours, thrice every 20 minutes, or continuously. The cointerventions included corticosteroids. Participants included in the review Adults (older than 16 years) with acute exacerbations of asthma were eligible. The mean age of the participants ranged from 30 to 50 years, and 36% were men. The mean baseline asthma severity ranged from 34% to greater than 40% for forced expiratory volume in 1 second (FEV1), and from less than 30% to less than 45% for peak expiratory flow (PF). Outcomes assessed in the review The inclusion criteria for the outcomes were not defined. All studies measured pulmonary function as a continuous variable in terms of FEV1 and PF, and reported them as percentages of the predicted values. The admission rates and adverse events were also assessed. How were decisions on the relevance of primary studies made? Two authors independently examined the search and reviewed each identified study according to the inclusion criteria. Any disagreements were resolved by consensus. Assessment of study quality Validity was assessed and scored using the following criteria: randomisation method, scored 1 (not specified) to 2 (specified); demographic characteristics of the sample provided, scored from 0 (none) to 2 (detailed; inclusion and exclusion criteria specified, scored from 0 (none) to 2 (detailed); asthma definition, scored from 0 (no definition) to 2 (American Thoracic Society criteria used);