The Clinical Efficacy of Combination Nebulized Anticholinergic and Adrenergic Bronchodilators vs Nebulized Adrenergic Bronchodilator Alone in Acute Asthma (original) (raw)
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The Professional Medical Journal, 2020
Objectives: Asthma affects about 15% of children while it is one of the commonest reason for admissions in pediatric emergencies and wards. We aimed this study to determine outcome of Salbutamol alone and salbutamol in combination with Ipratropium Bromide in acute asthma in children. Study Design: Randomized Controlled trial (RCT). Setting: Unit-II Department of Pediatric Medicine, Nishtar Medical College and Hospital, Multan. Period: 20th Nov 2017 to 30th June 2018. Material & Methods: The study consisted of 104 children, with 52 children each in Group ‘A’ and ‘B’ who were subjected to salbutamol alone and salbutamol in combination with Ipratropium bromide respectively. In both groups oxygen was administered via nasal prongs at a flow rate of 3L/minute. These children was monitored at 30 minutes interval for 2 hours (least value out of these 4 values was taken). Both groups were compared for outcome in terms of mean heart rate, respiratory rate, accessory muscle score, peak expirat...
Nebulized Salbutamol with & Without Ipratropium Bromide in the Treatment of Acute Severe Asthma
2016
MATERIAL AND METHODS Ipratropium Bromide is a synthetic derivative of atropine that was designed to act locally in the lung with minimal systemic absorption. Ipratropium has been shown to reduce bronco-spasm with minimal cardiovascular or other systemic effect. Ipratropium bromide remains a cornerstone unique therapy which primarily acts through parasympathetic pathway. The drug is shown to be virtually free of cholinergic side effects, as a result its preferred in treatment in older patients as with advancing age, there is decline of beta-2 adrenergic responsiveness. In combination with high dose agonist, Ipratropium improves pulmonary function above that seen with -agonist alone. Standard treatment of acute severe asthma is use of inhaled short acting -agonists (Salbutamol) systemic corticosteroids, and supplemental oxygen. Current guidelines recommend use of a combination of -agonist and anti-cholinergic (Ipratropium) for acute severe asthma (ASA). Frequent nebulization with -ago...
The Professional Medical Journal, 2021
Objective: To compare the Salbutamol alone and Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR. Study Design: Randomized Controlled Trial. Setting: Pediatrics Emergency, KRL Hospital Islamabad. Period: 1st August 2016 to 31 January 2017. Material & Methods: Group A patients were given only Salbutamol (0.15mg/kg per dose with minimum 2.5 mg, maximum 5 mg/dose). Group B was given Ipratropium Bromide supplemented Salbutamol (250 mcg/dose for <20 kg while 500 mcg/dose for >20kg of Ipratropium Bromide with same dose of Salbutamol as prescribed for Group A). Baseline spirometry was performed on each patient and after measurement of baseline peak expiratory flow. The outcome was measured by Peak flow meter and reassessed at 60 minutes. Results: Comparison of salbutamol alone and ipratropium bromide supplemented salbutamol in children with exacerbation of asthma in terms of PEFR shows that 40.5 + 4.28 in Group-A and 59.5 +4.75 in Gr...
Medical Journal of Australia, 1989
Twenty-one patients with mild-to-moderately-severe asthma participated in a placebo-controlled, double-blind, cross-over, randomized bronchodilator study of 200 Ilg of salbutamol (Glaxo) and 200 Ilg of salbutamol in the form of salbutamol sulphate (Riker;SO-Illand 2SiJl valves) that were administered by metered-dose inhalers. The mean baseline forced expired volumes in one second (FEY1) were similar for the four separate study days. The three active treatments caused a significantly-greater FEY1 response than did placebo for four hours (P<O.OS) and no difference was found between the treatments (P> O.OS). The power of the study was 7S% with a clinically-significant difference in the FEY 1 response of 2S%. The administration of 200 Ilg of salbutamol (Glaxo) caused the same FEY1 response as did that of 400 Ilg of salbutamol at the end of that study day (P> O.OS), but both 200-llg doses of salbutamol sulphate (Riker) caused a smaller FEY 1 response than did the 400 Ilg of salbutamol sulphate (P<O.OS). These observations indicate that no clinically-significant difference occurs between the bronchodilator effects of salbutamol and those of salbutamol sulphate which is administered as 200 Ilg of salbutamol equivalent, with different propellant mixtures, dispersal agents and valvular systems.
Canadian Respiratory Journal, 1997
STUDY OBJECTIVE: To compare two dosing regimens of salbutamol in acute asthma.DESIGN: Prospective randomized double-blind trial.SETTING: Urban emergency department.TYPE OF PARTICIPANTS: Patients who presented to the emergency department with moderate to severe asthma.INTERVENTIONS: All patients had pulmonary function testing and were randomized to group A (control; n=25) or group B (experimental; n=23). Group A (control) patients received salbutamol 2.5 mg delivered by wet aerosol at 0, 1 and 2 h (total dose 7.5 mg). At 20, 40, 80 and 100 mins a placebo aerosol was given. Group B patients received salbutamol 5 mg at 0 min and one-third the initial dose every 20 mins for a total of six doses by wet aerosol (total dose 15 mg).RESULTS: There were no differences in age, sex, preadmission medications or initial forced expiratory volume in 1 s (FEV1) between the groups. Forty-eight patients completed the study. Both groups of patients improved with mean absolute change in FEV1of 700 mL in...
Critical Care Medicine, 2002
A cute asthma is a major problem that is commonly encountered in children in emergency departments. Over the past decade, there has been a trend to give higher and more frequent doses of inhaled bronchodilators and, more recently, combination bronchodilator therapy as initial treatment of acute asthma in children (1-4). Using frequent doses of inhaled bronchodilators such as salbutamol in severe asthma leads to clinical improvement over a period of time in many cases but often requires a large dose, which has the potential to cause toxic effects (5, 6). In cases of severe asthma, delay in clinical response caused, in part, by inflammation in the airways results in airway obstruction that can impede the delivery of inhaled drugs (7). If these drugs can access the site of action unhindered by bronchial obstruction, then earlier clinical response may be achieved (8). Attempts to achieve earlier clinical response with few adverse effects renewed interest in the use of ipratropium bromide. Recent studies using frequent-dose inhaled ipratropium bromide showed improved pulmonary function
TAJ: Journal of Teachers Association, 2022
Background: Patients admitted with acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD) are often prescribed ipratropium bromide in combination with a β2 agonist like salbutamol. Many studies have not shown any benefit in adding ipratropium bromide to salbutamol in acute exacerbations of COPD. Objectives: To compare the response of combination therapy with two drugs vs. salbutamol alone in the treatment of acute exacerbations of COPD during hospital admission. Materials and Methods: This cross-sectional comparative study was conducted among one hundred patients of acute exacerbation of COPD admitted in Rajshahi Medical College Hospital from January 2012 to July 2012. The patients were randomly allocated to receive either solution-1 (salbutamol 5mg alone) or solution-2 (salbutamol 5mg plus ipratropium bromide 500μgm) (all four times a day) on admission. All other treatment was prescribed at the discretion of the attending physician.FEV1 and FVC values at baseline, at 1 ...
Combination bronchodilator therapy in asthma
Journal of Allergy and Clinical Immunology, 1982
This study has compared the short-term bronchodilator effects of inhaled anticholinergic (ipratropium bromide) and sympathomimetic (fenoterol) agents alone and in combination in 18 asthmatic patients. The study was of double-blind, placebo-controlled, crossover design. The combination of 60 hg ipratropium bromide and 200 pg offenoterol had a greater bronchodilator effect than lower dose combinations or either drug alone. Small but significant gains may be made with combination inhaled bronchodilator therapy. (J ALLERGY CLIN IMMUNOL 69:60, 1982.)