Randomized, double-blind, placebo-controlled trial of intravenous salbutamol and nebulized ipratropium bromide in early management of severe acute asthma in children presenting to an emergency department (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...
Paediatrica Indonesiana, 2012
Background The efficacy of salbutamol-ipratropium bromide practice for this drug combination to be given to patients with Objective To compare the efficacy of salbutamol-ipratropium bromide nebulization to salbutamol alone in children with mild Methods This single-blind, randomized clinical trial was held bromide (experimental group) or 2.5 mg salbutamol alone post-nebulization. Results There were no significant differences in clinical scores, oxygen saturations, respiratory rates, or hospitalization rates between the Conclusion Reprint requests to matahari_1780@yahoo. com A sthma is global health problem in children, and is increasing in prevalence, even though the pathogenesis, pathophysiology, and management of asthma is well In Indonesia, Rahajoe et al. reported 2 Controversies in asthma management may increase morbidity and mortality of patients. The addition of ipratropium bromide for patients with 2-between the two groups.
Journal of Pediatrics, 2001
nary ammonium derivative of atropine that is poorly absorbed from mucosal surfaces. Laboratory pulmonary function tests demonstrate enhanced bronchodilation from β-agonists when given in combination with IB. 1 Evidence from clinical trials, however, does not uniformly support the routine addition of inhaled anticholinergic therapy to β-agonists for the management of acute asthma. In the emergency department setting, some randomized placebo-controlled trials demonstrate modest benefits from combined IB-β agonist therapy for at least a subset of patients. 6,7 Although anticholinergic agents are often used in the hospital treatment of patients with status asthmaticus, their efficacy in this setting remains uncertain. We conducted a randomized, double-blind, placebo-controlled trial to examine the effect on hospital length of stay, asthma carepath progression, requirement for additional therapy, and side effects resulting from the addition of repeated doses of nebulized IB with standardized β-agonist and systemic corticosteroid therapy for hospitalized children with acute asthma.
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...
Efficacy of Ipratropium Bromide in Moderate and Severe Asthma Attack in Children
Haydarpasa Numune Training and Research Hospital Medical Journal
Introduction: Standard therapy for acute asthma attack includes beta 2 agonists, O 2 and systemic corticosteroids. Although there is a widespread usage of this therapy protocol in recent years, as some of the children still need hospitalization because of incomplete responses, adjunctive therapy measures should be considered. We planned this study protocol to assess the effects of ipratropium bromide (IB) for moderate and severe childhood asthma attacks. Methods: All of the consecutive 50 children admitted to the Pediatric Emergency Service of İstanbul University Cerrahpaşa Medicine Faculty were included in our study. All patients received short duration β2-adrenergic agonists and methylprednisolone consistent with current practice guidelines; then, they were randomized into two groups. While the first group received IB (250 µg/dosage) three times with 20 minutes of intervals, the second group received serum physiologic. Before each therapy regimen and at the 72 nd hour, clinical asthma scores (CAS) and peak expiratory flow rates (PEF) of the patients were screened and their hospitalization status was recorded. Results: There was not any significant difference in the hospitalization status of the two groups, which included patients aged three to 18 years. Clinical asthma scores and PEFR of the first and second group of patients had a statistically significant difference beginning from the 40 th minute. Discussion and Conclusion: In our study, we reported that IB added to the standard therapy regimen of moderate and severe childhood asthma attacks was efficient and did not have any adverse effect.
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...
Pediatric Pulmonology, 2019
Introduction: In moderate-severe asthma exacerbation, salbutamol by inhaler (MDI) is superior to salbutamol delivered by nebulizer (NEB); however, to our knowledge, no studies in children with exclusively severe exacerbations were performed. Objective: To compare the efficacy of salbutamol and ipratropium bromide by MDI versus by NEB in severe asthma exacerbations. Methods: We performed a clinical trial enrolling 103 children (2-14 years of age) with severe asthma exacerbations (defined by the Pulmonary Score ≥ 7) seen at the emergency room in Asuncion, Paraguay. One group received salbutamol and ipratropium (two puff every 10 min for 2 h and then every 30 min for 2 h more) by MDI with a valved-holding chamber and mask along with oxygen by a cannula separately (MDI-SIB); and the other received nebulization with oxygen (NEB-SIB) of salbutamol and ipratropium (1 every 20 min for 2 h and then every 30 min for 2 h more). Primary outcome was the rate of hospitalization (Pulmonary Score ≥ 7) after 4 h and secondary outcome was oxygen saturation. Results: Fifty two children received MDI-SIB and 51 NEB-SIB. After the 4th hour, children on MDI-SIB had significantly (P = 0.003) lower rate of hospital admission than on NEB-SIB (5.8% vs 27.5%, RR: 0.21 [0.06-0.69], respectively). Similarly, a significant improved clinical score after 60 min and increase in oxygen saturation after 90 min of treatment was observed in MDI-SIB versus NEB-SIB group (4.46 ± 0.7 vs 5.76 ± 0.65,
Thorax, 2003
Background: The relative efficacies of aminophylline and salbutamol in severe acute childhood asthma are currently unclear. A single bolus of salbutamol was compared with a continuous aminophylline infusion in children with severe asthma in a randomised double blind study. Methods: Children aged 1-16 years with acute severe asthma were enrolled if they showed little improvement with three nebulisers (combined salbutamol and ipratropium) administered over an hour and systemic steroids. Subjects were randomised to receive either a short intravenous bolus of salbutamol (15 µg/kg over 20 minutes) followed by a saline infusion or an aminophylline infusion (5 mg/kg over 20 minutes) followed by 0.9 mg/kg/h. Results: Forty four subjects were enrolled, with 18 randomly allocated to receive salbutamol and 26 to receive aminophylline. The groups were well matched at baseline. An intention to treat analysis showed that there was no statistically significant difference in the asthma severity score (ASS) at 2 hours between the two groups (median (IQR) 6 (6, 8) and 6.5 (5, 8) for salbutamol and aminophylline respectively, p=0.93). A similar improvement in ASS to 2 hours was seen in the two groups (mean difference -0.08, 95% CI -0.97 to 0.80), there was a trend (p=0.07) towards a longer duration of oxygen therapy in the salbutamol group (17.8 hours (95% CI 8.5 to 37.5) v 7.0 hours (95% CI 3.4 to 14.2)), and a significantly (p=0.02) longer length of hospital stay in the salbutamol group (85.4 (95% CI 66.1 to 110.2) hours v 57.3 hours (95% CI 45.6 to 72.0)). There was no significant difference in adverse events between the two groups.