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)

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