Purpose of the Study. High-dose nebulized albuterol has become the standard of treatment for the severely wheezing asthmatic child. The role, dose, and frequency of administration of ipratropium bromide in this same group of children requires further definition.
Methods. From the Emergency Department of the Hospital for Sick Children in Toronto, Ontario, Canada, 120 children 5 to 17 years of age with severe asthma as determined by a forced expiratory volume in 1 second (FEV1) of less than 50% predicted normal were equally divided and entered into a double-blinded, placebo-controlled treatment protocol. All groups received 0.15 mg albuterol/kg/dose nebulized every 20 minutes χ3. Group 1 had 250 µg of ipratropium bromide added to each treatment. Group 2 had the same amount of ipratropium bromide added to only the initial aerosol with a like amount of saline added to aerosols 2 and 3. Group 3 had only saline added to each aerosol. No corticosteroids were administered to any patient in the first hour. The entire cohort was meticulously monitored for oxygen saturation, heart rate, respiratory rate, accessory muscle use, cyanosis, wheezing and pulmonary function test parameters by a skilled research nurse.
Results. As expected, all patients improved to a degree but those with the lowest FEV1s who were treated with ipratropium in each aerosol responded the best and were admitted to the hospital less frequently. No serious untoward side effects were observed in any patient.
Reviewer's Comment. I feel the article is a must read for all physicians caring for acutely wheezing asthmatic children.
Effects of Ipratropium Bromide on Ventilatory Function or on Airway Hyperresponsiveness to Hypertonic Saline Challenge in asymptomatic Asthmatic Children