title: The influence of parasympatholytics on the resolution of acute attacks of asthma.
abstract: OBJECTIVE
  To evaluate the role of parasympatholytics in the resolution of acute attacks of asthma.
  
  
  METHODS
  This study employed a prospective sequential design in which the influence of 0.5 and 1.0 mg of ipratropium bromide on peak expiratory flow rates (PEFR), hospital admissions, and length of stay (LOS) in the emergency department (ED) was evaluated. The parasympatholytic was added to a well-investigated standard therapeutic regimen that was anchored by the use of repetitive doses of albuterol, and employed pretested decision algorithms.
  
  
  RESULTS
  One hundred and thirty-one patients received ipratropium (l) and 123 who did not (NI) served as controls. There were no significant pretreatment between group differences in gender, racial composition clinical signs and symptoms, or PEFR. The presence of ipratropium in the regimen did not influence discharge/admission patterns, LOS, the rate of improvement of the patients, or the level of PEFR achieved.
  
  
  CONCLUSIONS
  Anticholinergic agents such as ipratropium are not first-line treatments for acute asthma. They do not add any therapeutic benefit to the effects of albuterol given in divided doses over 1 hour, nor do they facilitate recovery in patients whose immediate response to sympathomimetics is impaired.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: E R
authors.initials: ER
authors.lastname: McFadden
authors.forename: N
authors.initials: N
authors.lastname: elSanadi
authors.forename: L
authors.initials: L
authors.lastname: Strauss
authors.forename: G
authors.initials: G
authors.lastname: Galan
authors.forename: L
authors.initials: L
authors.lastname: Dixon
authors.forename: C B
authors.initials: CB
authors.lastname: McFadden
authors.forename: L
authors.initials: L
authors.lastname: Shoemaker
authors.forename: L
authors.initials: L
authors.lastname: Gilbert
authors.forename: E
authors.initials: E
authors.lastname: Warren
authors.forename: T
authors.initials: T
authors.lastname: Hammonds
mesh_terms: D000208:Acute Disease; D000328:Adult; D000420:Albuterol / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D005260:Female; D006760:Hospitalization; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D010276:Parasympatholytics / Q000627:therapeutic use*; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D010276:Parasympatholytics; D009241:Ipratropium; D000420:Albuterol