Ipratropium bromide added to asthma treatment in the pediatric emergency department.
OBJECTIVE
To determine if the addition of ipratropium bromide to the emergency department (ED) treatment of childhood asthma reduces time to discharge, number of nebulizer treatments before discharge, and the rate of hospitalization.


METHODS
Patients >12 months of age were eligible if they were to be treated according to a standardized ED protocol for acute asthma with nebulized albuterol (2.5 mg/dose if weight <30 kg, otherwise 5 mg/dose) and oral prednisone or prednisolone (2 mg/kg up to 80 mg). Subjects were randomized to receive either ipratropium (250 microg/dose) or normal saline (1 mL/dose) with each of the first three nebulized albuterol doses. Further treatment after the first hour was determined by physicians blinded to subject group assignment. Records were reviewed to determine the length of time to discharge home from the ED, number of doses of albuterol given before discharge, and the number of patients admitted to the hospital.


RESULTS
Four hundred twenty-seven patients were randomized to ipratropium or control groups; these groups were similar in all baseline measures. Among patients discharged from the ED, ipratropium group subjects had 13% shorter treatment time (mean, 185 minutes, vs control, 213 minutes) and fewer total albuterol doses (median, three, vs control, four). Admission rates did not differ significantly (18%, vs control, 22%).


CONCLUSIONS
The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge.
Zorc
J J
JJ
Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland, USA.
Pusic
M V
MV
Ogborn
C J
CJ
Lebet
R
R
Duggan
A K
AK
D000280:Administration, Inhalation; D000284:Administration, Oral; D000293:Adolescent; D000420:Albuterol / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D004638:Emergency Treatment / Q000592:standards; D005260:Female; D006801:Humans; D007223:Infant; D009241:Ipratropium / Q000627:therapeutic use*; D007902:Length of Stay; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011241:Prednisone / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; D001993:Bronchodilator Agents; D011239:Prednisolone; D009241:Ipratropium; D000420:Albuterol; D011241:Prednisone