Effect of continuously nebulized ipratropium bromide plus albuterol on emergency department length of stay and hospital admission rates in patients with acute bronchospasm. A randomized, controlled trial.
OBJECTIVE
To compare the outcome of patients with acute bronchospasm treated with continuously nebulized albuterol plus ipratropium bromide vs albuterol alone.


METHODS
The Emergency Department (ED) at the University of California San Francisco Medical Center.


METHODS
Patients > or = 18 years old presenting to the ED with acute bronchospasm and a peak expiratory flow rate (PEFR) of < 70% predicted.


METHODS
This was a prospective, randomized, double-blind, placebo-controlled trial. Subjects were treated with either a combination of albuterol (10 mg/h) plus ipratropium bromide (1.0 mg/h) or albuterol alone via continuous nebulization for a maximum of 3 h. Vital signs, Borg dyspnea score, and PEFR were recorded hourly. Primary outcome measures were improvement in PEFR, hospital admission rates, and length of stay in the ED.


RESULTS
Data was analyzed for 67 subjects. The mean age (-/+ SD) was 47.5+/-18.8, and mean initial PEFR was 44.8+/-12.5% of predicted. The median length of stay for all subjects was 225 min, and 31% of all subjects were admitted. Patients given combination therapy averaged 6.3% greater improvement in PEFR compared with control subjects (95% confidence interval [CI], -15% to 27%. The odds ratio for admission with combination therapy was 0.88 (95% CI, 0.28 to 2.8). The median length of stay in the ED was 35 min shorter for those receiving combination treatment (210 vs 245 min; p = 0.03). However, when adjusted for initial PEFR, there was no statistically significant difference (p = 0.26).


CONCLUSIONS
Although the direction of all three outcome measures favored combination therapy, there was no statistically significant difference between ED patients with acute bronchospasm receiving continuous albuterol plus ipratropium bromide and those receiving albuterol alone.
Weber
E J
EJ
Division of Emergency Medicine, University of California San Francisco, 94143-0208, USA. weber@itsa.ucsf.edu
Levitt
M A
MA
Covington
J K
JK
Gambrioli
E
E
D000208:Acute Disease; D000280:Administration, Inhalation; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage*; D000420:Albuterol / Q000008:administration & dosage*; D001986:Bronchial Spasm / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage*; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010366:Peak Expiratory Flow Rate; D011446:Prospective Studies
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol