[Efficacy of early administration of nebulized ipratropium bromide in children with asthmatic crisis].
OBJECTIVE
To determine the efficacy of adding ipratropium bromide to nebulized salbutamol in the treatment of children with moderate-to-severe acute asthma attacks.


METHODS
A total of 102 patients aged between 5 months and 16 years were included in a double-blind randomized trial. All patients were given nebulized salbutamol (0.2 mg/kg) and oral steroids (1 mg/kg). Patients in group A received two doses of nebulized ipratropium bromide (250 mg per dose) and patients in group B were given placebo. Oxygen saturation (SaO2) and a clinical score (heart rate, respiratory rate, dyspnea, retraction of the intercostal spaces, and wheezing) rated from 0 to 5 were measured before treatment and at 120 min.


RESULTS
Patients in both groups showed similar SaO2 values and clinical scores at baseline (group A, 93.05% and 4.45; group B, 92.78% and 4.43) and at 120 min (group A, 94.33% and 2.45; group B, 94.03% and 2.74), but the percentage of patients admitted to the hospital was higher in group B than in group A (53% vs 35%, p = 0.07). In the subset of patients with the most severe attacks (baseline score 5), the clinical score after treatment and the percentage of admissions were significantly higher in group B (n = 22) than in group A (n = 23) (3.32 vs 2.69 and 73% vs 39%, p < 0.05).


CONCLUSIONS
Coadministration of ipratropium bromide and repeat doses of nebulized salbutamol produced a small beneficial clinical effect compared with administration of nebulized salbutamol alone. This beneficial effect was related to a decrease in the hospitalization rate, particularly in patients with severe asthma attacks.
Benito Fernández
J
J
Unidad de Urgencias de Pediatría. Departamento de Pediatría. Hospital de Cruces. Barakaldo. Vizcaya. jbenito@hcru.osakidetza.net
Mintegui Raso
S
S
Sánchez Echaniz
J
J
Vázquez Ronco
M A
MA
Pijoan Zubizarreta
J I
JI
D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D009241:Ipratropium / Q000008:administration & dosage*; D008297:Male; D009330:Nebulizers and Vaporizers; D013224:Status Asthmaticus / Q000188:drug therapy*; D013997:Time Factors
D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol