title: Lower arrythmogenic risk of low dose albuterol plus ipratropium.
abstract: OBJECTIVE
  Wheezy infants are in need of urgent bronchodilatation owing to their intermittent bronchoconstriction. beta 2 agonists are frequently used in emergencies and have previously shown to increase the QT dispersion (QTd), which may be associate with high risk of cardiac arrhythmia, in asthmatics. However, effect of low dose beta 2 agonist therapy in combination with the anticholinergic agents on QTd in wheezy infants is not known. This study aimed to assess the effect of standard dose of nebulized albuterol (NAB) and low doses of NAB combined with ipratropium-bromide (NIB) on QTd in wheezy infants.
  
  
  METHODS
  Twenty-nine children, under 2 years old, with the diagnosis of wheezy infant with acute exacerbation were enrolled in the study. Thirteen were treated by standard dose of NA therapy (0.15 mg/kg) and low doses of NAB (0.075 mg/kg) plus NIB (250 micrograms/dose) therapy was given to the remaining subjects. Respiratory distress score, O2 saturation and side effects were studied and QTd were measured from the standard electrocardiograms at baseline and after treatment. Significant improvement was achieved in clinical score and oxygenation of both groups.
  
  
  RESULTS
  The evaluation of the corrected QTd (QTcd) showed that there was no significant difference between pretreatment values of both groups (p > 0.05). However, while there was no statistically significant difference in the pre and post-treatment values of QTcd of infants treated with combination therapy, QTcd was found to be significantly increased in NAB group after treatment (p < 0.05).
  
  
  CONCLUSIONS
  Our results suggest that, while clinical improvement is same, the increase of the QT dispersion is more prominent with the use of standard dose of NAB compared to low dose NAB plus NIB therapy. So, low dose of beta 2 agonist in combination with anticholinergic agents may much safer than the use of standard dose of beta 2 agonists alone in regard to preventing the possibility of arrythmogenic effects in wheezy infants with acute exacerbation.
authors.affiliation: Celal Bayar University Medical Faculty, Department of Pediatrics, Manisa, Turkey. hyukselefe@hotmail.com
authors.forename: H
authors.initials: H
authors.lastname: Yuksel
authors.forename: S
authors.initials: S
authors.lastname: Coskun
authors.forename: M
authors.initials: M
authors.lastname: Polat
authors.forename: A
authors.initials: A
authors.lastname: Onag
mesh_terms: D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D001249:Asthma / Q000188:drug therapy; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D006801:Humans; D007223:Infant; D009241:Ipratropium / Q000008:administration & dosage* / Q000009:adverse effects; D008297:Male; D012135:Respiratory Sounds
chemical_list: D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol