[Benefits of ipratropium bromide in the management of asthmatic crises in the emergency department].
BACKGROUND
To determine if the addition of ipratropium bromide in the emergency department (ED) for the treatment of childhood asthma reduces rates of hospitalization and relapses for moderate and severe exacerbations.


METHODS
Patients were given an oral corticosteroid treatment (2 mg/kg) and received every 20 minutes either three nebulizations with albuterol (0.15 mg/kg) and ipratropium bromide (250 micrograms) or six nebulizations with albuterol alone (control group). The primary end point was the need for hospitalization, additional nebulizations or a relapse during the following week. Secondary end point included the effect of age.


RESULTS
One hundred and forty three children, two to 15 years old, were randomized to ipratropium or control groups and 121 were evaluated on day seven. As a whole, the control group was less often hospitalized or in relapse than those treated with three nebulizations of albuterol and ipratropium (17.5% vs 37.9%, p < 0.02). The ipratropium group reached the same result after three additional albuterol nebulizations. The benefit of anticholinergic therapy was observed for children less than six years of age who had a similar rate of success (73.5 vs 75.7%).


CONCLUSIONS
The association of ipratropium bromide to the first three doses of the albuterol protocol for acute asthma did not act as well as six nebulizations of albuterol alone. The effect was age dependent and two to six years old children needed more attention. Nevertheless the hospitalization rate did not support the use of ipratropium compared with repeated albuterol nebulizations.
Timsit
S
S
Département des urgences, hôpital Necker-Enfants malades, 149, rue de Sèvres, 75743 Paris, France.
Sannier
N
N
Bocquet
N
N
Cojocaru
B
B
Wille
C
C
Boursiquot
C
C
Garel
D
D
Marcombes
F
F
Chéron
G
G
D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009330:Nebulizers and Vaporizers; D016017:Odds Ratio; D011446:Prospective Studies; D011897:Random Allocation; D013224:Status Asthmaticus / Q000188:drug therapy*
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D009241:Ipratropium; D000420:Albuterol
Apport du bromure d'ipratropium dans la prise en charge des crises d'asthme aux urgences.