title: The effect of administrative cessation of the use of ipratropium bromide in the treatment of acute asthma attacks in the emergency department.
abstract: BACKGROUND
  The anticholinergic agent ipratropium bromide has demonstrated effectiveness in the treatment of severe asthma exacerbations.
  
  
  METHODS
  We conducted a retrospective quasi-experiment to investigate the clinical consequences on acute asthma patients of the administrative removal of ipratropium bromide from an emergency department (ED) of a large tertiary hospital. We compared the combined negative outcome (hospitalization, length of stay in the ED, hospital readmission within 48 hours or 7 days, intubation, and death) of acute asthma patients, treated in the 12 months preceding (n = 394; Period A) and the 12 months following (n = 334; Period B) the policy change. Multiple imputations based on sequentially improved regressions were performed for missing data on measures of severity.
  
  
  RESULTS
  Administration of steroid medications increased from 49.8% to 61.4%; p = .002 from Period A to Period B. There was no statistically significant difference in combined negative outcome between Periods A and B (41.1% and 42.9%, respectively).
  
  
  CONCLUSIONS
  An administrative decision to stop the purchase of ipratropium bromide in an ED was followed by an increased use of steroids; adverse consequences did not increase in acute asthmatic patients. In the absence of ipratropium bromide in the ED, steroids may thus serve as an appropriate substitute, an observation that calls for a randomized controlled clinical trial.
authors.affiliation: The Gertner Institute for Epidemiology and Health Policy Research, Chaim Sheba Medical Center, Ramat Gan, Israel. racheld@gertner.health.gov.il
authors.forename: Rachel
authors.initials: R
authors.lastname: Dankner
authors.forename: Cindy
authors.initials: C
authors.lastname: Cohen
authors.forename: Liraz
authors.initials: L
authors.lastname: Olmer
authors.forename: Ilya
authors.initials: I
authors.lastname: Novikov
authors.forename: Ariel
authors.initials: A
authors.lastname: Bentancur
authors.forename: Arnona
authors.initials: A
authors.lastname: Ziv
authors.forename: Amir
authors.initials: A
authors.lastname: Shahar
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D018680:Cholinergic Antagonists / Q000627:therapeutic use*; D004636:Emergency Service, Hospital; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use*; D007902:Length of Stay; D010359:Patient Readmission; D010607:Pharmacy Service, Hospital; D011682:Purchasing, Hospital; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D009241:Ipratropium