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Adding Ipratropium to Albuterol Does Not Improve Asthma

The extent to which the addition of ipratropium bromide (IB) improves the therapeutic effect of albuterol continues to be a subject of debate. These authors conducted a prospective, randomized, double-blind, placebo-controlled trial to further explore this issue. The study was industry supported.

Adult asthmatics presenting to the ED with acute bronchospasm and PEFR less than 70% of predicted were randomized to receive either albuterol (10 mg/hour) alone or with ipratropium bromide (1 mg/hour) by continuous nebulization for up to three hours. Among the 67 patients enrolled, the mean initial PEFR was 45(plusoverminus)12% of predicted, the median length of stay in the ED was 225 minutes, and 31% of patients were admitted. All three outcome measures improved with combination therapy, but none of the differences reached statistical significance. The authors considered the study to have sufficient power to detect significant differences had they existed.

Comment: There are several potential weaknesses in this study, including paucity of severely bronchospastic patients, lack of standardized endpoints for disposition, use of PEFR instead of less effort-dependent spirometric measurements, and wide confidence intervals for some of the key results. Further, individual patients vary in asthma symptomatology and response to therapy. Larger studies are needed to investigate the potential value of ipratropium bromide in the ED management of asthma.

— CV Pollack

Published in Journal Watch Emergency Medicine July 1, 1999

Citation(s):

Weber EJ et al. Effect of continuously nebulized ipratropium bromide plus albuterol on emergency department length of stay and hospital admission rates in patients with acute bronchospasm. Chest 1999 Apr 115 937-944.

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