A COMPARISON OF IPRATROPIUM AND ALBUTEROL VS ALBUTEROL ALONE FOR THE TREATMENT OF ACUTE ASTHMA

To evaluate the role of inhaled ipratropium bromide in acute asthma, a double-blind study of 384 emergency department patients compared the effect of the combination of ipratropium and albuterol with that of al buterol alone. Patients were randomized to receive nebulizer treatment s with either 2.5 mg of albuterol or 2.5 mg of albuterol mixed with 0. 5 mg of ipratropium bromide at entry and at 45 min. Spirometry, vital signs, and oxygen saturation were measured before and at 45 and 90 min following the nebulizer treatments, Serum potassium levels were obtai ned at entry and 90 min. The two groups did not differ significantly i n age (mean+/-SD=33.4+/-9.3 and 32.5+/-9.7 years for the albuterol and ipratropium group and the albuterol group, respectively), baseline FE V(1) (mean+/-SD=1.22+/-0.42 and 1.25+/-0.44 L respectively), or prior use of asthma medications. At 45 min, there were significantly more re sponders (15% increase in FEV(1) over baseline) in the group receiving albuterol and ipratropium compared with albuterol and saline solution (85% and 78%, respectively; p=0.045), but the median change in FEV(1) from baseline did not differ (0.530 L for the albuterol and ipratropi um group and 0.420 L for the albuterol and saline solution group; p=0. 347). By 90 min, the percentage of responders did not differ (88% and 89%, respectively), and the median change in FEV(1) was 0.680 L for th e group receiving albuterol and ipratropium and 0.650 L for the group receiving albuterol and saline solution (p=0.693). There were no signi ficant adverse events experienced by patients in either group. Further more, there were no significant differences in the number of patients requiring additional therapy in the emergency department or hospitaliz ation. We conclude that in this population of inner city asthmatics, w e were unable to demonstrate significant additive benefit of nebulized ipratropium bromide to nebulized albuterol.