EFFICACY OF IPRATROPIUM BROMIDE IN ACUTE CHILDHOOD ASTHMA - A METAANALYSIS

Purpose: To determine whether inhaled ipratropium bromide provides an additive, clinically important improvement in children with acute asth ma who are being treated with beta(2)-agonists. Methods: An English-la nguage literature search was conducted employing MEDLINE (1966 to 1992 ), Science Citation Index (1986 to 1992) using key citations, bibliogr aphic reviews of primary research and review articles, and corresponde nce with authors of recent articles. After independent review by two o bservers, six studies were selected on the basis of prespecified selec tion criteria. Two observers independently assessed the selected paper s by using explicit methodologic criteria for evaluating the quality o f studies dealing with therapeutic intervention. Results: None of the six studies found a significant difference in clinical rating score, a dmission rate; or length of stay in hospital between the ipratropium b romide and the control groups. The three studies with the highest meth odologic validity measured the change in percentage predicted forced e xpiratory volume in 1 second (FEV(1)) from baseline to 60 minutes. The pooled effect size (95% CI) for these studies was 0.88 (0.42-1.34), w hich translates to an improvement in percentage predicted FEV(1) over the control group of 12.5% (95% CI, 6.6-18.4). In a subset of 23 child ren who had severe airway obstruction, peak expiratory flow rate (PEFR ) responded better to a beta(2)-agonist alone (p = 0.007). Conclusion: The existing evidence reveals that the addition of ipratropium bromid e to a beta(2)-agonist offers a statistically significant improvement in percentage predicted FEV(1) but no clinical improvement. As it may cause deterioration in PEFR in severely asthmatic children, ipratropiu m bromide should not be used universally for acute childhood asthma un til further research determines the clinical significance of these spi rometric changes.