EFFICACY OF ATROPINE SULFATE IN COMBINATION WITH ALBUTEROL IN THE TREATMENT FOR ACUTE ASTHMA

Objective: To determine the efficacy of combination therapy using atro pine sulfate and albuterol in the treatment for an acute exacerbation of asthma. Methods: A prospective, randomized double-blind, placebo-co ntrolled study was performed in the ED of a large, inner-city, univers ity-affiliated teaching hospital, Participants were a convenience samp le of patients presenting to the ED between September 1993 and March 1 994 with acute exacerbations of their asthma. Patients judged to be in extremis were excluded, All patients received 3 nebulized treatments with 2.5 mg of albuterol at 0, 30, and 60 minutes. Patients were rando mized into 1 of 3 groups with the following added to their nebulizer s olutions: 1) saline placebo during all 3 treatments; 2) 2.0 mg atropin e sulfate added to the first nebulizer and saline in the second and th ird; or 3) 2.0 mg atropine to the first and third treatments (with sal ine in the second). No other medication was administered during the st udy period. At 90 minutes, the patients were evaluated for admission o r release from the ED according to predetermined criteria, and additio nal medications were given as necessary. Vital signs, peak expiratory flow rate (PEFR), degree of wheezing, level of distress, and side effe cts were measured before and after each nebulizer treatment. Results: Of the 153 patients eligible for the study, 126 completed the entire s tudy protocol. There was no significant difference between the 3 group s on any parameter studied, including improvement of PEFR, vital signs , or level of distress, There was no difference in the admission rate between the 3 groups, nor was there a difference in the incidence of s ide effects among the groups. Conclusion: In this study population, co mbination therapy with atropine sulfate and albuterol offered no signi ficant benefit over the use of albuterol alone in the treatment for ac ute exacerbation of asthma.