THE CLINICAL EFFICACY OF COMBINATION NEBULIZED ANTICHOLINERGIC AND ADRENERGIC BRONCHODILATORS VS NEBULIZED ADRENERGIC BRONCHODILATOR ALONE IN ACUTE ASTHMA

The role of ipratropium bromide as adjunct therapy to beta-agonists in acute asthma is uncertain. We therefore decided to compare the use of 3 mg of salbutamol sulfate alone vs 3 mg salbutamol sulfate with 0.5 mg ipratropium bromide in patients with acute asthma, Patients present ing with acute asthma and an FEV(1) less than 70% predicted were rando mized to a single combination treatment vs salbutamol alone, All patie nts received supplemental oxygen and methylprednisolone, 125 mg, IV. B aseline measurements were repeated at 45 and 90 min and these included spirometry, oximetry, and vital signs, A total of 952 patients were s creened of whom 342 patients were deemed eligible and were randomized in two groups of 171 patients. The mean (SE) age was 30 years (0.9) vs 29 years (0.7), women, 103 (60.2%) vs 110 (64%), 81 (47.4%) never-smo ked vs 83 (48.5%), and duration of asthma in years 16.0 (0.8) vs 16.6 (0.8) were no different in the combination vs salbutamol alone group, respectively. Likewise, there was no significant difference in asthma therapy received in the 24 h prior to presentation; most notably, 151 (88.3%) vs 153 (89.5%) received inhaled beta-agonists in that period. Baseline FEV(1) was 1.62 L (0.05 L) vs 1.53 L (0.03 L), and median tim e to treatment being received was no different between both groups, Bo th treatment arms improved significantly, The increase in FEV(1) in th e combination group was 0.61 L (0.04 L) and in the salbutamol alone gr oup was 0.52 L (0.04 L) at 90 min. There was a trend toward greater br onchodilatation in the combination group, but this did not reach stati stical significance, Fewer hospitalizations, 5.9% vs 11.2%, occurred i n the combination group, but this did not reach statistical significan ce. In, conclusion, this large multicenter study failed to show a sign ificantly better response to a combination of salbutamol and ipratropi um bromide vs salbutamol alone.