SUPERIORITY OF IPRATROPIUM PLUS ALBUTEROL OVER ALBUTEROL ALONE IN THEEMERGENCY DEPARTMENT MANAGEMENT OF ADULT ASTHMA - A RANDOMIZED CLINICAL-TRIAL

Study objective: The use of nebulized ipratropium in combination with beta-agonists for the treatment of acute asthma in adults is controver sial. We wished to test the hypothesis that combined aerosol treatment results in a greater rate of airflow improvement and a lower proporti on of hospital admission in adults with acute asthma. Methods: In a ra ndomized, double-blind, placebo-controlled trial, 55 adult asthmatic p atients with peak expiratory flow rate (PEFR) less than 200 L/min were randomly assigned to nebulization treatment with albuterol alone (2.5 mg initial dose followed by 2 more doses al 20-minute intervals), or the same albuterol regimen plus ipratropium (.5 mg combined with the i nitial dose of albuterol only). Patients were recruited from an emerge ncy department al an urban academic medical center. The primary endpoi nts were changes in PEFR and in percent predicted PEFR over time (ie, treatment by time effect). PEFRs were assessed at baseline and at 20-m inute intervals for a 1-hour period. The proportion of admissions in t he two groups were examined as secondary endpoints. Results: The incre ases in PEFR and percent predicted PEFR over time were both significan tly greater in the combined ipratropium plus albuterol treatment group (P less than or equal to.001). In addition, the proportion of admitte d patients was less in this group (3/27) than the proportion in the al buterol-only group (10/28). The 95% confidence interval for the absolu te difference of 25% in the proportion admitted was 3% to 46%, P=.03. Most of the baseline clinical and historical features in the two group s were similar. Conclusion: These data suggest that ipratropium should he combined with initial albuterol nebulization in the ED treatment o f acute asthma in adults, especially those with PEFRs less than 200 L/ min.