IS IT USEFUL TO ADD AN ANTICHOLINERGIC TREATMENT TO BETA(2)-ADRENERGIC MEDICATION IN ACUTE ASTHMA ATTACK

The aim of our study was to determine whether the combination of an an ticholinergic treatment with a beta(2)-adrenergic medication is a more effective treatment for acute asthma attack than the two treatments i ndividually. The association of salbutamol-ipratropium was compared to treatment with salbutamol and ipratropium alone. It was a prospective double-blind study in children with acute asthma attack, participatin g as outpatients. Their clinical history and characteristics of bronch ial obstruction were recorded on a standard form. Afterwards, they wer e included in one of the three following study groups: group one, 100 mu g/inh salbutamol; group two, 20 mu g/inh ipratropium; group three, 100 mu g/inh of salbutamol plus 20 mu g/inh ipratropium. There were 40 patients in each group, with Tal score +/- 5 and PEF < 80% of the pre dicted value. They were evaluated at the beginning (0 min), and at 15, 30, 45, 60, 80, 100 and 120 min. Each patient was treated with two in halations of the study medication and was then evaluated for variation s in Tal score. The mean age was 7.3 years; Tal score was 5.6, 5.6 and 6.0 at 0 min (p > 0.05). Decrease in Tal score after 15 min meant p < 0.01 for salbutamol-ipratropium and salbutamol vs, ipratropium. At 30 min p < 0.05 for salbutamol-ipratropium vs. salbutamol, and at 45 min p < 0.01 for salbutamol-ipratropium vs. salbutamol. PEF at O min was 70.9%, 71.3% and 68.6% (p > 0.05) increasing after 15 min. At 30 min p < 0.05 for salbutamol-ipratropium vs. salbutamol, and p < 0.01 vs. ip ratropium. At 45 min p < 0.01 for salbutamol-ipratropium vs. salbutamo l and ipratropium. A total 4.7 doses of salbutamol were needed to impr ove the asthma attack, 5.3 of ipratropium and 3.7 of salbutamol-ipratr opium, with p < 0.01 for salbutamol-ipratropium vs. salbutamol and ipr atropium. We conclude that the combination of salbutamol and ipratropi um is more effective than each medication alone in treating acute asth ma attacks in pediatric patients.