Ipratropium bromide added to asthma treatment in the pediatric emergency department

Objective. To determine if the addition of ipratropium bromide to the emerg ency department (ED) treatment of childhood asthma reduces time to discharg e, number of nebulizer treatments before discharge, and the rate of hospita lization. Methods. Patients >12 months of age were eligible if they were to be treate d according to a standardized ED protocol for acute asthma with nebulized a lbuterol (2.5 mg/dose if weight <30 kg, otherwise 5 mg/dose) and oral predn isone or prednisolone (2 mg/kg up to 80 mg). Subjects were randomized to re ceive either ipratropium (250 mu g/dose) or normal saline (1 mL/dose) with each of the first three nebulized albuterol doses. Further treatment after the first hour was determined by physicians blinded to subject group assign ment. Records were reviewed to determine the length of time to discharge ho me from the ED, number of doses of albuterol given before discharge, and th e number of patients admitted to the hospital. Results. Four hundred twenty-seven patients were randomized to ipratropium or control groups; these groups were similar in all baseline measures. Amon g patients discharged from the ED, ipratropium group subjects had 13% short er treatment time (mean, 185 minutes, vs control, 213 minutes) and fewer to tal albuterol doses (median, three, vs control, four). Admission rates did not differ significantly (18%, vs control, 22%). Conclusions. The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and am ount of treatment before discharge.