EFFECT OF NEBULIZED IPRATROPIUM ON THE HOSPITALIZATION RATES OF CHILDREN WITH ASTHMA

Background Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma, bu t their effect on hospitalization rates is uncertain. Methods We condu cted a randomized, double-blind, placebo-controlled study of 434 child ren (2 to 18 years old) who had acute exacerbations of moderate or sev ere asthma treated in the emergency department. All the children recei ved a nebulized solution of albuterol (2.5 or 5 mg per dose, depending on body weight) every 20 minutes for three doses and then as needed, A corticosteroid (2 mg of prednisone or prednisolone per kilogram of b ody weight) was given orally with the second dose of albuterol. Childr en in the treatment group received 500 mu g (2.5 mi) of ipratropium br omide with the second and third doses of albuterol; children in the co ntrol group received 2.5 mi of normal saline at these times. Results O verall, the rate of hospitalization was lower in the ipratropium group (59 of 215 children [27.4 percent]) than in the control group (80 of 219 [36.5 percent], P=0.05). For patients with moderate asthma (indica ted by a peak expiratory flow rate of 50 to 70 percent of the predicte d value or an asthma score of 8 to 11 on a 15-point scale), hospitaliz ation rates were similar in the two groups (ipratropium: 8 of 79 child ren [10.1 percent]; control: 9 of 84 [10.7 percent]). For patients wit h severe asthma (defined as a peak expiratory flow rate of <50 percent of the predicted value or an asthma score of 12 to 15), the addition of ipratropium significantly reduced the need for hospitalization (51 of 136 children [37.5 percent], as compared with 71 of 135 [52.6 perce nt] in the control group; P=0.02). Conclusions Among children with a s evere exacerbation of asthma, the addition of ipratropium bromide to a lbuterol and corticosteroid therapy significantly decreases the hospit alization rate. (N Engl J Med 1998;339:1030-5.) (C) 1998, Massachusett s Medical Society.