Ipratropium bromide plus nebulized albuterol for the treatment of hospitalized children with acute asthma

Objective: To determine whether the addition of repeated doses of nebulized ipratropium bromide (IB) to a standardized inpatient asthma care algorithm (ACA) for children with status asthmaticus improves clinical outcome. Study design: Children with acute asthma (N = 210) age 1 to is years admitt ed to the ACA were assigned to the intervention or placebo group in randomi zed double-blind fashion. Both groups received nebulized albuterol, systemi c corticosteroids, and oxygen according to the ACA. The intervention group received 250 mug IB combined with 2.5 mg albuterol by jet nebulization in a dosing schedule determined by the ACA phase. The placebo group received is otonic saline solution substituted for IB. Progression through each ACA pha se occurred based on assessments of oxygenation, air exchange, wheezing, ac cessory muscle use, and respiratory rate performed at prescribed intervals. Results: No significant differences were observed between treatment groups in hospital length of stay (P = .46), asthma carepath progression (P = .37) , requirement for additional therapy, or adverse effects. Children >6 years (N = 70) treated with IB had shorter mean hospital length of stay (P = .03 ) and more rapid mean asthma carepath progression (P = .02) than children i n the placebo group. However, after adjustment was done for baseline group differences, the observed benefit of IB therapy in older children no longer reached statistical significance. Conclusion: The routine addition of repeated doses of nebulized IB to a sta ndardized regimen of systemic corticosteroids and frequently administered b eta -2 agonists confers no significant enhancement of clinical outcome for the treatment of hospitalized children with status asthmaticus.