NEBULIZED SALBUTAMOL WITH AND WITHOUT IPRATROPIUM BROMIDE IN THE TREATMENT OF ACUTE ASTHMA

Background: Routine addition of ipratropium bromide to beta-agonist th erapy in acute asthma is of uncertain benefit. Objective: This study w as carried out to evaluate: (1) whether nebulized ipratropium (0.5 mg) plus salbutamol (2.5 mg) (Combivent) confers additional bronchodilati on over nebulized salbutamol (2.5 mg) alone in patients with acute ast hma and (2) whether adjustment for prognostic indicators of outcome in fluences any benefit seen with ipratropium. Methods: A double-blind, t wo-center, randomized, single-dose study was performed in 338 patients with asthma, aged 18 to 55 years, who attended the emergency departme nt for treatment of acute asthma, The primary end point was FEV1 at 90 minutes. Results: The mean absolute difference in FEV1 at 90 minutes for Combivent compared with salbutamol was 113 ml (SEM +/- 48 ml, p < 0.05), Independent of the study drug received, a poor response to trea tment was predicted by frequent use of inhaled P-agonist before presen tation (p < 0.0001), severity of the attack (p < 0.05), and longer dur ation of attack (p < 0.05), Subjects who had taken more than 10 puffs of inhaled beta-agonist through a metered-dose inhaler or who had seru m salbutamol levels of greater than 2 mmol/L on presentation demonstra ted no benefit from the addition of ipratropium. Patients with an FEV1 less than 1 L on presentation also responded less well to C ombivent, which was explained by the association between severity of attack and greater use of inhaled beta-agonist therapy. Conclusion: A single dos e of nebulized Combivent confers additional bronchodilation over salbu tamol alone (p < 0.05) in acute asthma, Patients who exhibited most be nefit from the addition of ipratropium were those who had consumed the least inhaled beta-agonist before presentation, not those with the mo st severe asthma.