Objective: To compare the outcome of patients with
acute bronchospasm treated with continuously nebulized albuterol plus
ipratropium bromide vs albuterol alone.
Emergency Department (ED) at the University of California San Francisco
Participants: Patients ≥ 18 years
old presenting to the ED with acute bronchospasm and a peak expiratory
flow rate (PEFR) of < 70% predicted.
This was a prospective, randomized, double-blind, placebo-controlled
trial. Subjects were treated with either a combination of albuterol (10
mg/h) plus ipratropium bromide (1.0 mg/h) or albuterol alone via
continuous nebulization for a maximum of 3 h. Vital signs, Borg
dyspnea score, and PEFR were recorded hourly. Primary outcome measures
were improvement in PEFR, hospital admission rates, and length of stay
in the ED.
Measurements and results: Data was analyzed
for 67 subjects. The mean age (± SD) was 47.5 ± 18.8, and
mean initial PEFR was 44.8 ± 12.5% of predicted. The median length
of stay for all subjects was 225 min, and 31% of all subjects were
admitted. Patients given combination therapy averaged 6.3% greater
improvement in PEFR compared with control subjects (95% confidence
interval [CI], −15% to 27%. The odds ratio for admission with
combination therapy was 0.88 (95% CI, 0.28 to 2.8). The median length
of stay in the ED was 35 min shorter for those receiving combination
treatment (210 vs 245 min; p = 0.03). However, when adjusted for
initial PEFR, there was no statistically significant difference
(p = 0.26).
Conclusion: Although the direction
of all three outcome measures favored combination therapy, there was no
statistically significant difference between ED patients with acute
bronchospasm receiving continuous albuterol plus ipratropium bromide
and those receiving albuterol alone.
Abbreviations: CI = confidence interval;
ED = emergency department; NHLBI = National Heart, Lung, and Blood
Institute; PEFR = peak expiratory flow rate; RT = respiratory