To determine the effect of adding ipratropium bromide(IB) to salbutamol compared with salbutamol alone for acute asthma exacerbation in children.
In a double-blind, randomized, control trial, 74 children aged 3 to 15 years were enrolled in the study. Subjects were randomized to receive 3 doses of nebulized salbutamol mixed with normal saline or IB every 20 min then additional doses of salbutamol were given every 30 min as needed. Outcome measures were assessed at 40, 70, 100, and 120 min. Primary outcomes were the differences in % change in clinical score (PCC) and % change in peak expiratory flow rate (PPEFR). Secondary outcomes included change in % predicted peak expiratory flow rate (PDPEFR) and additional salbutamol required.
Thirty three subjects received salbutamol alone (control group) and 38 subjects received the combined IB and salbutamol (treatment group). PPEFR and PDPEFR at any time line of the treatment group were higher without statistically significant difference (NS). Number of subjects with 100% PPEFR at any time point was greater and number of subjects received additional salbutamol at 100 min was lower in the treatment group (NS). There were no significant difference in PCC in the whole group and in the stratified subgroup analysis by age and severity.
Although this study did not demonstrate a significant advantage in clinical score and PEFR, the trend toward additional effect of IB was consistent with previous study.
Additional use of IB is considered in acute asthma exacerbation in children.
A. Watanasomsiri, None.