Original ArticlesIpratropium bromide plus nebulized albuterol for the treatment of hospitalized children with acute asthma☆
Section snippets
Study Population
Rainbow Babies and Childrens Hospital is a university-affiliated tertiary care children’s hospital in Cleveland, Ohio. In 1996, the asthma care algorithm was universally implemented in a dedicated inpatient asthma care unit to treat children aged 1 to 18 years with acute asthma.8 The ACA excludes children who require supplemental home oxygen or have cystic fibrosis, cyanotic congenital heart disease, chronic neonatal lung disease, or pulmonary hypertension. Children entered in the ACA were
Baseline Characteristics
Of 491 eligible children, 210 were enrolled during the 40-week study period from December 15, 1996, to September 21, 1997. Twelve children were enrolled more than once. Study participants and eligible nonparticipants who refused enrollment were similar with regard to sex, age, race, number of previous asthma-related hospitalizations, and the proportion of children who required supplemental oxygen in the ED. Enrolled children were significantly more likely to have been prescribed inhaled
Discussion
For children hospitalized with status asthmaticus managed with a standardized regimen of systemic corticosteroids, frequent nebulized β-agonists, and subcutaneous epinephrine and IB as needed, the addition of repeated doses of nebulized IB provided no significant benefit. For children >6 years old, combination therapy produced a trend toward shorter LOS and more rapid ACA-P that did not reach statistical significance.
Previous randomized clinical trials comparing combined nebulized
Acknowledgements
We are indebted to Dr Mike Reed and the RBC Center for Drug Research for supplying, coding, and monitoring the sterility of the study medications; to Kathy Spaude, Cheryl Velotta, Marsha Rogers, Cal Dorton, and the other respiratory therapists in the Rainbow inpatient asthma unit for their dedication to patient enrollment and care.
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2019, Kendig's Disorders of the Respiratory Tract in ChildrenManagement of Acute Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease in the Emergency Department
2016, Emergency Medicine Clinics of North AmericaCitation Excerpt :In the first 24 hours of the respiratory obstructive crisis, some believe that the adrenergic receptors, which constitute the majority of pulmonary airway receptors, are downregulated and perhaps temporarily unresponsive to β2-receptor agonists. During this time, pulmonary muscarinic acetylcholine receptors remain functional leading to their contribution in bronchodilation.60–62 Method of pharmacotherapy delivery is via a pressurized metered dose inhaler with a holding chamber or an oxygen-driven nebulizer.
Wheezing: Asthma, Chronic Obstructive Pulmonary Disease, and More
2015, Hospital Medicine ClinicsPediatric Status Asthmaticus
2013, Critical Care ClinicsCitation Excerpt :Additionally, the cardiovascular side effects of ipratropium, which is not absorbed into the bloodstream when delivered by inhalation, are minimal. In children with status asthmaticus, the addition of ipratropium nebulizations to albuterol therapy has been shown to significantly reduce hospitalizations.31–33 This therapy was most effective in moderate to severely ill children.32,33
Asthma Diagnosis and Management
2012, Emergency Medicine Clinics of North AmericaCitation Excerpt :Anticholinergics are not recommended for hospitalized patients.20 Two randomized controlled trials did not show significant benefit from ipratropium for hospitalized patients with severe asthma.81,82 Acute asthma is characterized by airway edema, mucus hypersecretion, and cellular infiltration, in addition to bronchospasm.
Wheezing in Older Children
2012, Kendig and Chernick's Disorders of the Respiratory Tract in Children
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Reprint requests: Daniel Craven, MD, Division of Pediatric Pulmonology, Rainbow Babies and Childrens Hospital, 11100 Euclid Ave, Cleveland, OH 44106.