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Nebulized Ipratropium May Reduce Hospitalization for Children with Severe Asthma.

Anticholinergic medications such as ipratropium are useful in treating children with acute asthma. This study of 434 children (aged 2 to 18 years) treated in an emergency department for a moderate to severe asthma exacerbation found that ipratropium reduced the need for hospitalization in children with severe attacks.

According to a standardized protocol, all children received three doses of nebulized albuterol 20 minutes apart, and additional doses as needed; oral prednisone was given with the second dose of albuterol. In addition, the children were randomized to receive either 500 microg of ipratropium or placebo with the second and third doses. The overall rate of hospitalization was significantly lower in the treatment group (27 percent vs. 37 percent). Among children with severe asthmatic attacks, 38 percent of the treatment group required hospitalization, compared with 53 percent of the placebo group. Children with moderate asthma did not have significantly lower hospitalization rates. Ipratropium was well tolerated.

Comment: This study makes a good case for adding an anticholinergic medication to standardized treatment protocols for children having severe asthmatic attacks.

— RA Dershewitz

Published in Journal Watch General Medicine October 13, 1998

Citation(s):

Qureshi F et al. Effect of nebulized ipratropium on the hospitalization rates of children with asthma. N Engl J Med 1998 Oct 8 339 1030-1035.

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