Effect of nebulized ipratropium on the hospitalization rates of children with asthma

被引:191
作者
Qureshi, F
Pestian, J
Davis, P
Zaritsky, A
机构
[1] Eastern Virginia Med Sch, Childrens Hosp Kings Daughters, Div Pediat Emergency Med, Norfolk, VA 23507 USA
[2] Eastern Virginia Med Sch, Childrens Hosp Kings Daughters, Dept Clin Outcomes, Norfolk, VA 23507 USA
[3] Eastern Virginia Med Sch, Childrens Hosp Kings Daughters, Dept Pediat, Norfolk, VA 23507 USA
关键词
D O I
10.1056/NEJM199810083391503
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma, but their effect on hospitalization rates is uncertain. Methods We conducted a randomized, double-blind, placebo-controlled study of 434 children (2 to 18 years old) who had acute exacerbations of moderate or severe asthma treated in the emergency department. All the children received a nebulized solution of albuterol (2.5 or 5 mg per dose, depending on body weight) every 20 minutes for three doses and then as needed, A corticosteroid (2 mg of prednisone or prednisolone per kilogram of body weight) was given orally with the second dose of albuterol. Children in the treatment group received 500 mu g (2.5 mi) of ipratropium bromide with the second and third doses of albuterol; children in the control group received 2.5 mi of normal saline at these times. Results Overall, the rate of hospitalization was lower in the ipratropium group (59 of 215 children [27.4 percent]) than in the control group (80 of 219 [36.5 percent], P=0.05). For patients with moderate asthma (indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale), hospitalization rates were similar in the two groups (ipratropium: 8 of 79 children [10.1 percent]; control: 9 of 84 [10.7 percent]). For patients with severe asthma (defined as a peak expiratory flow rate of <50 percent of the predicted value or an asthma score of 12 to 15), the addition of ipratropium significantly reduced the need for hospitalization (51 of 136 children [37.5 percent], as compared with 71 of 135 [52.6 percent] in the control group; P=0.02). Conclusions Among children with a severe exacerbation of asthma, the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate. (N Engl J Med 1998;339:1030-5.) (C) 1998, Massachusetts Medical Society.
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页码:1030 / 1035
页数:6
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