EFFICACY OF FREQUENT NEBULIZED IPRATROPIUM BROMIDE ADDED TO FREQUENT HIGH-DOSE ALBUTEROL THERAPY IN SEVERE CHILDHOOD ASTHMA

被引:118
作者
SCHUH, S
JOHNSON, DW
CALLAHAN, S
CANNY, G
LEVISON, H
机构
[1] HOSP SICK CHILDREN, DIV CLIN PHARMACOL, TORONTO, ON M5G 1X8, CANADA
[2] HOSP SICK CHILDREN, DIV CHEST, TORONTO, ON M5G 1X8, CANADA
[3] HOSP SICK CHILDREN, DEPT PEDIAT, TORONTO, ON M5G 1X8, CANADA
关键词
D O I
10.1016/S0022-3476(95)70368-3
中图分类号
R72 [儿科学];
学科分类号
100202 ;
摘要
Objective: The objective of this trial was to determine the efficacy of frequent nebulized ipratropium added to high-dose albuterol therapy in children with severe asthma. Methods: One hundred twenty children (5 to 17 years) of age) with severe acute asthma (forced expiratory volume in 1 second (FEV(1)), <50% of the predicted value) were enrolled into a randomized double-blind three-arm placebo-controlled trial comparing three groups: group 1, three doses of nebulized ipratropium bromide within 60 minutes (250 mu g/dose); group 2, one dose of ipratropium; group 3, no ipratropium. All patients were also treated with three doses of nebulized albuterol within 60 minutes (0.15 mg/kg per dose). Pulmonary function and clinical measures were assessed every 20 minutes for up to 120 minutes. Results: The groups were comparable at baseline. At 120 minutes, the mean percentage of predicted FEV(1) improved from 33.4% to 56.7% in group 1, from 34.2% to 52.3% in group 2, and from 35.4% to 48.4% in group 3 (p = 0.0001). The differences between groups were larger in those children with a baseline FEV(1) less than or equal to 30% of the predicted value: FEV(1) increased from 24.5% to 50.9% in group 1, from 25.0% to 39.8% in group 2, and from 25.9% to 36.5% in group 3 (P = 0.0001). In group 1, 38% of the patients were hospitalized after the study, 44% in group 2, and 46% in group 3 (p value not significant). However, in patients with FEV(1) less than or equal to 30%, the hospitalization rates were 27% in group 1, 56% in group 2, and 83% in group 3 (p = 0.027). There were no toxic effects attributable to ipratropium. Conclusion: The addition of repeated doses of nebulized ipratropium to frequent high-dose albuterol therapy in patients with acute severe asthma is both safe and more effective than albuterol alone; its use in patients with very severe asthma may reduce hospitalizations.
引用
收藏
页码:639 / 645
页数:7
相关论文
共 28 条
[1]  
[Anonymous], 1979, AM REV RESPIR DIS, V119, P831
[2]  
BARNES PJ, 1983, AM REV RESPIR DIS, V127, P758
[3]   COMBINED SALBUTAMOL AND IPRATROPIUM BROMIDE BY INHALATION IN THE TREATMENT OF SEVERE ACUTE ASTHMA [J].
BECK, R ;
ROBERTSON, C ;
GALDESSEBALDT, M ;
LEVISON, H .
JOURNAL OF PEDIATRICS, 1985, 107 (04) :605-608
[4]  
BONER AL, 1987, ANN ALLERGY, V58, P54
[5]  
COOK JJ, 1985, PHARMATHERAPEUTICA, V4, P383
[6]   DETERMINATION OF DOSE-RESPONSE RELATIONSHIP FOR NEBULIZED IPRATROPIUM IN ASTHMATIC-CHILDREN [J].
DAVIS, A ;
VICKERSON, F ;
WORSLEY, G ;
MINDORFF, C ;
KAZIM, F ;
LEVISON, H .
JOURNAL OF PEDIATRICS, 1984, 105 (06) :1002-1005
[7]  
Fleiss J. L., 1986, RELIABILITY MEASUREM
[8]   SHOULD IPRATROPIUM BROMIDE BE ADDED TO BETA-AGONISTS IN TREATMENT OF ACUTE SEVERE ASTHMA [J].
HIGGINS, RM ;
STRADLING, JR ;
LANE, DJ .
CHEST, 1988, 94 (04) :718-722
[9]   ANISOCORIA AND AEROSOLIZED ANTICHOLINERGICS [J].
JANNUN, DR ;
MICKEL, SF .
CHEST, 1986, 90 (01) :148-149
[10]  
KEREM E, 1991, PEDIATRICS, V87, P481