A Cochrane review [Abstract] 1 included 6 studies with a total of 321 infants in 3 different settings (emergency room, 2 studies; hospitalised patients, 3 studies; outpatients, 1 study). The use of ipratropium bromide in the emergency department in addition to beta2-agonist resulted in significantly fewer patients requiring further therapy 45 minutes after initial therapy compared with beta2-agonist alone in one study (OR 0.22, 95% CI 0.08 to 0.61). However, in the other emergency department study, there was no difference in the frequency of a perceived 'excellent' response, change in respiratory rate or improvement in oxygen saturation.
There was no significant difference in length of hospital stay between ipratropium bromide and placebo (WMD -0.40 days, 95% CI -1.41 to 0.61; 1 study, n=31); or between ipratropium bromide and beta2-agonist combined compared with beta2-agonist alone (WMD 0.29 days, 95% CI -0.38 to 0.95; 2 studies, n=62). Combined ipratropium bromide and beta2-agonist compared to placebo showed significantly improved clinical scores at 24 hours (OR 0.06; 95% CI 0.01 to 0.23; 1 study, n=30).
In 1 study (n=46), maintenance treatment with ipratropium bromide was perceived by parents to be preferable to nebulised water overall (OR 0.15, 95% CI 0.04 to 0.64) and better than placebo for immediate response to treatment (OR 0.11; 95% CI 0.02, 0.58) although there was no significant difference in the relief of symptoms as defined by diary cards (OR 0.60; 95% CI 0.19 to 1.88).
Comment: The quality of evidence is downgraded by inconsistency (variability in results across studies), and by imprecise results (few patients and wide confidence intervals).
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