Inhaled Ipratropium Bromide Added to Beta2-Agonists for Hospitalized Children with Acute Asthma

Summary

A Cochrane review [Abstract] 1 included 7 studies, 4 of which reported usable data on 472 children with asthma 1 to 18 years of age who were admitted to paediatric wards. Ipratropium bromide 250 μg was given every 1 to 8 hours over a period from 4 hours to the entire length of the hospital stay. The addition of anticholinergics to β₂-agonists showed no evidence of effect on the duration of hospital admission (MD -0.28 hours, 95% CI -5.07 to 4.52; 3 studies, n=327) and no serious or non-serious adverse events were reported in any included studies. No statistically significant group difference was noted in other secondary outcomes, including the need for supplemental asthma therapy, time to short-acting β₂-agonists spaced at four hours or longer, asthma clinical scores, lung function and overall withdrawals for any reason. No studies included patients admitted to the intensive care unit (ICU), and in the absence of trials conducted in ICUs, no conclusion can be drawn regarding children with impending respiratory failure.

Comment: Another Cochrane review showed that ipratropium added to beta₂-agonists reduced hospitalization rates in the initial treatment of moderate and severe exacerbations of childhood acute asthma; see Ipratropium Bromide Added to Beta2-Agonists in Acute Childhood Asthma. Current guidelines recommend that anticholinergics are not indicated in children hospitalised for an acute asthma exacerbation, beyond initial treatment in the emergency department.