Acute severe asthma; salbutamol plus ipratropium bromide nebulization versus salbutamol nebulization alone

ABSTRACT

To compare the improvement in peak expiratory flow rate [PEFR] of patients presenting to the emergency department with acute severe asthma by using the following two regimens of broncho-dilator therapy. a] Salbutamol nebulization. b] Salbutamol plus Ipratropium bromide nebulization. c] To compare the hospital admission rates in the above mentioned two treatment groups. A comparative study. Military Hospital Rawalpindi, Feb 2002 to Dec 2002. Sixty adult asthmatic patients with peak expiratory flow rate [PEFR] less than 200 liters per minute were randomly assigned to nebulization treatment with salbutamol [5.0 mg initial dose followed by 2 more doses at 30 and 60 minutes] or the same salbutamol regimen plus ipratropium bromide [0.5 mg]. The primary end point was change in PEFR. The PEFR was measured at 30 minutes, 60 minutes and 90 minutes after the onset of study protocol. The proportion of admission in the two groups was examined as secondary end point. The increase in PEFR over time was significantly greater in combined ipratropium plus salbutamol group [p = 0.01] also the proportion of admitted patients was less in combined salbutamol plus ipratropium bromide group 4/30 vs 11/30, p = 0.036. The data suggested that combined iratropium bromide plus salbutamol nebulization was superior to salbutamol nebulization alone and it should be used in the initial management of patients who present with acute severe asthma