Comparison of clinical efficacy and safety between salbutamol-ipratropium bromide nebulization and salbutamol alone in children with asthmatic attack
Keywords:
childhood asthma, ipratropium bromide, salbutamol, nebulization
Abstract
Background Indonesian guidelines for childhood asthma recom-mend giving ipratropium bromide when there are no improvement
after 2 times salbutamol nebulization. The efficacy and safety of
early nebulization of ipratropium bromide combined with salbutamol
as first line in moderate asthma exacerbation in children are still
unknown.
Objective To compare efficacy and safety between nebulized
salbutamol-ipratropium bromide and salbutamol alone in children
with moderate asthma exacerbation.
Methods Fifty-two children (2-6 years) with acute asthma (clinical
score 5-10) were enrolled into a randomized single blind controlled
trial comparing 2 groups of 2.5 mg nebulized salbutamol (group 1)
and 2.5 mg salbutamol combined with 0.5 mg ipratropium bromide
(group 2). Nebulization was given until clinical score decreased
<5, maximum of 3 doses during 2 hours. Clinical measurements
included clinical score, oxygen saturation and side effects which
were assessed every 20 minutes up to 120 minutes. Statistical
test for homogeneity and comparison of clinical outcomes and side
effects used independent t-test, Fisher’s exact test, and Mann-
Whitney U test (P<0.05).
Results The groups were similar in all baseline measures. There
were significantly decreasing clinical score in groups 2 at 20, 40,
60, 80, 100, and 120 minutes (P<0.05), and the means of oxygen
saturation were significantly higher in group 2 at 20, 40, 60, 80,
100, and 120 minutes (P<0.05). In group 1, 11.5% of patients were
hospitalized after the study and none in groups 2 (P> 0.05). There
were no toxic effects attributable to ipratropium bromide, and the
side effects were not different between these two groups.
Conclusion The combination of nebulized ipratropium bromide
and salbutamol in a child with acute moderate asthma exacerba-
tion was associated with higher reduction of clinical score and higher
oxygen saturation, and may reduce hospitalization
References
1. Liu A, Spahn J, Leung D. Childhood Asthma. In:
Behrman RE, Kliegman RM, Nelson WE, editors. Text-
book of Pediatrics, 17th edition. Philadelphia: Elsevier,
2004:760-74.
2. NHLBI/WHO. Global initiative for asthma, NHLBI/
WHO workshop report, 1995.
3. Rahajoe N, Supriyanto B, Budi Setyanto D. Tatalaksana
serangan asma. In: Rahajoe N, Supriyanto B, Budi
Setyanto D, editors. Pedoman nasional asma anak.
UKK Pulmonologi-PP IDAI, 2004: 25-34
4. Gross NJ. Ipratropium bromide. N Eng J Med,
1988:319(8),486-94.
5. Rodrigo GJ, Rodrigo C. The role of anticholinergics in
acute asthma treatment. An evidence-based evalua-
tion. Chest,2002;121(6):1977-87.
6. Schuh S. Efficacy of frequent nebulized ipratropium
bromide added to frequent high-dose albuterol
therapy in severe childhood asthma. J Pediatr,
1995:126,639-45.
7. Qureshi F, Pestian J, Davis P, Zaritsky A. Effect of nebu-
lized ipratropium on the hospitalization rates of chil-
dren with asthma. N Engl J Med,1998:339,1030-5.
8. Plotnick LH, Ducharme FM. Should inhaled anticho-
linergics be added to β 2 agonists for treating acute
childhood and adolescent asthma? A systematic re-
view. BMJ,1998:317,971-7.
9. Sharma A and Madaan A (2004). Nebulized salbutamol
vs salbutamol and ipratropium combination in asthma.
Indian J Pediatr 71(2), 121-4.
Behrman RE, Kliegman RM, Nelson WE, editors. Text-
book of Pediatrics, 17th edition. Philadelphia: Elsevier,
2004:760-74.
2. NHLBI/WHO. Global initiative for asthma, NHLBI/
WHO workshop report, 1995.
3. Rahajoe N, Supriyanto B, Budi Setyanto D. Tatalaksana
serangan asma. In: Rahajoe N, Supriyanto B, Budi
Setyanto D, editors. Pedoman nasional asma anak.
UKK Pulmonologi-PP IDAI, 2004: 25-34
4. Gross NJ. Ipratropium bromide. N Eng J Med,
1988:319(8),486-94.
5. Rodrigo GJ, Rodrigo C. The role of anticholinergics in
acute asthma treatment. An evidence-based evalua-
tion. Chest,2002;121(6):1977-87.
6. Schuh S. Efficacy of frequent nebulized ipratropium
bromide added to frequent high-dose albuterol
therapy in severe childhood asthma. J Pediatr,
1995:126,639-45.
7. Qureshi F, Pestian J, Davis P, Zaritsky A. Effect of nebu-
lized ipratropium on the hospitalization rates of chil-
dren with asthma. N Engl J Med,1998:339,1030-5.
8. Plotnick LH, Ducharme FM. Should inhaled anticho-
linergics be added to β 2 agonists for treating acute
childhood and adolescent asthma? A systematic re-
view. BMJ,1998:317,971-7.
9. Sharma A and Madaan A (2004). Nebulized salbutamol
vs salbutamol and ipratropium combination in asthma.
Indian J Pediatr 71(2), 121-4.
Published
2016-10-18
How to Cite
1.
Kartininingsih L, Setiawati L, S M. Comparison of clinical efficacy and safety between salbutamol-ipratropium bromide nebulization and salbutamol alone in children with asthmatic attack. PI [Internet]. 18Oct.2016 [cited 27Apr.2024];46(6):241-. Available from: https://paediatricaindonesiana.org/index.php/paediatrica-indonesiana/article/view/937
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Received 2016-10-16
Accepted 2016-10-16
Published 2016-10-18
Accepted 2016-10-16
Published 2016-10-18
