Work was carried out at the Department of Emergency Medicine, Princess Margaret Hospital for Children, Roberts Road, Subiaco, Western Australia 6008, Australia.
Metered-dose inhaler ipratropium bromide in moderate acute asthma in children: A single-blinded randomised controlled trial
Article first published online: 14 JUL 2014
© 2014 The Authors. Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
How to Cite
Wyatt, E. L., Borland, M. L., Doyle, S. K. and Geelhoed, G. C. (2014), Metered-dose inhaler ipratropium bromide in moderate acute asthma in children: A single-blinded randomised controlled trial. Journal of Paediatrics and Child Health. doi: 10.1111/jpc.12692
Clinical Trial Registration: Australian New Zealand Clinical Trials Registry (No. ACTRN12607000383460).
Conflict of interest: The authors have no conflict of interest to disclose.
- Article first published online: 14 JUL 2014
- Manuscript Accepted: 12 JUN 2014
- Emergency Department, Princess Margaret Hospital for Children
- emergency service;
To determine if the addition of ipratropium bromide (IB) by metered-dose inhaler in moderate acute asthma in children affects hospital admission rates when compared with inhaled salbutamol and oral prednisolone alone.
A prospective, single-blinded, randomised, controlled, equivalence trial in a tertiary paediatric emergency department. Patients aged 2–15 years with acute, moderate asthma were randomised to two groups, one receiving salbutamol, prednisolone and IB, the other receiving only salbutamol and prednisolone. The managing doctor was blinded to treatment. Admission rates were compared, and less than 15% difference was accepted as statistically equivalent.
Recruitment ran from June 2007 until January 2011. Three hundred forty-seven subjects were analysed. The admission rate in the IB group was 70.1% (122/174) compared with 64.2% (111/173) in the non-IB group. The absolute difference of +5.9% (95% confidence interval −4.0% to 15.8%) is not statistically equivalent but does not show a statistically significant decrease in admission rates when IB was given. Adverse effects were more prevalent in the IB group, at 13.2% (23/174), compared with 4.6% (8/173) in the non-IB group, a relative risk of 2.86 (95% confidence interval 1.31–6.21).
In children with acute asthma of moderate severity who are treated with adequate doses of salbutamol and prednisolone, the addition of IB is not significantly associated with a reduction in admission rates. There is a significantly higher rate of adverse effects if IB is given. IB should be reserved for children with severe asthma exacerbations.