Bronchodilator effect of fenoterol and ipratropium bromide in infants with acute wheezing: use of MDI with a spacer device. Use of ipratropium bromide in asthma. Results of a multi-clinic study. Salbutamol and ipratropium in acute asthma. Randomized trial of the addition of ipratropium bromide to albuterol and corticosteroid therapy in children hospitalized because of an acute asthma exacerbation. Effect of nebulized ipratropium on the hospitalization rates of children with asthma. Efficacy of nebulized ipratropium in severely asthmatic children. Frequent administration by inhalation of salbutamol and ipratropium bromide in the initial management of severe acute asthma in children. Combined treatment with ipratropium bromide and beta-2-adrenoceptor agonists in childhood asthma. A place for ipratropium bromide in the treatment of severe acute asthma. Ipratropium bromide in acute asthma. Ipratropium Bromide Added to Asthma Treatment in the Pediatric Emergency Department Combination of atropine and isoetharine aerosol therapy in pediatric acute asthma. Nebulised ipratropium and salbutamol in asthma. Comparison of ipratropium solution, fenoterol solution, and their combination administered by nebulizer and face mask to children with acute asthma. Inhaled Salbutamol Plus Ipratropium in Moderate and Severe Asthma Crises in Children Ipratropium bromide plus nebulized albuterol for the treatment of hospitalized children with acute asthma. Randomized, double-blind, placebo-controlled trial of intravenous salbutamol and nebulized ipratropium bromide in early management of severe acute asthma in children presenting to an emergency department Randomized controlled trial of ipratropium bromide and frequent low doses of salbutamol in the management of mild and moderate acute pediatric asthma. Efficacy of frequent nebulized ipratropium bromide added to frequent high-dose albuterol therapy in severe childhood asthma. Bronchodilating effect of ipratropium bromide inhalation powder and aerosol in children and adolescents with stable bronchial asthma Additive effect of albuterol and ipratropium bromide in the treatment of bronchospasm in children. Comparison of the effects of inhaled SCH 1000 and fenoterol on exercise-induced bronchospasm in children. Comparison of the bronchodilating effect of oxitropium bromide and fenoterol in asthmatic children Combined salbutamol and ipratropium bromide by inhalation in the treatment of severe acute asthma. Dexamethasone and salbutamol in the treatment of acute wheezing in infants. A clinical trial of the bronchodilator effect of Sch 1000 aerosol in asthmatic children. [Bronchial asthma in childhood. Therapy with fenoterol and ipratropium bromide powder]. Double-blind study with Duovent and placebo in 20 asthmatic children.
Twenty-eight infants admitted to Exequiel González Cortes Children 's Hospital because of acute wheezing ( AW ) were r and omly assigned to three study groups . Fenoterol ( FNT ) , ipratropium bromide ( IB ) , and placebo were administered respectively to children in the different groups by means of metered dose inhalers ( MDI ) with spacers , using doses of 3 puffs every hour , for 4 hours . The degree of bronchial obstruction was assessed clinical ly and scored with the single-blind method every hour prior to each treatment . The criterion of a bronchodilator effect was a significant decrease in the degree of bronchial obstruction at subsequent scorings . The scores of the three groups were compared using the Student 's t test for matched sample s. The same test was also applied to the independent sample s for determining the superiority of one treatment , FNT or IB , over the other . The results indicated a significant decrease in the scores of the groups receiving FNT and IB ( P less than 0.05 ) ; this did not occur in the group in which placebo was used . FNT produced a more rapid and sustained effect  than IB ( P less than 0.05 ) . Significant bronchodilator effect was obtained in infants with AW  when repeated doses of FNT or IB were administered with MDI and spacers . This effect was significantly greater in the group treated with FNT A multi-center , double-blind , 90-day study compared an ipratropium bromide metered-dose inhaler ( 40 microgram four times a day ) with a metaproterenol metered-dose inhaler ( 1,500 micrograms four times a day ) in 164 patients with asthma ; of the 144 patients who completed the study , 71 received ipratropium and 73 received metaproterenol . Our results suggest that both drugs were equally effective bronchodilators . Although the shape of the pulmonary function response curves suggested that ipratropium has different bronchodilator kinetics than metaproterenol ( in that it has a slower onset of action and a more prolonged duration ) , comparison of the areas under the curves for the two drugs showed that there was no statistical difference between ipratropium or metaproterenol . The only significant side effects noted with ipratropium were cough and exacerbation of symptoms ; no anticholinergic side effects were noted Thirty seven children with acute asthma were given nebulised ipratropium or placebo 30 minutes after their first dose of salbutamol and eight hourly thereafter . There were no significant differences between the two groups in clinical scores , peak expiratory flow rates , length of stay in hospital , or the need for oral steroids OBJECTIVE To determine whether the addition of inhaled ipratropium bromide to inhaled albuterol and systemic corticosteroid therapy was more efficacious than inhaled albuterol and systemic corticosteroids alone in the inpatient treatment of acute asthma exacerbations in children . DESIGN Double-blind , r and omized , placebo-controlled trial . SETTING Pediatric inpatient unit of a tertiary urban hospital . PARTICIPANTS Eighty children ( aged 1 - 18 years ) hospitalized because of an acute asthma exacerbation . INTERVENTION Children were r and omized to receive either nebulized ipratropium bromide , 250 microg , or nebulized isotonic sodium chloride solution , 1 mL. All children received albuterol and systemic corticosteroids . MAIN OUTCOME MEASURES The primary outcome variable was a vali date d clinical asthma score , measured at baseline and every 6 hours for 36 hours . Secondary outcome measures included the forced expiratory volume in 1 second , the oxygen saturation , the number of doses of inhaled study drug , the time to an inhaled drug-dosing interval of 4 hours , and the length of the hospital stay . RESULTS There were no differences between groups on baseline characteristics . The intention-to-treat analysis , using repeated- measures analysis of variance , showed no significant ( P = .07 ) difference between the groups in the clinical asthma score over time . There were also no significant differences between groups on secondary outcomes . CONCLUSION The addition of nebulized ipratropium bromide to nebulized beta(2)-agonist and corticosteroid therapy in the treatment of children hospitalized because of asthma ( following intensive emergency department treatment ) confers no extra benefit BACKGROUND Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma , but their effect on hospitalization rates is uncertain . METHODS We conducted a r and omized , double-blind , placebo-controlled study of 434 children ( 2 to 18 years old ) who had acute exacerbations of moderate or severe asthma treated in the emergency department . All the children received a nebulized solution of albuterol ( 2.5 or 5 mg per dose , depending on body weight ) every 20 minutes for three doses and then as needed . A corticosteroid ( 2 mg of prednisone or prednisolone per kilogram of body weight ) was given orally with the second dose of albuterol . Children in the treatment group received 500 microg ( 2.5 ml ) of ipratropium bromide with the second and third doses of albuterol ; children in the control group received 2.5 ml of normal saline at these times . RESULTS Overall , the rate of hospitalization was lower in the ipratropium group ( 59 of 215 children [ 27.4 percent ] ) than in the control group ( 80 of 219 [ 36.5 percent ] , P=0.05 ) . For patients with moderate asthma ( indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale ) , hospitalization rates were similar in the two groups ( ipratropium : 8 of 79 children [ 10.1 percent ] ; control : 9 of 84 [ 10.7 percent ] ) . For patients with severe asthma ( defined as a peak expiratory flow rate of < 50 percent of the predicted value or an asthma score of 12 to 15 ) , the addition of ipratropium significantly reduced the need for hospitalization ( 51 of 136 children [ 37.5 percent ] , as compared with 71 of 135 [ 52.6 percent ] in the control group ; P=0.02 ) . CONCLUSIONS Among children with a severe exacerbation of asthma , the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate STUDY OBJECTIVE To determine the effect of adding the nebulized anticholinergic drug ipratropium bromide to st and ard therapy compared with st and ard therapy alone for acute severe asthma ( peak expiratory flow rate [ PEFR ] < 50 % of predicted ) in children presenting to the emergency department . METHODS Ninety children aged 6 to 18 years were r and omly assigned to two groups in a prospect i ve , double-blind , placebo-controlled study performed in the ED of an urban children 's hospital . All children received nebulized albuterol solution ( .15 mg/kg ) every 30 minutes , and all received oral steroids with the second dose of albuterol . Children in group 1 received ipratropium bromide ( 500 micrograms/dose ) with the first and third dose of albuterol those in group 2 received saline placebo instead of ipratropium .  Pulmonary functions ( PEFR and 1-second forced expiratory volume [ FEV1 ] ) and physiologic measurements were assessed every 30 minutes up to 120 minutes . By chance , the baseline values for percent of predicted PEFR and FEV1 differed between the two groups . Therefore a multivariate model accounting for both time and baseline effects was used to compare the response between groups . RESULTS On average , and adjusting for baseline measures , children in the ipratropium group had a significantly greater improvement in percent of predicted PEFR than did children in the placebo group at 60 minutes ( P = .02 ) , 90 minutes ( P = .002 ) , and 120 minutes ( P < .0001 ) . The improvement in percent predicted FEV1 was significantly greater for children in the ipratropium group only at 120 minutes ( P = .013 ) . Nine children ( 20 % ) from the ipratropium group and 14 ( 31.1 % ) from the control group were admitted ( P = .33 , chi 2 ) . There were no significant adverse effects attributable to the ipratropium , and there was no relation between ipratropium use and changes in pulse , respiratory rate , blood pressure , or oxygen saturation . CONCLUSION We detected significant improvement in pulmonary function studies over 120 minutes in children with severe asthma who were given nebulized ipratropium combined with albuterol and oral steroids , compared with children who received the st and ard therapy . Further study is needed to determine whether early use of ipratropium decreases the need for hospitalization A study was performed to compare the efficacy and safety of two therapeutic regimens for the treatment of children presenting to the emergency department with acute asthma . A regimen of inhaled salbutamol alone was compared to inhaled salbutamol combined with ipratropium bromide .  Twenty-five children ranging in age from 5 to 15 years were enrolled in the study . Children with FEV1 less than or equal to 55 % predicted were eligible to participate in the study . Subjects were r and omized in a double-blind fashion into one of two treatment groups . Both groups received an initial dose of salbutamol by nebulizer of 150 micrograms/kg ( 0.03 cc/kg ) , followed by six consecutive doses of 50 micrograms/kg ( 0.01 cc/kg ) at 20-minute intervals . In one group of subjects , 250 micrograms ( 1.0 ml ) of ipratropium bromide respirator solution was added to the salbutamol administered at the time of the initial inhalation , and at 40 and 80 minutes , whereas the remaining subjects received a placebo with salbutamol at those times . Formal one-way statistical ANOVA with change in percent predicted FEV1 as a response variable confirmed there was a statistically significant difference at all time points caused by drug regimen during the 150-minute observation period . There was no significant difference in side effects reported in the two groups . Significant additional bronchodilation achieved with salbutamol and ipratropium bromide together indicates that there is likely a substantial cholinergic element to the bronchospasm observed in acute exacerbations of asthma in the pediatric age group The effect of adding ipratropium bromide to treatment with beta-2-adrenoceptor agonists was studied in 13 asthmatic children in a double-blind cross-over trial . In the acute phase of the study inhalation of salbutamol 0.1 mg/kg followed by inhalation of 0.25 mg of ipratropium bromide was found to improve pulmonary function variables to a significantly greater extent than salbutamol followed by placebo . The combined therapy also provided significantly better protection than salbutamol plus placebo against exercise-induced asthma . Maintenance treatment with ipratropium bromide ( two inhalations four times daily , 20 micrograms per inhalation ) in combination with oral terbutaline and aerosolized salbutamol did not alleviate asthmatic symptoms or pulmonary function variables to a degree beyond that achieved with the beta-stimulants alone . There were no side effects associated with the ipratropium bromide treatment . These data suggest that higher doses of ipratropium bromide than are presently used should be tested for maintenance treatment of chronic asthma Twenty-four consecutive patients admitted to hospital with severe acute asthma were studied . Eleven were given 10 mg salbutamol by nebulizer followed 2 hours later by 500 micrograms of nebulized ipratropium bromide . These patients had a greater response in PEFR than 13 patients given two doses of 10 mg salbutamol 2 hours apart Ipratropium bromide was given to patients admitted to hospital with acute asthma . A cumulative-dose-response technique in six patients showed that 500 micrograms given by nebuliser produced a maximal increase in peak expiratory flow rate . This dose of ipratropium bromide was included in a regimen in which it was given either two hours before or two hours after nebulised salbutamol to 22 patients .  Ipratropium bromide given on admission was as effective as nebulised salbutamol . The two drugs in sequence produced greater bronchodilatation than either used alone , and the mean peak expiratory flow rate rose by 96 % in four hours . Thus giving ipratropium bromide in addition to salbutamol in severe asthma enhances the bronchodilator effect . Further studies are needed to determine whether the same effect may be obtained by giving two maximal doses of salbutamol two hours apart Objective . To determine if the addition of ipratropium bromide to the emergency department ( ED ) treatment of childhood asthma reduces time to discharge , number of nebulizer treatments before discharge , and the rate of hospitalization . Methods . Patients > 12 months of age were eligible if they were to be treated according to a st and ardized ED protocol for acute asthma with nebulized albuterol ( 2.5 mg/dose if weight < 30 kg , otherwise 5 mg/dose ) and oral prednisone or prednisolone ( 2 mg/kg up to 80 mg ) . Subjects were r and omized to receive either ipratropium ( 250 μg/dose ) or normal saline ( 1 mL/dose ) with each of the first three nebulized albuterol doses . Further treatment after the first hour was determined by physicians blinded to subject group assignment . Records were review ed to determine the length of time to discharge home from the ED , number of doses of albuterol given before discharge , and the number of patients admitted to the hospital . Results . Four hundred twenty-seven patients were r and omized to ipratropium or control groups ; these groups were similar in all baseline measures . Among patients discharged from the ED , ipratropium group subjects had 13 % shorter treatment time ( mean , 185 minutes , vs control , 213 minutes ) and fewer total albuterol doses ( median , three , vs control , four ) . Admission rates did not differ significantly ( 18 % , vs control , 22 % ) . Conclusions . The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge Seventeen hospitalized children with acute asthma , ages 7 to 15 years , were studied to determine the efficacy of simultaneous administration of atropine sulfate and isoetharine . Combination therapy was superior in 11/17 ( 65 % ) patients while isoetharine alone was superior in 4/17 ( 23 % ) patients ( P = .037 ) . We conclude that simultaneous administration of combination therapy is safe and beneficial in some children with acute asthma Treatment with nebulised salbutamol or a mixture of salbutamol and ipratropium was given to 138 children .  Length of hospital stay and number of nebulised doses required did not differ . In severe asthma response was greater with salbutamol alone . In mild asthma response was greater with combined treatment In a r and omized , double-blind , parallel-group trial , 47 children with acute asthma received a combination of ipratropium bromide solution ( 250 micrograms ) and fenoterol hydrobromide solution ( 625 micrograms ) , fenoterol solution ( 625 micrograms ) alone , or ipratropium solution ( 250 micrograms ) alone , administered by face mask and nebulizer , with the dose repeated 60 minutes later . The groups did not differ significantly with regard to age , pulmonary function at baseline , or any other variable . They were monitored at 30 , 60 , 90 , and 120 minutes by use of a clinical score , oxygen saturation , and pulmonary function tests . At the end of the study , albuterol was administered to assess residual bronchoconstriction . Clinical scores improved significantly after treatment in all groups at all times compared with baseline . The greatest improvement in FEV1 was seen in the patients treated with ipratropium/fenoterol , whether considered as absolute change , change in percent predicted , or percent change from baseline .  Ipratropium/fenoterol  was significantly better than fenoterol alone only when considered as percent change from baseline . Improvement in flow at mid and low lung volumes was significantly greater for the  ipratropium/fenoterol combination than for  ipratropium alone ; no significant differences were noted between ipratropium/fenoterol and fenoterol for flow at mid and low lung volumes . Treatment with albuterol did not significantly improve pulmonary function in the groups receiving ipratropium/fenoterol or fenoterol alone , but it did increase flow at all lung volumes in the group receiving ipratropium alone . No patient complained spontaneously of any adverse reactions , and no clinical ly significant changes in heart rate or systolic or diastolic blood pressures occurred . ( ABSTRACT TRUNCATED AT 250 WORDS Background . The combination of inhaled β2 agonists and anticholinergics is recommended for children with acute asthma , although there are few r and omized controlled trials . The aim of the study was to determine whether salbutamol plus ipratropium bromide  improves oxygenation and lung function and reduces the frequency of hospitalization in children with asthma crises . Methods . A prospect i ve , r and omized , double-blind study of children aged 2–18 years with moderate to severe asthma crises . Patients were evaluated using the asthma score and spirometry . They received six nebulizations of salbutamol plus placebo or salbutamol plus ipratropium and were reevaluated at 30 , 60 , 90 , 120 , and 240 minutes , at which time it was decided whether they were to be admitted . Results . A total of 97 patients completed the study , 49 in the salbutamol plus ipratropium group and 48 in the salbutamol-only group . There were no differences in the status at baseline between the two groups . Children treated with salbutamol plus ipratropium presented a greater improvement in clinical state and lung function and required hospitalization less frequently ( 18.4 % ) than children in the salbutamol group ( 43.8 % ) ( p = .007 ) . Improvement was more marked in children with severe asthma crises than in those with moderate crises . The effect of salbutamol plus ipratropium was similar in children over 8 years of age and in younger children . Conclusions . Salbutamol plus ipratropium bromide improves lung function in asthmatic children with moderate to severe asthma crises , independently of age . The effect is greater in children with severe crises , with a substantial reduction in the need for hospitalization OBJECTIVE To determine whether the addition of repeated doses of nebulized ipratropium bromide ( IB ) to a st and ardized inpatient asthma care algorithm ( ACA ) for children with status asthmaticus improves clinical outcome . STUDY DESIGN Children with acute asthma ( N = 210 ) age 1 to 18 years admitted to the ACA were assigned to the intervention or placebo group in r and omized double-blind fashion . Both groups received nebulized albuterol , systemic corticosteroids , and oxygen according to the ACA . The intervention group received 250 microg IB combined with 2.5 mg albuterol by jet nebulization in a dosing schedule determined by the ACA phase . The placebo group received isotonic saline solution substituted for IB . Progression through each ACA phase occurred based on assessment s of oxygenation , air exchange , wheezing , accessory muscle use , and respiratory rate performed at prescribed intervals . RESULTS No significant differences were observed between treatment groups in hospital length of stay ( P = .46 ) , asthma carepath progression ( P = .37 ) , requirement for additional therapy , or adverse effects .  Children > 6 years ( N = 70 ) treated with IB had shorter mean hospital length of stay ( P = .03 ) and more rapid mean asthma carepath progression ( P = .02 ) than children in the placebo group . However , after adjustment was done for baseline group differences , the observed benefit of IB therapy in older children no longer reached statistical significance . CONCLUSION The routine addition of repeated doses of nebulized IB to a st and ardized regimen of systemic corticosteroids and frequently administered beta-2 agonists confers no significant enhancement of clinical outcome for the treatment of hospitalized children with status asthmaticus Background In acute severe asthma , treatment must be initiated early to reverse the pathophysiology that may render airways less responsive to bronchodilation . The addition of nebulized ipratropium bromide to initial emergency department therapy improves pulmonary function , but it is unclear whether this approach results in earlier hospital discharge . The early use of bolus intravenous salbutamol has also been shown to improve outcome , including earlier discharge . We therefore assessed the relative benefits of intravenous salbutamol and nebulized ipratropium bromide in the early management of acute severe asthma in children by a double-blind , r and omized , controlled trial . Methods This study was undertaken at a tertiary children ’s hospital , The Children ’s Hospital at Westmead , The Royal Alex and ra Hospital for Children , Westmead , Sydney , Australia . Only children with severe acute asthma as determined by the National Asthma Campaign guidelines criteria and pulmonary index were included . All children received initial nebulized salbutamol therapy ( 2.5–5 mg salbutamol in 4 mL of normal saline depending on age ) at initial emergency department presentation . If asthma remained severe 20 mins later , an intravenous cannula was inserted and intravenous methylprednisolone ( 1 mg/kg ) was administered to all children receiving nebulized salbutamol every 20 mins . Children were then r and omized to one of three groups : intravenous salbutamol ( 15 & mgr;g/kg as a single bolus over 10 mins ) , ipratropium bromide ( 250 & mgr;g ) , or intravenous salbutamol plus ipratropium bromide . All observers were blinded to treatment groups . Children were r and omly assigned to receive a single-dose intravenous bolus of either saline or salbutamol and either nebulized saline or ipratropium bromide determined by a number generated r and omly in the hospital pharmacy . The primary outcomes were recovery time and discharge time of each group . Respiratory and hemodynamic monitoring were continuous during the first 2 hrs of the study and then children were monitored clinical ly for 24 hrs . Results A total of 55 children with acute severe asthma were entered into the study over an 18-month period . The three groups were similar demographically , with a mean age of 5.9 yrs , and mean duration of attack of 19.6 hrs .  No side effects or treatment intolerance were reported . Children in the groups that received intravenous salbutamol had a significant reduction in recovery time to achieving second hourly inhaled salbutamol ( p = .008 ) compared with those administered inhaled bronchodilator alone . The addition of ipratropium bromide to intravenous salbutamol provided no significant further benefit in terms of nebulizer therapy ( intravenous salbutamol compared with intravenous salbutamol plus ipratropium bromide ) . Children administered intravenous salbutamol  ceased supplemental oxygen therapy earlier than those administered ipratropium alone at 12 hrs postr and omization ( p = .0003 ) . Children administered intravenous salbutamol could be discharged from the hospital 28 hrs earlier than those administered ipratropium bromide ( p = .013 ) . Conclusion Children administered intravenous salbutamol for severe acute asthma showed a more rapid recovery time , which result ed in earlier discharge from the hospital than those administered inhaled ipratropium bromide . There was no additional benefit obtained by combining ipratropium bromide and intravenous salbutamol administration OBJECTIVES To compare the effectiveness and safety of alternative nebulized drug protocol s in children with mild or moderate asthma exacerbations . METHODS We conducted a blinded , r and omized , controlled trial with a 2 x 2 factorial design . Two interventions , nebulized salbutamol in frequent low doses ( 0.075 mg/kg every 30 minutes ) and the addition of ipratropium bromide ( 250 micrograms ) , were compared with salbutamol in hourly high doses ( 0.15 mg/kg every 60 minutes ) in children with mild or moderate acute asthma . The primary end point was the improvement in respiratory resistance . Secondary end points included oxygen saturation , corticosteroid use , patient disposition , and relapse status . RESULTS A total of 298 participants aged 3 to 17 years were studied , and 15 % were admitted to the hospital ; 14 % of the children had  relapses . No increased bronchodilation was associated with frequent low doses versus hourly high doses of salbutamol ( RR = 0.9 [ 95 % confidence interval 0.7 , 1.3 ] ) or the addition of ipratropium bromide versus placebo ( RR = 1.0 [ 0.8 , 1.3 ] ) . No group differences were observed in secondary end points . Salbutamol in frequent low doses was associated with increased vomiting ( RR = 2.5 [ 1.1 , 6.0 ] ) . CONCLUSION Our results do not support the use of frequent low doses of nebulized salbutamol or the addition of ipratropium bromide compared with hourly high doses of salbutamol in children with mild or moderate asthma OBJECTIVE The objective of this trial was to determine the efficacy of frequent nebulized ipratropium added to high-dose albuterol therapy in children with severe asthma . METHODS One hundred twenty children ( 5 to 17 years ) of age ) with severe acute asthma ( forced expiratory volume in 1 second ( FEV1 ) , < 50 % of the predicted value ) were enrolled into a r and omized double-blind three-arm placebo-controlled trial comparing three groups : group 1 , three doses of nebulized ipratropium bromide within 60 minutes ( 250 micrograms/dose ) ; group 2 , one dose of ipratropium ; group 3 , no ipratropium . All patients were also treated with three doses of nebulized albuterol within 60 minutes ( 0.15 mg/kg per dose ) . Pulmonary function and clinical measures were assessed every 20 minutes for up to 120 minutes . RESULTS The groups were comparable at baseline . At 120 minutes , the mean percentage of predicted FEV1 improved from 33.4 % to 56.7 % in group 1 , from 34.2 % to 52.3 % in group 2 , and from 35.4 % to 48.4 % in group 3 ( p = 0.0001 ) . The differences between groups were larger in those children with a baseline FEV1 < or = 30 % of the predicted value : FEV1 increased from 24.5 % to 50.9 % in group 1 , from 25.0 % to 39.8 % in group 2 , and from 25.9 % to 36.5 % in group 3 ( p = 0.0001 ) . In group 1 , 38 % of the patients were hospitalized after the study , 44 % in group 2 , and 46 % in group 3 ( p value not significant ) . However , in patients with FEV1 < or = 30 % , the hospitalization rates were 27 % in group 1 , 56 % in group 2 , and 83 % in group 3 ( p = 0.027 ) . There were no toxic effects attributable to ipratropium . CONCLUSION The addition of repeated doses of nebulized ipratropium to frequent high-dose albuterol therapy in patients with acute severe asthma is both safe and more effective than albuterol alone ; its use in patients with very severe asthma may reduce hospitalizations Ulrik CS , Backer V , Bach‐Mortensen N. Bronchodilating effect of ipratropium bromide inhalation powder and aerosol in children and adolescents with stable bronchial asthma Inhaled albuterol ( A ) ( salbutamol ) alone and albuterol plus ipratropium bromide ( IB ) were administered to 12 asthmatic children . Following administration of A alone or in combination with IB , there was a significant increase in FEV1 and FEF . Significant statistical difference in favor of the association A plus IB was observed at 120 and 240 minutes for FEV1 and in the period 120 , 180 , and 240 minutes for FEF . The additive effect was present both in the large and small airways . The short-lived additive effect of A plus IB suggests the opportunity to increase the frequency of drug administration in patients with severe bronchial obstruction The effect of 40 microgram of SCH 1000 ( ipratropium bromide , an anticholinergic agent ) on bronchodilation and suppression of exercise-induced bronchospasm ( EIB ) was compared with 400 microgram of fenoterol and a placebo in a single-blind controlled study . Twenty-seven r and omly selected asthmatic children performed a st and ardized treadmill exercise challenge and the 17 children who were shown to have EIB continued in the study .  Pulmonary function was evaluated before and after drug administration and exercise . When individual results were analyzed and grouped according to the responsiveness of EIB to the drugs , two patterns emerged : ( 1 ) the EIB was more severe in those ( 6/17 ) children who did not respond to either drug than in the rest of children ; ( 2 ) the resting pulmonary function was significantly better in the children ( 4/17 ) who responded to both drugs than in those ( 7/17 ) who responded to fenoterol alone . In conclusion SCH 1000 was shown to be an effective bronchodilator comparable to , but no better than , fenoterol . It had minimal side effects . As an EIB inhibitor it depended on relatively normal base line pulmonary function and only a moderate deterioration following exercise , whereas fenoterol depended on the exercise response alone . Although anticholinergic drugs are not very extensively used , SCH 1000 may be useful in some patients where the beta 2 adrenergic drugs cause signficant side effects or are contraindicated Using a r and omized double blind study design , the bronchodilating effect of 200 µg inhaled oxitropium bromide ( OB ) was compared with 200 µg inhaled fenoterol ( F ) after an interval of 20 min , in 20 asthmatic children aged 12.7 years ( range : 4.9–15.1 years ) , suffering from mild bronchoconstriction ( mean forced expiratory volume during ls : 73.4 % , range : 51%–85 % ) . Both drugs induced a comparable degree of bronchodilatation and no significant differences were found between the OB group and the F group , suggesting equipotency for both drugs after a 20 min interval , at the 200 µg dose level . Furthermore , a significant improvement of lung function parameters was detected in both groups after subsequent administration of 400 µg F , indicating that inhalation of 200 µg of OB or F results in submaximal bronchodilation in asthmatic children suffering from mild bronchoconstriction NEBULIZED specific beta-2 agonists such as salbutamol ( albuterol ) are widely preferred as the first-line drugs of choice for treating acute asthma in Children . Many studies have shown their efficacy as well as convenience in delivery ) , 2 Administration of frequent small doses ( 50 t ~ g/kg/dose every 20 minutes ) of nebulized salbutamol is safe and superior to the more conventional hourly dosing ( 150 /~g/kg/dose ) , producing a smoother rise in forced expiratory volume in 1 second and an earlier peak response without deterioration between doses ) However , even with this aggressive approach , significant residual airways obstruction remains despite additional doses of salbutamol . This suggests that the residual airways obstruction is related to factors unresponsive to beta-2 bronchodilators , such as mucosal edema , secretions , or cholinergic bronchomotor .tone . Ipratropium bromide is a quaternary ammonium derivative of atropine . When delivered by inhalation , it produces a local anticholinergic effect with no systemic absorption ? . 5 It is a potent bronchodilator , comparable to beta-2 agonists , and has been found to be very Useful , especially in adults with chronic bronchitis ? . 5 Our study was design ed to determine whether ipratropium bromide , by its anticholinergic action , could improve the residual airways obstruction seen after treatment with salbutamol alone . Thirty-two infants , aged 1 to 12 months , hospitalized with acute wheezing , were studied . They were r and omly divided into four treatment groups of eight patients each . The treatments were intramuscular dexamethasone or placebo ( double-blind ) , and salbutamol ( oral and inhaled ) , or none ( open ) , in all four possible combinations . The study was carried out as a r and omized block design with eight blocks of four infants each , matched by age and clinical score . Average daily improvements , as reflected by changes in the clinical score and length of hospital stay , was essentially the same for infants treated with placebo , salbutamol alone , and dexamethasone alone . However , combined salbutamol-dexamethasone treatment result ed in more than twice the rate of improvement of the other treatments . The difference was statistically highly significant ( P less than .01 ) . Furthermore , the response of this combined treatment was observed within 24 hours ; none of the ten infants in whom there was no significant improvement within 48 hours and neither of the two patients who developed respiratory failure received the combined salbutamol-dexamethasone treatment . A potentiating effect of corticosteroids on the beta-adrenergic responsiveness is a possible explanation for the advantage of this combined treatment in the management of acute wheezing in infancy In a double-blind study in 23 asthmatic patients Sch 1000 was found to be an effective bronchodilator with an onset of effect within 15 minutes and a duration of four hours . It was effective on both small and large airways In a double blind r and omized study during a period of 2 weeks we compared the therapeutic effectiveness and side effects of IK-6-Inhaletten ( 0.1 mg Fenoterol + 0.04 mg Ipratropiumbromide ) and SCH 1000-Inhaletten ( 0.2 mg Ipratropiumbromide ) in 39 children ( 4 - 14 years ) suffering from mild , moderate or severe asthma bronchiale . All measurements were performed with a whole body plethysmograph . In contrast to SCH 1000-inhalation after inhalation of IK-6-Inhaletten , we found a good improvement of the total airway resistance Rtot , the specific airway resistance SRaw and the forced exspiratory volume FEV1 . Especially SRaw was significantly diminished compared to the less effective SCH 1000-inhalation . IK-6-inhalation allowed to decrease the amount of bronchospasmolytic therapy in our group of patients . We did not observe any severe side effects after inhalation of IK-6 or SCH 1000 . In summary , we recommend the application of the IK-6-Inhaletten in children suffering from mild and moderate asthma bronchiale Duovent activity was compared with placebo in a double-blind study carried out in 20 children , aged between 5 and 14 years , suffering from bronchial asthma . The experiment lasted 2 weeks . The patients were divided into two groups . In the 1st week , group I was treated with Duovent and group II with placebo , in the 2nd week vice versa . There was no reduction in cough or dyspnea in subjects treated with placebo , and only a slight increase ( not significant ) in peak expiratory flow ( PEF ) . In the subjects treated with Duovent , there was a clear reduction in cough and dyspnea and a significant increase in PEF . The effect of the drug was still evident after 8 h , and it was well tolerated without side effects . The high number of additional sprays required during the placebo period was further evidence of the therapeutic efficacy of Duovent , which in almost all cases met the daily therapeutic requirements of the small patients . Duovent appears to be an effective drug in the treatment of bronchial asthma in children , both clinical ly and functionally
BACKGROUND Inhaled anticholinergics as single agent bronchodilators ( or in combination with beta(2)-agonists ) are one of the several medications available for the treatment of acute asthma in children .
OBJECTIVES To determine the effectiveness of only inhaled anticholinergic drugs ( i.e. administered alone ) , compared to a control in children over the age of two years with acute asthma .