Reply to: Contemporary treatment of children with critical and near-fatal asthma

Shein, Steven L.; Speicher, Richard; Rotta, Alexandre T.

doi:10.5935/0103-507x.20160064

Cited by 10 publications

(7 citation statements)

References 12 publications

(12 reference statements)

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“…3 Severe asthma exacerbations (sometimes termed "status asthmaticus" or "critical asthma") are a common indication for admission to a PICU. [4][5][6] Standard therapies are systemic corticosteroids and continuous nebulization of b-agonist bronchodilators (eg, albuterol), along with the consideration of adjunct therapies. 7 Two suggested adjunct therapies are inhaled ipratropium and intravenous magnesium.…”

mentioning

confidence: 99%

Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings From The Ohio Pediatric Asthma Repository

Shein¹,

Farhan

Morris

et al. 2018

Hospital Pediatrics

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Ipratropium and magnesium were both often used in children with severe asthma hospitalizations that required continuous albuterol therapy. Magnesium use was associated with unfavorable outcomes, possibly reflecting preferential treatment to patients with more severe cases and differing practices between centers. Given the high prevalence of asthma, wide variations in practice, and the potential to improve outcomes and costs, prospective trials of these adjunctive therapies are needed.

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mentioning

confidence: 99%

Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings From The Ohio Pediatric Asthma Repository

Shein¹,

Farhan

Morris

et al. 2018

Hospital Pediatrics

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“…The treatment mainstays of severe acute asthma exacerbations in the ICU are systemic corticosteroids and inhaled beta‐agonist medications 4,5 . Numerous adjunctive medications are used in critical asthma with little supportive evidence, including ipratropium bromide 4‐6 . When added to systemic corticosteroids and an inhaled beta‐agonist in the emergency room, inhaled ipratropium decreases hospital admissions in the pediatric population, particularly among children with the highest illness severity 7 .…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Randomized pilot trial of ipratropium versus placebo in children with critical asthma

Murphy

Mahmood

Craven

et al. 2020

Pediatric Pulmonology

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Objective To test the effects of inhaled ipratropium on clinical outcomes of critical asthma in the first randomized trial of this adjunctive therapy in critically ill children. Design Pilot, placebo‐controlled, double‐blinded, and randomized‐controlled trial Patients Thirty children (15 per group) with critical asthma receiving high‐intensity albuterol per a standardized pathway utilizing objective assessments to wean patients to less frequent albuterol administration. Interventions Subjects were randomized to receive either nebulized ipratropium bromide (500 µg in 0.9% saline per dose) or an equivalent volume of nebulized 0.9% saline every 6 h until the patient was successfully weaned to albuterol doses every 2 h (“q2 albuterol”). Measurements and Main Results Demographics, initial clinical severity score, and asthma histories were similar between groups. There was no significant difference in the median duration of high‐intensity albuterol between the treatment group (17.5 [10.3–22.1] h) and placebo group (14.6 [12.7–24.5] days; p = .56). Similarly, there was no significant difference in pediatric intensive care unit length of stay (22.6 [21.1–33.6] vs. 21.4 [16.1–35.8] h; p = .74) or hospital length of stay (48.0 [41.8–59.8] vs. 47.3 [37.2–63.1] h; p = .67). In multivariate linear regression adjusting for identified confounders, treatment with ipratropium was not significantly associated with any of the three outcomes. Side effects were rare and occurred with equally between both groups Conclusions Adjunctive therapy with ipratropium was not associated with decreased duration of high‐intensity albuterol or shortened length of stay when compared to placebo. A larger, multicenter trial is warranted to confirm that ipratropium does not improve clinical outcomes.

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“…6 Bronchodilators and corticosteroids are standard therapy for children with acute severe asthma, which similarly causes wheezing and dyspnea, but are not indicated for bronchiolitis. 7,8 In clinical practice, it may be challenging to distinguish if a dyspneic, wheezing child has bronchiolitis or is having a first asthma exacerbation. Asthma is characterized by a recurrent nature that is inherently absent during the first episode but is more likely to develop in children with eczema, familial asthma, and familial atopy.…”

mentioning

confidence: 99%

Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma

Shein¹,

Rotta²,

Speicher³

et al. 2017

Hospital Pediatrics

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Reply to: Contemporary treatment of children with critical and near-fatal asthma

Cited by 10 publications

References 12 publications

Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings From The Ohio Pediatric Asthma Repository

Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings From The Ohio Pediatric Asthma Repository

Randomized pilot trial of ipratropium versus placebo in children with critical asthma

Corticosteroid Therapy During Acute Bronchiolitis in Patients Who Later Develop Asthma

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