Efficacy of Addition of Nebulized Ipratropium Bromide to Nebulized Albuterol Therapy in Acute Bronchiolitis

Cehuh, S.; Johnson, DW; Canny, Gerard J.; Reisman, Joe; Kovesi, T.; Karem, E.; Bentur, Lea; Levison, Henry; Jaffe, David M.

doi:10.1097/00006565-199112000-00065

Cited by 8 publications

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“…16 The measures we used to evaluate clinical response included respiratory rate, use of accessory muscle, severity of wheezing, and SaO 2 . A clinical scoring system may enhance the evaluation of therapeutic responses in bronchiolitis because it takes into account key measures of severity of illness that are not necessarily reflected in simple physiological variables.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of corticosteroids in acute bronchiolitis: Short-term and long-term follow-up

et al. 1998

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Section: Discussionmentioning

confidence: 99%

Efficacy of corticosteroids in acute bronchiolitis: Short-term and long-term follow-up

et al. 1998

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“…[6][7][8][9] Viral identification was not routinely carried out in our hospital for diagnosis of bronchiolitis, and only three patients had this examination at the initial episode of AVB. Adenovirus (serotype not identified) was found in all three patients in tracheal secretions, examined by the immunofluorescent technique.…”

Section: Methodsmentioning

confidence: 99%

Clinical course of postinfectious bronchiolitis obliterans

et al. 2000

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We performed a prospective observational study to define the clinical course and the prognostic factors of 31 patients with postinfectious bronchiolitis obliterans. All patients presented with an episode of acute bronchiolitis in the first 2 years of life, and respiratory symptoms and signs persisted since then. Other diseases which may cause chronic airflow obstruction were excluded. The patients were followed after their inclusion in the study and the clinical findings were recorded in a standardized questionnaire and form. Repeated chest radiographs and lung perfusion scans were obtained in all 31 patients and semiannual spirometry was performed in 8 older patients. Eight patients had lung biospies. The clinical course varied in the 31 patients during a mean of 3.5 years of follow‐up. The outcome of the patients included clinical remission (22.6%), persistence of respiratory symptoms and signs (67.7%), and death (9.7%). An older age at onset of illness and presence of atopy as suggested by an elevated serum IgE appeared to predispose to a poor prognosis. Pediatr Pulmonol. 2000; 29:341–350. © 2000 Wiley‐Liss, Inc.

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“…The effect of ipratropium bromide (either alone or in combination with salbutamol or albuterol) on bronchiolitis has been evaluated in four recent randomised controlled trials [5,6,9,13] and none has shown any significant effect.…”

Section: Salbutamol Albuterol and Ipratropium Bromidementioning

confidence: 99%

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Schindler

2002

Crit Care

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RSV = respiratory syncytial virus; t PTEF /t E = exhaled time to reach peak expiratory flow as a fraction of total expiratory time; V maxFRC = maximal flow at functional residual capacity produced by forced expiration as a result of a rapid chest compression; V PTEF /V E = tidal volume exhaled at peak tidal expiratory flow as a fraction of total tidal volume.Available online http://ccforum.com/content/6/2/111In this issue of Critical Care, Totapally and colleagues [1] evaluate the effect of albuterol on tidal breathing loops of 20 infants with respiratory syncytial virus (RSV) bronchiolitis. They found that the wheeze score and the pulmonary function tests were not significantly affected by albuterol. This is the latest of 12 randomised controlled trials in 12 years [2][3][4][5][6][7][8][9][10][11][12], involving 843 infants, that evaluated the effect of bronchodilators on bronchiolitis. After so many trials, have we resolved whether bronchodilators have a role in the management of bronchiolitis, and have pulmonary function measurements been helpful? Salbutamol, albuterol and ipratropium bromideOf the 12 most recent randomised controlled trials published in English, evaluating the effect of salbutamol or albuterol on bronchiolitis, nine (75%) showed that bronchodilators had no effect. In three of these studies, some difference had been observed [3,11,12], yet it resulted in only a small transient improvement in the acute clinical score and had no effect on hospital admission rates or duration of stay in hospital. In one of these three studies [11], ex-premature infants who might have had some mild underlying chronic lung disease, which might have resulted in the response to bronchodilators, were not excluded. Several studies reported an increase in heart rate [12] or a decrease in oxygen saturation [3] after salbutamol or albuterol.The effect of ipratropium bromide (either alone or in combination with salbutamol or albuterol) on bronchiolitis has been evaluated in four recent randomised controlled trials [5,6,9,13] and none has shown any significant effect. Nebulised adrenalineIn contrast, there have been five published randomised controlled trials in the last 10 years, involving 225 infants, evaluating the effect of nebulised adrenaline (epinephrine) on bronchiolitis [7,[14][15][16][17]. All five (100%) have shown significant clinical improvement in infants with bronchiolitis, with decreases in oxygen requirement, respiratory rate, wheeze and retractions. Menon [14] showed lower hospital admission rates, and Bertrand et al. [15] AbstractOver the past 12 years there have been 12 randomised control trials, involving 843 infants, evaluating the effect of salbutamol or albuterol on bronchiolitis. Of these, nine (75%) showed that bronchodilators had no effect. In three studies a small transient improvement in the acute clinical score was seen. Ipratropium bromide had no significant effect. There have been five recent randomised trials involving 225 infants, evaluating the effect of nebulised adrenaline (epinephrin...

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Efficacy of Addition of Nebulized Ipratropium Bromide to Nebulized Albuterol Therapy in Acute Bronchiolitis

Cited by 8 publications

References 0 publications

Efficacy of corticosteroids in acute bronchiolitis: Short-term and long-term follow-up

Efficacy of corticosteroids in acute bronchiolitis: Short-term and long-term follow-up

Clinical course of postinfectious bronchiolitis obliterans

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