Metered‐dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non‐randomized, observational study

Abstract

Background Ipratropium bromide (IB), when administered with β2‐agonists, is effective in reducing hospital admissions of children presenting to the emergency department (ED) with severe asthma. While IB is commonly delivered in its nebulized form, using a metered‐dose inhaler (MDI), can, reportedly, shorten patients’ length of stay in the ED. However, the effectiveness and safety of IB administration using an MDI with a spacer have not been established. This study aimed to investigate the effectiveness and safety of MDI‐delivered IB in pediatric patients with acute asthma exacerbation. Methods This prospective, non‐randomized, observational study included patients aged ≥4 years with a history of severe asthma exacerbation. Patients received IB via MDI with a spacer three times at 20‐min intervals. IB use was determined by the physicians’ treatment policy. Propensity score matching was used to adjust the confounding factors related to IB administration. Results Of the 158 patients, 88 were treated with IB and 70 were treated without IB. A propensity score‐matching analysis extracted 54 patients from each group. We found no statistical difference in the admission rate of the two groups (IB group: 25.9% vs non‐IB group: 31.5%; P = 0.67). The post‐treatment modified pulmonary index scores (mean ± SD) were also similar (IB: 6.6 ± 2.0 vs non‐IB: 6.3 ± 2.5; P = 0.53). Only one patient (1.0%) treated with IB experienced vomiting, which resolved spontaneously. Conclusion The metered‐dose inhaler IB was ineffective in reducing the admission rate possibly because it was less effective than a nebulizer for IB inhalation.

Paediatrics: how to manage acute asthma exacerbations

“…7 , 11 – 13 , 15 , 16 Finally, several guidelines extrapolate the benefits of MDI and spacer with salbutamol with emerging evidence suggesting that ipratropium bromide delivered in this fashion does not reduce admission rates. 7 , 11 , 15 , 71 , 72 …”

Critical reappraisal of short-acting bronchodilators for pediatric respiratory diseases

“…Several studies report safety information linked to the use of inhaled ipratropium bromide in the pediatric population with asthma. In a prospective observational study investigating the safety of ipratropium bromide in pediatric asthma exacerbations, Nomura et al reported a single case of mild vomiting among the 77 children treated [ 74 ]. This isolated finding suggests that emesis may be a rare AE associated with ipratropium bromide use; however, further research is necessary to establish a definitive link.…”

“…This isolated finding suggests that emesis may be a rare AE associated with ipratropium bromide use; however, further research is necessary to establish a definitive link. The observed AE, mild vomiting, was infrequent and categorized as the mildest grade on the Common Terminology Criteria for Adverse Events (CTCAE) scale, indicating its minimal impact on the patient's overall well-being [ 74 ]. The favorable safety profile observed in this study is consistent with findings from a Cochrane Systematic Review, which reinforces the established safety and efficacy of ipratropium bromide in pediatric asthma treatment [ 37 ].…”

Acute asthma management considerations in children and adolescents during the COVID-19 pandemic

“…9 Another study from Japan also showed no benefit. 10 In summary, there is no evidence to support the use of inhaled salbutamol or IB administered as MDI in the acute management of children with moderate to severe wheeze. The administration of two drugs by MDI…”