Randomized Trial of the Addition of Ipratropium Bromide to Albuterol and Corticosteroid Therapy in Children Hospitalized Because of an Acute Asthma Exacerbation

Goggin, Norma; Macarthur, Colin; Parkin, Patricia C.

doi:10.1001/archpedi.155.12.1329

Cited by 58 publications

(29 citation statements)

References 21 publications

(31 reference statements)

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“…Similar data have been reported in the paediatric literature (Evidence A) [329]. However, once hospitalised, the addition of nebulised ipratropium bromide to nebulised b 2 -agonist and systemic glucocorticosteroids appears to confer no extra benefit [346].…”

Section: Initial Assessmentsupporting

confidence: 66%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2008

European Respiratory Journal

2,643

2,301

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Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled ''A Global Strategy for Asthma Management and Prevention'', first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that ''it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,'' and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

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Section: Initial Assessmentsupporting

confidence: 66%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2008

European Respiratory Journal

2,643

2,301

View full text Add to dashboard Cite

show abstract

“…[108][109][110] Systemic effects are usually minimal; nevertheless, mydriasis and blurred vision have been reported. 111,112 Although there is no significant apparent benefit with the addition of multiple doses of ipratropium to an albuterol and steroid regimen in hospitalized pediatric patients, 113,114 there is a need for specific data in the PICU population. With the high safety profile and documented beneficial effects in the ED setting, 115 we recommend its use every 6 hours in the critically ill patient owing to its potential advantages, despite not being recommended by the current National Heart, Lung, and Blood Institute asthma guidelines, until further data are obtained.…”

Section: Ipratropiummentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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“…It is important to point out that ipratropium has only been shown to be effective in the emergency room setting. Many studies of children with severe asthma requiring hospitalization have failed to show any benefit to the addition of ipratropium to their treatment regimens [12]. Thus it appears that using ipratropium in the intensive care setting may not be beneficial or cost effective but is still often used due to its high safety profile and reported beneficial effects in the ED setting.…”

Section: Ipratropium Bromidementioning

confidence: 99%