Ipratropium does indeed reduce admissions to hospital with severe asthma

BMJ 1999;318:738 ( 13 March )

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Ipratropium does indeed reduce admissions to hospital with severe asthma

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EDITOR $---$ We agree with Plotnick and Ducharme that inhaled anticholinergics should be added to $beta$ ₂ agonists for treating acuteasthma in childhood and adolescence.¹ In a follow up to ouroriginal study² we conducted a large (434 children) prospectivedouble blind study in children with moderate or severe asthmatreated with two doses of ipratropium bromide.³ Briefly, wefound that the rate of admission to hospital was reduced from52.6% to 37.5% in children with severe asthma. Thus, 6.6 childrenwith severe asthma (95% confidence interval 3.7 to 29.4) wouldneed to be treated with ipratroprium to avoid one admission tohospital. Ipratropium had no effect on the rate of admission ofchildren with moderate asthma. Our study therefore strengthensthe authors' conclusions regarding the use of ipratropium bromidein acuteasthma.

Arno Zaritsky, Chairman, department of pediatrics.
azaritsk@chkd.com

Faiqa Qureshi, Assistant professor of pediatrics, division of pediatric medicine Children's Hospital of the King's Daughters, Norfolk, VA 23507, USA. ^a

^a Competing interests: Nonedeclared.

Plotnick LH, Ducharme FM. Should inhaled anticholinergics be added to $beta$ ₂ agonists for treating acute childhood and adolescent asthma? A systematic review. BMJ 1998; 317: 971-977[Abstract/Free Full Text]. (10 October.)
Qureshi FA, Zaritsky A, Lakkis H. Efficacy of nebulized ipratroprium bromide in severe asthmatic children. Ann Emerg Med 1997; 29: 205-211[Medline].
Qureshi F, Pestian J, Davis P, Zaritsky A. Effect of nebulized ipratropium on the hospitalization rate of children with asthma. N Engl J Med 1998; 339: 1030-1035[Abstract/Free Full Text].

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Should inhaled anticholinergics be added to $beta$ ₂ agonists for treating acute childhood and adolescent asthma? A systematic review: Laurie H Plotnick and Francine M Ducharme
BMJ 1998 317: 971-977. [Abstract] [Full Text] [PDF]

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