Content area
Full Text
Current recommendations regarding the treatment of an acute severe attack of asthma advocate short term use of nebulised salbutamol, with or without the addition of ipratropium bromide. 1 The data on the efficacy of added ipratropium bromide are equivocal, but the majority of papers describe a benefit. Compared with single therapy, the combination of a [beta] agonist and an anticholinergic may increase the maximal bronchodilatation, 2-6 increase the duration, 7 or the rate of bronchodilatation. 8 However, most work has investigated only single doses or dosing over a few hours. Only one study involved administration for more than 24 hours, 3 and the optimal duration of treatment with ipratropium bromide is not known.
Recent work has shown that, as the baseline peak flow rate improves in the days following an acute attack of asthma, the proportion of bronchodilatation provided by ipratropium bromide relative to the [beta] agonist terbutaline increases. 9 This might suggest that ipratropium bromide provides a specific and increasing benefit, and that use should be continued rather than stopped early. The aim of this study was to ascertain whether continued administration of ipratropium bromide beyond the first few hours after admission to hospital would aid recovery and, if so, to determine the optimal duration of treatment.
Methods
SUBJECTS
All patients admitted to hospital with an acute attack of asthma were deemed eligible for entry. Those found subsequently, from notes or on observation during the admission, to have chronic obstructive pulmonary disease, defined as <15% variability in peak expiratory flow rate (PEFR) with treatment or from night to morning, were excluded from the study. The study was approved by the local ethics committee and all patients gave their informed consent.
STUDY DESIGN
The study was a double blind, placebo controlled, three group comparison. Following admission, all patients were prescribed 5mg nebulised salbutamol and 500[mu]g nebulised ipratropium every four hours. The requirement for nebulised treatment during the night was judged in each individual case. Nebuliser solutions were isotonic and preservative-free, and made up to 4ml with the addition of normal saline. Salbutamol was administered first, followed by ipratropium, and ipratropium was administered only after the measurements of response to salbutamol had been made.
On entry to the study patients were randomised double blind to one...