Comparison efficacy of randomized nebulized magnesium sulfate and ipratropium bromide/fenoterol in children with moderate to severe asthma exacerbation

AbstractBackgroundA combination of ipratropium bromide (IB) and salbutamol is commonly used to treat asthma in children and adolescents; however, there has been a lack of consistency in its usage in clinical practice.ObjectiveTo evaluate the efficacy and safety of IB + salbutamol in the treatment of asthma in children and adolescents.MethodsThe MEDLINE, Embase, and Cochrane Library as well as other Chinese biomedical databases (including China Biological Medicine Database, Chinese National Knowledge Infrastructure, Chongqing VIP, and Wanfang Chinese language bibliographic database) were systematically searched from the date of database inception to 02/09/2019 for randomized controlled trials in children and adolescents (≤18 years) with asthma who received IB + salbutamol or salbutamol alone. The primary outcomes included hospital admission and adverse events. A random effects model with a 95% confidence interval (CI) was used. Subgroup analysis was performed according to age, severity of asthma, and co-interventions with other asthma controllers. This study was registered with PROSPERO.ResultsOf the 637 studies that were identified, 55 met the inclusion criteria and involved 6396 participants. IB + salbutamol significantly reduced the risk of hospital admission compared with salbutamol alone (risk ratio [RR] 0.79; 95% CI 0.66–0.95; p = 0.01; I2 = 40%). Subgroup analysis only showed significant difference in the risk of hospital admission in participants with severe asthma exacerbation (RR 0.71; 95% CI 0.60–0.85; p = 0.0001; I2 = 0%) and moderate-to-severe exacerbation (RR 0.69; 95% CI 0.50–0.96; p = 0.03; I2 = 3%). There were no significant differences in the risk of adverse events between IB + salbutamol group and salbutamol alone group (RR 1.77; 95% CI 0.63–4.98).ConclusionIB + salbutamol may be more effective than salbutamol alone for the treatment of asthma in children and adolescents, especially in those with severe and moderate to severe asthma exacerbation. Future prospective research on these subgroup population are needed.

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Combination of ipratropium bromide and salbutamol in children and adolescents with asthma: A meta-analysis

PLoS ONE ◽

10.1371/journal.pone.0237620 ◽

2021 ◽

Vol 16 (2) ◽

pp. e0237620

Author(s):

Hongzhen Xu ◽

Lin Tong ◽

Peng Gao ◽

Yan Hu ◽

Huijuan Wang ◽

...

Keyword(s):

Adverse Events ◽

Hospital Admission ◽

Children And Adolescents ◽

Severe Asthma ◽

Subgroup Analysis ◽

Asthma Exacerbation ◽

Ipratropium Bromide ◽

Cochrane Library ◽

Severe Asthma Exacerbation ◽

Asthma In Children

Background A combination of ipratropium bromide (IB) and salbutamol is commonly used to treat asthma in children and adolescents; however, there has been a lack of consistency in its usage in clinical practice. Objective To evaluate the efficacy and safety of IB + salbutamol in the treatment of asthma in children and adolescents. Methods The MEDLINE, Embase, and Cochrane Library as well as other Chinese biomedical databases (including China Biological Medicine Database, Chinese National Knowledge Infrastructure, Chongqing VIP, and Wanfang Chinese language bibliographic database) were systematically searched from the earliest record date to September 2020 for randomized controlled trials in children and adolescents (≤18 years) with asthma who received IB + salbutamol or salbutamol alone. The primary outcomes included hospital admission and adverse events. A random effects model with a 95% confidence interval (CI) was used. Subgroup analysis was performed according to age, severity of asthma, and co-interventions with other asthma controllers. This study was registered with PROSPERO. Results Of the 1061 studies that were identified, 55 met the inclusion criteria and involved 6396 participants. IB + salbutamol significantly reduced the risk of hospital admission compared with salbutamol alone (risk ratio [RR] 0.79; 95% CI 0.66–0.95; p = 0.01; I2 = 40%). Subgroup analysis only showed significant difference in the risk of hospital admission in participants with severe asthma exacerbation (RR 0.73; 95% CI 0.60–0.88; p = 0.0009; I2 = 4%) and moderate-to-severe exacerbation (RR 0.69; 95% CI 0.50–0.96; p = 0.03; I2 = 3%). There were no significant differences in the risk of adverse events between IB + salbutamol group and salbutamol alone group (RR 1.77; 95% CI 0.63–4.98). Conclusion IB + salbutamol may be more effective than salbutamol alone for the treatment of asthma in children and adolescents, especially in those with severe and moderate to severe asthma exacerbation. The very low to high quality of evidence indicated that future well-designed double-blind RCTs with large sample are needed for research on evaluating the effectiveness of IB + salbutamol treatment for asthma in children and adolescents.

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Childhood Obesity Increases Duration of Therapy During Severe Asthma Exacerbation

Pediatric Critical Care Medicine ◽

10.1097/00130478-200611000-00041 ◽

2006 ◽

Vol 7 (6) ◽

pp. 616

Author(s):

&NA;

Keyword(s):

Childhood Obesity ◽

Severe Asthma ◽

Asthma Exacerbation ◽

Duration Of Therapy ◽

Severe Asthma Exacerbation

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Heart involvement detected by magnetic resonance in a patient with Churg-Strauss syndrome, mimicking severe asthma exacerbation

Allergy ◽

10.1111/j.1398-9995.2009.02278.x ◽

2009 ◽

Vol 65 (8) ◽

pp. 1063-1064 ◽

Cited By ~ 5

Author(s):

W. Szczeklik ◽

B. Sokolowska ◽

L. Mastalerz ◽

T. Miszalski-Jamka ◽

J. Musial

Keyword(s):

Magnetic Resonance ◽

Severe Asthma ◽

Asthma Exacerbation ◽

Churg Strauss Syndrome ◽

Heart Involvement ◽

Severe Asthma Exacerbation ◽

Strauss Syndrome ◽

Churg Strauss

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Bilevel Positive Airway Pressure ventilation efficiently improves respiratory distress in initial hours treating children with severe asthma exacerbation

Journal of the Formosan Medical Association ◽

10.1016/j.jfma.2019.11.013 ◽

2020 ◽

Vol 119 (9) ◽

pp. 1415-1421

Author(s):

Chun-Min Kang ◽

En-Ting Wu ◽

Ching-Chia Wang ◽

Frank Lu ◽

Bor-Luen Chiang ◽

...

Keyword(s):

Respiratory Distress ◽

Severe Asthma ◽

Airway Pressure ◽

Asthma Exacerbation ◽

Positive Airway Pressure ◽

Bilevel Positive Airway Pressure ◽

Severe Asthma Exacerbation ◽

Positive Airway Pressure Ventilation

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Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies

Annals of Intensive Care ◽

10.1186/s13613-019-0584-x ◽

2019 ◽

Vol 9 (1) ◽

Cited By ~ 3

Author(s):

Philippe Le Conte ◽

Nicolas Terzi ◽

Guillaume Mortamet ◽

Fekri Abroug ◽

Guillaume Carteaux ◽

...

Keyword(s):

Emergency Medicine ◽

Intensive Care ◽

Severe Asthma ◽

Asthma Exacerbation ◽

Pediatric Patients ◽

Pediatric Intensive Care ◽

Extensive Literature ◽

Level Of Evidence ◽

Severe Asthma Exacerbation ◽

Evidence Grade

Abstract Background The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. Results The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/−) and 7 a low level of evidence (GRADE 2+/−). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. Conclusion The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.

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8: IMPACT OF LATE USE MAGNESIUM SULFATE IN INNER CITY CHILDREN HOSPITALIZED FOR ASTHMA EXACERBATION

Journal of Investigative Medicine ◽

10.1136/jim-2016-000080.8 ◽

2016 ◽

Vol 64 (3) ◽

pp. 802.1-802

Author(s):

P Shukla ◽

E Aragona ◽

J Wang ◽

D Pillai

Keyword(s):

Length Of Stay ◽

Magnesium Sulfate ◽

Severe Asthma ◽

Asthma Exacerbation ◽

Status Asthmaticus ◽

Asthma Severity ◽

Day Length ◽

Multiple Doses ◽

Significant Difference ◽

The Impact

Purpose of StudyAsthma is typically treated acutely with β2-agonists and systemic steroids. Adjunctive therapies such as magnesium sulfate (MgSO4) have proven useful with early addition potentially improving clinical outcomes in asthma (reduced hospital admission rates, length of stay and intubation rates). Exact administration time and impact on outcomes in children are not fully understood. We sought to identify the impact of timing of initiating MgSO4 therapy in innercity children admitted for status asthmaticus.Methods UsedWe performed a retrospective chart review of children (age 2–21 yrs) admitted to a children's hospital over a 12 month period with asthma exacerbation and administered MgSO4. Data collected included ethnicity, gender, medications, timing of interventions, length of stay, BMI percentile, comorbidities and NAEPP asthma severity. Statistical analysis performed with SPSS 22.Summary of Results150 innercity children were admitted for asthma exacerbation and received MgSO4 during the study period. 85% were African American, 36% female, 39% had moderate/severe asthma and mean time to initial MgSO4 was 3.8 hours from triage. Those receiving initial MgSO4 after 4 hours were more likely to receive multiple doses of MgSO4 (OR2.8 [95%CI:1.4–5.6]). Time of initial MgSO4 dose (<4 vs. >4 hrs) showed no significant difference in other parameters including age, obesity, asthma severity, and comorbidities. A sub-analysis of children that received 1 dose vs. >1 MgSO4 dose demonstrated that those receiving >1 MgSO4 doses were more likely to be obese (OR2.7 [1.3–5.7]), have moderate/severe asthma (OR3.2 [1.6–6.8]) and have increased length of stay (p=0.005) and charges (p=0.042). Additionally, obese children (OR8.9 [2.2–35.2]), and intermittent/mild asthmatic children (OR6.4 [1.2–31.2]) receiving >1 MgSO4 dose were more likely to have >2 day length of stay.ConclusionsDelay in administration of MgSO4 in children hospitalized for status asthmaticus may be associated with poor outcomes including multiple doses of MgSO4 which in turn is associated with longer length of stay and increased charges. Obesity and asthma severity are important factors associated with these outcomes. A prospective analysis in a larger cohort is recommended to further evaluate these findings.

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