Should Ipratropium Bromide be Added to Beta-Agonists in Treatment of Acute Severe Asthma?

Objective: To compare the improvement in peak expiratory flow rate (PEFR) of patients presentingto the emergency department with acute severe asthma by using the following two regimens of broncho-dilator therapy.a) Salbutamol nebulization. b) Salbutamol plus Ipratropium bromide nebulization. c) To compare the hospital admissionrates in the above mentioned two treatment groups. Design: A comparative study. Place and Duration of Study:Military Hospital Rawalpindi, Feb 2002 to Dec 2002. Material and Methods: Sixty adult asthmatic patients with peakexpiratory flow rate (PEFR) less than 200 liters per minute were randomly assigned to nebulization treatment withsalbutamol (5.0 mg initial dose followed by 2 more doses at 30 and 60 minutes) or the same salbutamol regimen plusipratropium bromide (0.5 mg). The primary end point was change in PEFR. The PEFR was measured at 30 minutes,60 minutes and 90 minutes after the onset of study protocol. The proportion of admission in the two groups wasexamined as secondary end point. Results: The increase in PEFR over time was significantly greater in combinedipratropium plus salbutamol group (p = 0.01) also the proportion of admitted patients was less in combined salbutamolplus ipratropium bromide group 4/30 vs 11/30, p = 0.036. Conclusion: The data suggested that combined iratropiumbromide plus salbutamol nebulization was superior to salbutamol nebulization alone and it should be used in the initialmanagement of patients who present with acute severe asthma.

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Dose of nebulized ipratropium bromide in acute severe asthma

Respiratory Medicine ◽

10.1016/s0954-6111(06)80270-2 ◽

1991 ◽

Vol 85 (6) ◽

pp. 517-520 ◽

Cited By ~ 9

Author(s):

K.F. Whyte ◽

G.A. Gould ◽

A.A. Jeffrey ◽

M.A.A. Airlie ◽

D.C. Flenley ◽

...

Keyword(s):

Severe Asthma ◽

Ipratropium Bromide ◽

Acute Severe Asthma

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Response to nebulizaed ipratropium bromide and terbutaline in acute severe asthma

Respiratory Medicine ◽

10.1016/s0954-6111(06)80058-2 ◽

1992 ◽

Vol 86 (3) ◽

pp. 215-218 ◽

Cited By ~ 10

Author(s):

C. Teale ◽

J.F.J. Morrison ◽

M.F. Muers ◽

S.B. Pearson

Keyword(s):

Severe Asthma ◽

Ipratropium Bromide ◽

Acute Severe Asthma

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Beta-Adrenergic Agonists for Acute, Severe Asthma

Annals of Pharmacotherapy ◽

10.1177/106002809202600115 ◽

1992 ◽

Vol 26 (1) ◽

pp. 81-91 ◽

Cited By ~ 29

Author(s):

H. William Kelly ◽

Shirley Murphy

Keyword(s):

Severe Asthma ◽

Acute Asthma ◽

The Body ◽

Beta Agonist ◽

Acute Severe Asthma ◽

Adrenergic Agonists ◽

Aerosol Delivery ◽

Beta Adrenergic ◽

Beta Agonists ◽

Beta Adrenergic Agonists

OBJECTIVE: To critically review the use of beta-adrenergic agonists in acute, severe asthma with particular focus on aerosol administration. DATA SOURCES: English language articles published since 1971 on the use of beta-agonists for acute asthma. Studies were identified from bibliographies of book chapters, review articles, and other research articles. STUDY SELECTION: All studies (21 total) comparing systemic with inhaled beta-agonists were reviewed, regardless of their design or outcome. Selected studies highlighting specific aspects of beta-agonist use in acute asthma such as beta-agonists versus other bronchodilators, aerosol delivery, and intravenous beta-agonists were also reviewed. DATA EXTRACTION: Performed subjectively by the authors with specific aspects of quality discussed within the body of the article. DATA SYNTHESIS: The beta-agonists provide superior bronchodilation in acute severe asthma compared with either the methylxanthines and/or anticholinergics. The majority of studies found aerosolized beta-agonists to be either as effective as or more effective than parenteral beta-agonists and to produce fewer adverse cardiovascular effects. Studies showing preference for parenteral therapy have either been of poor design or used low doses of an aerosolized beta-agonist. Based on studies of aerosol delivery, there is no advantage of jet nebulization over metered-dose inhalers; however, other aspects, including ease of administration, favor nebulization as the delivery method of choice. The articles recommending intravenous beta-agonists consist of a series of uncontrolled cases. CONCLUSIONS: Aerosolized selective beta2-agonists are the bronchodilator treatments of choice for acute, severe asthma. Attention to the details of dosing and delivery are required for optimal results. The final dose and dosing interval are determined by the patient's response. Intravenous beta-agonists are hazardous and cannot be recommended.

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How do intravenous beta-agonists and aminophylline compare for treating acute severe asthma?

Cochrane Clinical Answers ◽

10.1002/cca.172 ◽

2020 ◽

Author(s):

Karen Pettersen

Keyword(s):

Severe Asthma ◽

Acute Severe Asthma ◽

Beta Agonists

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Potentially (near) fatal asthma

Allergy and Asthma Proceedings ◽

10.2500/aap.2019.40.4257 ◽

2019 ◽

Vol 40 (6) ◽

pp. 403-405 ◽

Cited By ~ 1

Author(s):

Paul A. Greenberger

Keyword(s):

Severe Asthma ◽

Health Care Professionals ◽

Rescue Therapy ◽

Respiratory Acidosis ◽

Acute Severe Asthma ◽

Increased Risk ◽

High Risk Type ◽

Fatal Asthma ◽

Long Acting ◽

Near Fatal Asthma

Potentially (near) fatal asthma (PFA) defines a subset of patients with asthma who are at increased risk for death from their disease. The diagnosis of PFA should motivate treating physicians, health professionals, and patients to be more aggressive in the monitoring, treatment, and control of this high-risk type of asthma. A diagnosis of PFA is made when any one of the following are present: (1) a history of endotracheal intubation from asthma, (2) acute respiratory acidosis (pH < 7.35) or respiratory failure from acute severe asthma, (3) two or more episodes of acute pneumothorax or pneumomediastinum from asthma, (4) two or more episodes of acute severe asthma, despite the use of long-term oral corticosteroids and other antiasthma medications. There are two predominant phenotypes of near-fatal exacerbations: “subacute” exacerbation and “hyperacute” exacerbation. The best way to “treat” acute severe asthma is 3‐7 days before it occurs (i.e., at the onset of symptoms or change in respiratory function) and to optimize control of asthma by decreasing the number of symptomatic days and the days and/or nights that require rescue therapy and increasing baseline respiratory status in “poor perceivers.” PFA is treated with a multifaceted approach; physicians and health-care professionals should appreciate limitations of pharmacotherapy, including combination inhaled corticosteroid‐long-acting β-agonist products as well as addressing nonadherence, psychiatric, and socioeconomic issues that complicate care.

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