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Norma Goggin, MD, MRCP; Colin Macarthur, MB, ChB, PhD; Patricia C. Parkin, MD, FRCPC

Arch Pediatr Adolesc Med. 2001;155:1329-1334.

Objective  To determine whether the addition of inhaled ipratropium bromide to inhaled albuterol and systemic corticosteroid therapy was more efficacious than inhaled albuterol and systemic corticosteroids alone in the inpatient treatment of acute asthma exacerbations in children.

Design  Double-blind, randomized, placebo-controlled trial.

Setting  Pediatric inpatient unit of a tertiary urban hospital.

Participants  Eighty children (aged 1-18 years) hospitalized because of an acute asthma exacerbation.

Intervention  Children were randomized to receive either nebulized ipratropium bromide, 250 µg, or nebulized isotonic sodium chloride solution, 1 mL. All children received albuterol and systemic corticosteroids.

Main Outcome Measures  The primary outcome variable was a validated clinical asthma score, measured at baseline and every 6 hours for 36 hours. Secondary outcome measures included the forced expiratory volume in 1 second, the oxygen saturation, the number of doses of inhaled study drug, the time to an inhaled drug-dosing interval of 4 hours, and the length of the hospital stay.

Results  There were no differences between groups on baseline characteristics. The intention-to-treat analysis, using repeated-measures analysis of variance, showed no significant (P = .07) difference between the groups in the clinical asthma score over time. There were also no significant differences between groups on secondary outcomes.

Conclusion  The addition of nebulized ipratropium bromide to nebulized ß₂-agonist and corticosteroid therapy in the treatment of children hospitalized because of asthma (following intensive emergency department treatment) confers no extra benefit.

From the Department of Paediatrics, University of Toronto Faculty of Medicine, and the Paediatric Outcomes Research Team (Drs Goggin, Macarthur, and Parkin) and the Hospital for Sick Children Research Institute (Drs Macarthur and Parkin), Toronto, Ontario; and the Department of Paediatrics, Waterford Regional Hospital, Waterford, Ireland (Dr Goggin). The authors have no commercial, proprietary, or financial interest in the products or companies described in this article.

Corresponding author and reprints: Patricia C. Parkin, MD, FRCPC, Division of Paediatric Medicine, Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8 (e-mail: patricia.parkin{at}sickkids.ca).

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