Metered-dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non-randomized, observational study.

Abstract

BACKGROUND:

Ipratropium bromide (IB), when administered with β2-agonists, is effective in reducing hospital admissions of children presenting to the emergency department (ED) with severe asthma. While IB is commonly delivered in its nebulized form, using a metered-dose inhaler (MDI), can, reportedly, shorten patients' length of stay in the ED. However, the effectiveness and safety of IB administration using an MDI with a spacer have not been established. This study aimed to investigate the effectiveness and safety of MDI-delivered IB in pediatric patients with acute asthma exacerbation.

METHODS:

This prospective, non-randomized, observational study included patients aged ≥4 years with a history of severe asthma exacerbation. Patients received IB via MDI with a spacer three times at 20-min intervals. IB use was determined by the physicians' treatment policy. Propensity score matching was used to adjust the confounding factors related to IB administration.

RESULTS:

Of the 158 patients, 88 were treated with IB and 70 were treated without IB. A propensity score-matching analysis extracted 54 patients from each group. We found no statistical difference in the admission rate of the two groups (IB group: 25.9% vs non-IB group: 31.5%; P = 0.67). The post-treatment modified pulmonary index scores (mean ± SD) were also similar (IB: 6.6 ± 2.0 vs non-IB: 6.3 ± 2.5; P = 0.53). Only one patient (1.0%) treated with IB experienced vomiting, which resolved spontaneously.

CONCLUSION:

The metered-dose inhaler IB was ineffective in reducing the admission rate possibly because it was less effective than a nebulizer for IB inhalation.

• Authors: Osamu Nomura, Takateru Ihara, Yoshihiko Morikawa, Hiroshi Sakakibara, Yusuke Hagiwara, Nobuaki Inoue, Akira Akasawa
• Journal: Pediatrics international : official journal of the Japan Pediatric Society (Pediatr Int) Vol. 62 Issue 3 Pg. 319-323 (Mar 2020) ISSN: 1442-200X [Electronic] Australia
• PMID: 31930755 (Publication Type: Journal Article, Observational Study)
• Copyright: © 2020 Japan Pediatric Society.

Chemical References

• Bronchodilator Agents
• Ipratropium

Topics

• Administration, Inhalation
• Asthma (drug therapy)
• Bronchodilator Agents (administration & dosage, adverse effects)
• Child
• Child, Preschool
• Emergency Service, Hospital
• Female
• Hospitalization
• Humans
• Ipratropium (administration & dosage, adverse effects)
• Male
• Metered Dose Inhalers
• Propensity Score
• Prospective Studies