Airflow obstruction: ipratropium bromide added to salbutamol improved peak flow more effectively than salbutamol alone.

Clinical bottom line (level 1b)

  1. Patients with acute airflow obstruction admitted to an accident and emergency department who were given salbutamol plus ipratropium bromide, were more likely to have a larger percentage rise in peak flow rate, than those given salbutamol alone.
  2. There was no noticeable change in hospitalisation rates.
O'Driscoll et al: Lancet 1989; 1: 1418-1420
Expires May 2003

The study

Double-blinded concealed quasi-randomised trial without intention-to-treat
Setting: accident and emergency of a teaching hospital, UK

103 patients (aged range 17 to 81 years; mean 58, ?% male) acute airflow obstruction

Excluded if
  • history of heart or renal disease


    • Control Group: (n = 44, 44 analysed): salbutamol nebuliser solution (10 mg) in 2 ml of 0.9% saline
    Experimental Group: (n = 59, 59 analysed): salbutamol nebuliser solution (10 mg) in 2 ml of preservative-free ipratropium bromide

    100% followed for ?

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean percentage peak flow rate rise 28%
    ()     		52%
    ()     		24%
    (1 to 48)

    Comments

    1. Although there is evidence for the use of ipratropium in acute asthma, less evidence supports its use in COPD. This may be through the more variable aspects of COPD.

    Citation

    1. O'Driscoll BR, Taylor RJ, Horsley MG, et al: Nebulised salbutamol with and without ipratropium bromide in acute airflow obstruction. Lancet 1989; 1: 1418-1420
    Contributor: Clare Wotton and Bob Phillips, May 2000
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient acute airflow obstruction
    Intervention or Exposure salbutamol plus ipratropium bromide
    Comparison salbutamol alone
    Outcome peak flow rate