Asthma: acute exacerbation: regular ipratropium and fenoterol improved lung function better than fenoterol alone.

Clinical bottom line (level 1b)

  1. Patients admitted to hospital with acute asthma who received ipratropium and fenoterol compared with fenoterol alone had a greater improvement in FEV1 at 48 hours.
Bryant : Chest 1985; 88 (1): 24-29
Expires November 2002

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: thoracic unit, university hospital, Australia

28 patients (aged mean 40 years, 54% male) admitted with acute asthma

Excluded if
  • PEFR > 75% predicted
  • severe asthma; PEFR < 25% predicted, pO2 < 60 mmHg, pCO2 > 45 mmHg
  • history of cigarette smoking


    • Control Group: (n = 13, 13 analysed): placebo
    Experimental Group: (n = 15, 15 analysed): 500 mcg ipratropium nebulised every six hours
    All patients received fenoterol 1mg nebulised every six hours. No patients received steroids during the study.
    100% followed for 3 months

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean change in FEV1 at 48 hours (l/min) 40.1
    (7.2)     		54.3
    (9.2)     		14
    (7.7 to 21)

  • There was no significant difference in side effects noted between the two groups.

    • Comments

    1. It is unclear whether nebulised ipratropium and short acting beta2-agonist is better than more frequent use of short acting beta2-agonist or not as an immediate treatment.
    2. No comments were made on long-term consequences of using ipratropium.
    3. We would like to know if there is a difference of effect between delivery device ( MDI with spacer or wet nebulization )

    Citation

    1. Bryant DH, : nebulized ipratropium bromide in the treatment of acute asthma. Chest 1985; 88 (1): 24-29
    Search Terms: acute asthma in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient acute asthma
    Intervention or Exposure ipratropium and fenoterol
    Comparison fenoterol alone
    Outcome peak flow