Asthma: In children with severe asthma, nebulised Ipratropium reduced hospitalisation

Clinical bottom line (level 1b)

  1. In children with severe asthma, hospitalisation rates after 60 minutes were considerably reduced by adding two doses of ipratropium (NNT = 7 at 2.5 hours)
  2. In children with moderate asthma, treatment with ipratropium did not significantly affect hospitalisation rates (NNT = 140 at 2.5 hours)
Qureshi and Pestian: NEJM 1998; 339 (15): 1030-1035
Expires November 2002

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: Paediatric emergency department in USA

480 patients (aged 8.3 years, 57% male) Acute exacerbation of asthma

Excluded if
  • Mild asthma
  • Aged <2 or >18
  • Treated with Ipratropium within 6 hours
  • Disease with known chronic effect on respiratory function
  • Concurrent stridor
  • Possible foreign body
  • Need for resuscitation
  • Medical condition to contraindicate use of ß ² andrenergic or anticholinergic medication


    • Control Group: (n = 243, 219 analysed): 3 doses of nebulised 0.5% Salbutamol (2.5mg if bodyweight up to 20kg, 5mg if 20kg or over) with 2.5ml saline at 20 minute intervals; oral corticosteroid with 2nd dose of Salbutamol (2mg per kg bodyweight, to max 60mg)
    Experimental Group: (n = 237, 215 analysed): As control group, plus 500mcg Ipratropium with 2nd and 3rd doses of Salbutamol

    90% followed for 2.5 hours

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    Overall hospitalisation 2.5 hours 80
    (37%)    		 59
    (27%)    		 25%
    (1% to 43%)    		 9%
    (0% to 18%)    		 11
    (6 to 281)
    Hospitalisation in moderate asthma 2.5 hours 9
    (11%)    		 8
    (10%)    		 5%
    (-133% to 62%)    		 1%
    (-9% to 10%)    		 170
    (10 to -11)
    Hospitalisation in severe asthma 2.5 hours 71
    (53%)    		 51
    (38%)    		 29%
    (7% to 46%)    		 15%
    (3% to 27%)    		 7
    (4 to 30)

    Citation

    1. Qureshi F, and Pestian J: Effect of nebulized Ipratropium on the hospitalization rates of children with Asthma. NEJM 1998; 339 (15): 1030-1035
    Contributor: Lee Bailey; Bob Phillips, November 1999
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient Children with asthma
    Intervention or Exposure nebulised ipratropium
    Outcome hospitalisation