COPD: exacerbation: no clear benefit from ipratropium

Clinical bottom line (level 1b-)

Patients admitted with COPD who received ipratropium and salbutamol compared with salbutamol alone did not clearly spend less time on nebulisers or in hospital.

Moayyedi et al: Thorax 1995; 50: 834-837

Expires November 2003

The study

Unblinded ?concealed randomised trial without intention-to-treat
Setting: acute hospital, UK

70 patients (aged mean 69, ?% male) admitted with an acute exacerbation of COPD (FEV1 < 65% predicted when well, and a history of exertional dyspnoea from respiratory disease for over 3 years)

Excluded if

>20% reversibility of FEV1 with bronchodilators

peripheral eosinophilia of >10%

smoking history of < 10 years

history suggestive of asthma (childhood respiratory disease, atopy, night time wheezing)

taking regular nebulised bronchodilators

aged <45

Control Group: (n = 35, 33 analysed): nebulised salbutamol 5 mg four times a day
Experimental Group: (n = 35, 29 analysed): nebulised salbutamol 5 mg four times a day and ipratropium 500 microgram four times a day

89% followed for ? length of hospital stay

The evidence

Outcome	Control Group (SD)	Experimental Group (SD)	Mean Difference (95% CI)
days on nebulisers	8.20 (3.60)	8.50 (4.20)	-0.3 (-2.3 to 1.7)
length of hospital stay	10.5 (4.70)	11.8 (4.40)	1.3 (-1.0 to 3.6)

Comments

The study is too small to show any clear differences between the two groups.
No difference in spirometry was noted at any time between the two groups.

Citation

Moayyedi P, Congleton J, Page RL, et al: comparison of nebulised salbutamol and ipratropium bromide with salbutamol alone in the treatment of chronic obstructive pulmonary disease. Thorax 1995; 50: 834-837

Search Terms: ?
Contributor: Bob Phillips & Chris Ball, November 1999
Reviewer: Gerard Ryan

_{Clinical Question.}

_Patient	_{with acute exacerbation of COPD}
_{Intervention or Exposure}	_ipratropium
_Outcome	_{time on nebuliser or in hospital}