COPD: ipratropium bromide decreases therapy time.

Clinical bottom line (level 1b)

  1. Patients with an exacerbation of chronic obstructive pulmonary disease who are given ipratropium bromide with β -agonist therapy are more likely to have a shorter length of therapy, than those given β -agonist therapy alone.
Shrestha et al: Annals of Emergency Medicine 1991; 20 : 1206-1209
Expires December 2000

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: emergency department of a general hospital, USA

76 patients (aged mean 63 years, 64% male) clinical diagnosis of chronic obstructive pulmonary disease exacerbation and moderately to severely dyspneic as determined by FEV1

Excluded if
  • <40 years old

    Note:
  • The majority of patients were said to be black.

    Control Group: (n = 37, 25 analysed): placebo by metered-dose inhaler
    Experimental Group: (n = 39, 30 analysed): three puffs of ipratropium (54 µ g in total) by metered-dose inhaler. A second dose of ipratropium (two puffs or 36 µ g) at one hour. If the patient had not been discharged after a fourth dose of isoetharine was given, two more puffs of ipratropium were given
    All patients were given isoetharine (0.5 mL of a 1% solution) by nebulised inhalation every hour if possible. Aminophylline and corticosteroids were given to all patients if necessary.
    100% followed for ?

    The evidence

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    mean duration of therapy (minutes) 317
    (135)     		226
    (102)     		91.0
    (26.9 to 155)

    Comments

    1. Eight patients visited the emergency department twice, but were only included in the analysis once. thirteen further patients were not included in the analysis for various reasons.

    Citation

    1. Shrestha M, O'Brien T, Haddox R, et al: Decreased duration of emergency department treatment of chronic obstructive pulmoanry disease exacerbations with the addition of ipratropium bromided to β-agonist therapy. Annals of Emergency Medicine 1991; 20 : 1206-1209
    Contributor: Clare Wotton, December 1999
    Reviewer:

    Clinical Question.
    Patient COPD
    Intervention or Exposure ipratropium bromide added to β-agonist therapy
    Comparison no ipratropium bromide
    Outcome decreased duration of emergency department
    		•