Asthma: exacerbation: adding ipratropium to beta-agonists reduces hospital admission and improves pulmonary function

Clinical bottom line (level 1a)

  1. Patients attending an emergency department with acute asthma who receive ipratropium and a beta-agonist compared with placebo and a beta-agonist are less likely to be admitted to hospital (NN T = 11 at hours) .
  2. Patients give ipratropium have a small improvement in pulmonary function (on average FEV1 rising by ~10%)
Rodrigo et al: American Journal of Medicine 1999; 107 : 363-370
Expires October 2003

The study

Systematic review of all randomised double-blind, controlled trials of
  • Patients: adults with acute asthma receiving beta-agonists
  • Intervention: ipratropim
  • Outcome: pulmonary function, hospital admission

    Articles found in English using Medline, Current Contents, Science Citations Index, Medical Editors' Trial Amnesty, 1978 to 1999 (search terms: n-isopropylateropine or ipratropium bromide and adults, acute asthma or status asthmaticus ) and and contacting pharmaceutical companies and content experts.

    Selection criteria: by 2 independent reviewers
    Appraisal criteria: by 2 blinded independent reviewers: using randomisation method, sample size and withdrawals
    Articles excluded if:
    • aged <16


    10 studies involving 1483 patients (aged mean 32; 64% female)
    Studies were not found to be heterogeneous.

    The evidence

    Outcome Time to outcome CER OR
    (95% CI)    		 NN T
    (95% CI)
    hospital admission hours /
    (%)    		 0.62
    (0.44 to 0.88)     		18
    (11 to 77)

    • ipratropium v. placebo: FEV1 % improvemen 10% (95% CI: 2% to 18%)

    Comments

    1. By limiting the search to English, important articles in other languages may have been missed.
    2. Typical dose of ipratropium 0.5 mg mixed with a beta-agonist. In 4 studies a new dose was give within 60 or 120 minutes. In 2 others, ipratropium was given twice at 45 and 120 min).

    Citation

    1. Rodrigo G, Rodrigo C, Burschtin O: a meta-analysis of the effects of ipratropium bromide in adults with acute asthma. American Journal of Medicine 1999; 107 : 363-370
    Search Terms: from ACP Journal Club other articles noted
    Contributor: Chris Ball, October 2001
    Reviewer:

    Clinical Question.
    Patient acute asthma attending emergency department
    Intervention or Exposure ipratropium bromide and beta-agonist
    Comparison placebo and beta-agonist
    Outcome pulmonary function, hospital admission