Evidence-based On-call

internal medicine

Asthma exacerbation

Prevalence
Clinical features
Differential Diagnosis
Investigations
Therapy
Prevention
Prognosis

Therapy

Add an anticholinergic ^a

(e.g. ipratropium 500 µg), especially in moderate to severe cases. ^a

Why?

The combination of ipratropium and beta-agonists given together reduces hospital admissions and improves FEV1 (on average 100 ml) and PEFR (on average 32 l/min) better than beta-agonists alone ^a
Combination treatment is more effective in severe over moderate/mild cases (in children) ^a

Ipratropium and beta-agonists together reduce hospital admissions.

Patient	Treatment	Comparison	Outcome	CER	OR (95% CI)	NNT (95% CI)
asthma exacerbation ^a	ipratropium and beta-agonists	beta-agonists	hospitalisation at ?hours	20%	0.62 (0.44 to 0.88)	18 (11 to 77)

Patient	Treatment	Comparison	Outcome	CER	RRR (95% CI)	NNT (95% CI)
children with severe exacerbation of asthma ^a	ipratropium and beta-agonists	beta-agonists	hospitalisation at 2.5 hours	53%	29% (7% to 46%)	7 (4 to 30)

Expiry date: November 2003
Levels of Evidence used in grading these guides

Authors	B Wong , CM Ball
Reviewer	B R O'Driscoll
CAT Writers	B Wong , CM Ball