ACUTE SEVERE ASTHMA

SALBUTAMOL PLUS IPRATROPIUM BROMIDE NEBULIZATION VERSUS SALBUTAMOL NEBULIZATION ALONE

Abstract

Objective: To compare the improvement in peak expiratory flow rate (PEFR) of patients presenting
to the emergency department with acute severe asthma by using the following two regimens of broncho-dilator therapy.
a) Salbutamol nebulization. b) Salbutamol plus Ipratropium bromide nebulization. c) To compare the hospital admission
rates in the above mentioned two treatment groups. Design: A comparative study. Place and Duration of Study:
Military Hospital Rawalpindi, Feb 2002 to Dec 2002. Material and Methods: Sixty adult asthmatic patients with peak
expiratory flow rate (PEFR) less than 200 liters per minute were randomly assigned to nebulization treatment with
salbutamol (5.0 mg initial dose followed by 2 more doses at 30 and 60 minutes) or the same salbutamol regimen plus
ipratropium bromide (0.5 mg). The primary end point was change in PEFR. The PEFR was measured at 30 minutes,
60 minutes and 90 minutes after the onset of study protocol. The proportion of admission in the two groups was
examined as secondary end point. Results: The increase in PEFR over time was significantly greater in combined
ipratropium plus salbutamol group (p = 0.01) also the proportion of admitted patients was less in combined salbutamol
plus ipratropium bromide group 4/30 vs 11/30, p = 0.036. Conclusion: The data suggested that combined iratropium
bromide plus salbutamol nebulization was superior to salbutamol nebulization alone and it should be used in the initial
management of patients who present with acute severe asthma.