bromide to children with moderate to severe asthma exacerbations reduces admissions and asthma symptoms when given with appropriate [beta]-agonists and corticosteroids in the ED.
Only 3 studies evaluated hospitalization rates (n = 1064); those receiving ipratropium
bromide were 27% less likely to be hospitalized (relative risk = 0.73; 95% CI, 0.53-0.99) Rates were not given, thus precluding a number-needed-to-treat calculation.
In the clinic, salmeterol could have the added benefit of improving compliance, since it only needs twice daily administration versus 4 times daily for ipratropium
Patients then received either 10 mg per hour of continuous nebulized albuterol plus 1 mg per hour of ipratropium
bromide, or albuterol plus saline (control group).
Children were excluded for such reasons as the use of ipratropium
within 6 hours before the visit to the emergency department; having a disease known to have a chronic effect on lung function (eg, cystic fibrosis); any possible presence of an intrathoracic foreign body; a contraindication to the use of a beta-agonist; or the need for immediate resuscitation or airway intervention.
Costs of Nebulization Therapy * With Levalbuterol and Racemic Albuterol Treatment Condition Levalbuterol Racemic Albuterol Asthma $44 $99 COPD $65 $116 Asthma and COPD combined $61 $112 * Includes [[beta].sub.2]-agonist and adjuvant ipratropium
The activity of the vagus nerve is influenced by central stimulation induced by emotional states; consequently, ipratropium
is reported to be especially beneficial in those with a strong emotional component in the disease.[24,25]
He studied 30 chronic obstructive pulmonary disease patients with an [FEV.sub.1] less than 70% of predicted; on each of four occasions, they used albuterol (2.3 mg), 1evalbuterol (1.25 mg), ipratropium
and albuterol (0.5 mg and 2.3 mg), or placebo.
In addition to ipratropium
, they include short-acting [[beta].sub.2] adrenergic agonists like albuterol and the two available longacting inhaled [[beta].sub.2] adrenergic agonists: salmeterol (Serevent) and formoterol (Foradil), which are taken twice a day.
In the same study, patients were randomized to either an inhaled bronchodilator containing ipratropium
bromide or placebo.