How long should Atrovent be given in acute asthma?
a Department of Thoracic Medicine, Castle
Hill Hospital, Cottingham, East Yorkshire HU16 5JQ, UK, b Department of Medicine, Highland Hospital of
Rochester, 1000 South Ave., Rochester, NY 14620, USA
Correspondence to: Dr C J Brophy.
Received 2 July 1997; Returned to authors 15 August 1997; Revised version received 7 January 1998; Accepted for publication 30 January 1998
BACKGROUND
In acute asthma the optimal duration of
treatment with combination 
agonist and anticholinergic nebuliser
solutions is unknown; most studies have investigated single doses or
treatment for up to 12 hours. To determine whether longer treatment
with ipratropium bromide might aid recovery a study was undertaken in
106 patients with acute asthma.
METHODSA double blind, randomised, placebo
controlled, three group study was performed with all patients receiving
ipratropium for 12 hours and salbutamol for 60 hours after admission
(both nebulised four hourly), systemic steroids and, if necessary,
theophylline. At 12 hours ipratropium was stopped in group I (n = 35)
but was continued in the other two groups, and at 36 hours ipratropium was also stopped in group II (n = 35) while patients in group III (n = 36) continued with ipratropium for 60 hours. Spirometric tests were
performed before and after salbutamol, and again 30 and 60 minutes
after ipratropium or placebo at 12, 36 and 60 hours. Peak flow rates
(PEFR) were measured before and after each nebulisation.
RESULTSThere were no differences between the
groups in PEFR on admission (group I: 214 l/min, group II: 198 l/min,
group III: 221 l/min), or mean forced expiratory volume in one second
(FEV1) at 12 hours (group I: 1.8 l, group II: 2.0 l,
group III: 2.2 l), 36 hours (group I: 2.1 l, group II: 2.3 l, group
III: 2.4 l), or at 60 hours (group I: 2.2 l, group II: 2.3 l, group
III 2.5 l). Despite this, median time to discharge was significantly
higher for patients in group I (5.4 days) than for those in groups II (4.1 days) and III (4.0 days).
CONCLUSIONSCombination nebulised therapy can be
continued beyond 12 hours and up to 36 hours after admission with
improved recovery time. Lung function testing may not reflect the full
benefit of treatment.
© 1998 by Thorax
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