Download PDF 1998 Abstracts The American Pediatric Society and The Society for Pediatric Research Published: 01 April 1998 Nebulized Ipratropium Decreases Hospitalization Rate of Children

with Severe Asthma • 389 Faiqa Qureshi1, John Pestian1, Paris Davis1 & …Arno Zaritsky1 Show authors Pediatric Research volume 43, page 69 (1998)Cite this article

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emergency department were assigned randomly to one of two groups in a double-blind, placebo-controlled study. When unable to perform PEFR, children were stratified by an objective asthma

score. All children received nebulized albuterol (2.5 mg if <20 kg or 5 mg if >20 kg) every 20 mins for 3 doses, and subsequently at the attending physician's discretion. Oral steroid

(prednisone or prednisolone, 2 mg/kg, max. 60 mg) was given with the second albuterol dose. The treatment group received 500 μg of ipratropium bromide with the second and third albuterol

dose; the control group received an equal volume of saline. Outcome measurements included hospitalization rate, changes in PEFR readings, time to disposition, number of nebulizer treatments

and return visits within 72 hours. Groups were compared by Fisher's Exact Test.

Results:219 children (mean 8.3 years; 84 moderate, 135 severe) were enrolled in the control group; 215 children (mean 8.4 years; 79 moderate, 136 severe) were enrolled in the treatment

group. There were no differences in demographic factors between groups. Overall hospitalization rate was reduced in the treatment group from 36.6% to 27.5% (p=.051). In the moderate

group(163 children) admission rates were similar for the control (10.7%)and treatment (10.1%) groups. In the 271 children with severe asthma the admission rate was significantly reduced from

52.6% in the control group to 37.5% in the treatment group (p=.015). The relative risk reduction in admission rate was 28.7%; the absolute risk reduction was 15.1%. The number of severe

asthmatics needed to treat with ipratropium to prevent one admission was 6.6 (95% CI: 3.7 to 29.4). There were no differences in secondary outcome measures. To evaluate the cost

effectiveness of ipratropium treatment, co-administration of ipratropium with albuterol costs an additional $3.00/dose. Treating 7 children with 2 doses each would cost $42.00. In

comparison, our average cost of each hospitalization for acute asthma is $3,267.

Conclusion: The addition of ipratropium bromide inhalation to a standardized ED treatment regimen in children with severe asthma significantly reduced the rate of hospitalization and

represents a cost effective intervention.

Author informationAuthors and Affiliations Pediatrics, Eastern VA Medical School, Norfolk, VA

Faiqa Qureshi, John Pestian, Paris Davis & Arno Zaritsky

AuthorsFaiqa QureshiView author publications You can also search for this author inPubMed Google Scholar

John PestianView author publications You can also search for this author inPubMed Google Scholar

Paris DavisView author publications You can also search for this author inPubMed Google Scholar

Arno ZaritskyView author publications You can also search for this author inPubMed Google Scholar

(Spon by: Daniel J. Isaacman)

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About this articleCite this article Qureshi, F., Pestian, J., Davis, P. et al. Nebulized Ipratropium Decreases Hospitalization Rate of Children with Severe Asthma • 389. Pediatr Res 43

(Suppl 4), 69 (1998). https://doi.org/10.1203/00006450-199804001-00410

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Issue Date: 01 April 1998

DOI: https://doi.org/10.1203/00006450-199804001-00410

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