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Does high dose ipratropium bromide added to salbutamol improve pulmonary function for patients with chronic obstructive airways disease in the emergency department? *
Author(s) -
Koutsogiannis Z.,
Kelly A.M.
Publication year - 2000
Publication title -
australian and new zealand journal of medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 0004-8291
DOI - 10.1111/j.1445-5994.2000.tb01052.x
Subject(s) - ipratropium bromide , salbutamol , medicine , ipratropium , anesthesia , exacerbation , bronchodilator , pulmonary function testing , emergency department , asthma , copd , metered dose inhaler , nebulizer , inhaler , psychiatry
Background : To determine the effect of high dose ipratropium bromide, both alone or in combination with standard dose salbutamol, on pulmonary function in patients presenting to the Emergency Department (ED) with acute exacerbation of chronic obstructive airways disease (COAD). Method : The trial was a prospective, randomised, double blind trial of adult patients with COAD. All patients received nebulised salbutamol 5 mg and 500 μg ipratropium and hydrocortisone 250 mg IV at time=0, then were randomised to receive further nebulisers at time=15 minutes and time=30 minutes of salbutamol 5 mg combined with ipratropium 500 μg or salbutamol 5 mg alone or ipratropium 500 μg alone. Pulmonary function tests were conducted at time=0 and time=90 minutes. The primary endpoints were absolute and percent change in FEV 1 . Results : The group randomised to receive 5 mg salbutamol and 500 μg ipratropium ( n =18) showed a mean percentage change of FEV 1 of 6.4% with a mean absolute change of 0.06 L (SD 0.18 L). Those who received 5 mg salbutamol ( n =16) had a mean percentage change of 18.6% with a mean absolute change of 0.13 L (SD of 0.21 L). Those who received 500 μg ipratropium ( n =16) had a mean percentage change of 4.8% with a mean absolute change of 0.023 L (SD of 0.07 L). There was no significant difference between the groups in FEV 1 ( p =0.56 for percentage change; p =0.36 for absolute change). Conclusion : The addition of 500 μg ipratropium to 5 mg salbutamol in subsequent nebulisers adds no benefit to pulmonary function after the initial nebuliser of both bronchodilators in the treatment of COAD in the ED.