None listed
Conditions
Brief summary
The management of severe acute asthma with inhaled medications has been well researched and documented. First line medicines are inhaled salbutamol (Ventolin) and steroid medication (eg Prednisilone). Extra medicines such as ipratropium bromide (Atrovent) give a small benefit causing better lung function and reducing hospital admissions. In moderate acute asthma the benefit of extra medicines like ipratropium bromide (Atrovent) is less well established. Most studies have shown little benefit, if any, from ipratropium bromide administered by either nebuliser or metered dose inhaler (puffer). Despite this, the current practice in most Australian paediatric hospitals including Princess Margaret Hospital is to add ipratropium bromide (via a puffer) to inhaled salbutamol (also by a puffer) in the management of moderate acute asthma. We think that any marginal effect obtained by giving ipratropium bromide over and above optimal doses of salbutamol and prednisolone will not change hospital admission rates. In addition this medication adds cost to the management of asthma and has side effects including unpleasant taste and causing cough which can reduce patient cooperation. This study will compare admission rates between two groups of children with moderate acute asthma. Both groups will receive normal established treatment as per the current Emergency Department protocol. One group would also receive ipratropium bromide by puffer. We predict there will be no benefit in using ipratropium bromide in moderate asthma when looking at admission rates. This would be an opportunity to change asthma protocols for children with moderate asthma thereby reducing medication costs and improving patient cooperation.
Interventions
Intervention: administration of ipratropium bromide by metered dose inhaler and spacer (4 puffs of 20mcg inhaler 3 times at 20 minute intervals for children 2-5 years and 8 puffs of 20mcg inhaler 3 times at 20 minute intervals for children 6-15 years). All participants (both treatment and control groups) will receive inhaled salbutamol (6 puffs of 100mcg inhaler 3 times at 20 minute intervals for children 2-5 years and 12 puffs of 100mcg inhaler 3 times at 20 minute intervals for children 6-15 y
Intervention: administration of ipratropium bromide by metered dose inhaler and spacer (4 puffs of 20mcg inhaler 3 times at 20 minute intervals for children 2-5 years and 8 puffs of 20mcg inhaler 3 times at 20 minute intervals for children 6-15 years). All participants (both treatment and control groups) will receive inhaled salbutamol (6 puffs of 100mcg inhaler 3 times at 20 minute intervals for children 2-5 years and 12 puffs of 100mcg inhaler 3 times at 20 minute intervals for children 6-15 years) and oral prednisolone 1mg/kg stat dose
Sponsors
Dr Emma Wyatt
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
2 Years to 15 Years
Healthy volunteers
No
Inclusion criteria
Children with an acute exacerbation of asthma of moderate severity (ie one or more of SaO2 90-94%, speaking in phrases, moderate to loud wheeze)
Exclusion criteria
Children less than 2 years or after 16th birthdaychronic respiratory problemwheeze better accounted for by another diagnosisuse of ipratropium bromide in last 6 hoursmarkers of severity (SaO2 less than 90%, cyanosis, unable to speak, silent chest, abnormal conscious state).
Outcome results
None listed