Determination of dose-response reltionship for nebulized ipratropium in asthmatic children

Davis, Alan; Vickerson, F.; Worsley, Geoffrey H.; Mindorff, Catherine; Kazim, Farouk; Levison, Henry

doi:10.1016/s0022-3476(84)80099-2

Cited by 42 publications

(7 citation statements)

References 6 publications

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“…After salbutamol 9-1 (0-8) 8-6 (0-9) After trial drug 7-6 (0-7) 6-6 (0-7) Next morning 3-9 (0-3) 4-6 (0.7) On admission 36-9 (2 5) 32-2 (2-6) After salbutamol 51-0 (4-4) 55-4 (7-0) After trial drug 56-6 (4-8) 57-4 (9-0) Next morning 72-0 (4-6) 70-4 ( 6 5) The mean (SEM) length of stay in hospital was 23-9 (3-3) hours in the control group and 24-5 (2)(3)(4)(5) hours in the treatment group. Fourteen (78%) of those in the control group and 14 (74%) of those in the treatment group required oral steroids.…”

Section: Resultsmentioning

confidence: 99%

Salbutamol and ipratropium in acute asthma.

Rayner

Cartlidge

Upton

1987

Archives of Disease in Childhood

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SUMMARY Thirty seven children with acute asthma were given nebulised ipratropium or placebo 30 minutes after their first dose of salbutamol and eight hourly thereafter. There were no significant differences between the two groups in clinical scores, peak expiratory flow rates, length of stay in hospital, or the need for oral steroids.Ipratropium bromide is an effective bronchodilator in children, -3 but its place in the management of acute asthma is not clear. Storr and Lenney were unable to show any benefit when children were given a mixture of nebulised salbutamol and ipratropium compared with salbutamol alone.4 The two drugs in sequence, however, have been reported to produce greater bronchodilatation than either used separately.5 6 We wanted to establish whether giving nebulised ipratropium after salbutamol conferred any therapeutic benefit over salbutamol alone. Patients and methodsTwenty eight boys and 12 girls, mean age 6&5 years (range 2-15), who were admitted to this hospital with acute asthma were randomly allocated to two groups in a double blind trial. All had received 132 receptor agonists at home, but none had been given ipratropium or oral steroids. Both groups received nebulised salbutamol (2-5 mg, or 5 mg for those over 6 years old) on admission and four hourly thereafter. Thirty minutes after the first dose of salbutamol, and eight hourly thereafter, they received either nebulised placebo (3 ml physiological saline) or ipratropium (250 ,ug in 2 ml physiological saline). Steroids were given as usual if good relief was not obtained.Assessments were made by one of us on admission, immediately before and 45 minutes after the first administration of the trial drug, and the next morning (12-24 hours later). Thirty one of the children were assessed by the same person (RJR). Pulse, respiratory rate, and, when possible, peak expiratory flow rate were measured. A clinical score was given, based on clinical examination, activity, and speech, the worst possible score being 25. The time taken to achieve 80% of the expected peak flow rate, or to be considered fit for discharge, was recorded.The study was approved by the hospital ethical committee, and written consent was obtained from the parents.The results were analysed with Student's t test. We calculated that a difference of more than 3 in clinical score, or 15% of the expected peak expiratory flow rate, between the two groups would be significant (p<0.05).

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Section: Resultsmentioning

confidence: 99%

Salbutamol and ipratropium in acute asthma.

Rayner

Cartlidge

Upton

1987

Archives of Disease in Childhood

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“…However, the fact that RV de creased also after inhalation of 0.08 mg, while TLC was unchanged, indicates that even inhalation of 0.08 mg might have had an effect on the distribution of gas in the lungs. Davis et al [1984] found in asthmatic children according to their premises of small airways (M E F 50 and M E F 25), a dose-response relationship (0.0075-0.250 mg) for nebulized IB. To achieve an effect in variables which might measure the effect on 'small airways' (M E F 50 , M E F 25, MEF6oo/0 tlc and phase III), it is necessary to inhale at least a dose of 0.15 mg.…”

Section: Discussionmentioning

confidence: 95%

Effect of Nebulized Ipratropium Bromide on Lung Function in Nonallergic Bronchial Asthma

Wegener¹,

Hedenström²

1987

Respiration

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The present investigation was performed on 64 randomly chosen never-smoking patients, 40–60 years old, with nonallergic bronchial asthma with an average FEV₁ of 69–73 % of predicted, a positive methacholine test, a normal serum IgE level, and a negative RAST or skin test to common allergens and not receiving oral steroid treatment. Sensitive spirometric tests were used to evaluate the dose-response effect of inhalation of 0.08, 0.15 or 0.25 mg of ipratropium bromide. The drug caused bronchodilatation with a nearly linear dose-response relationship for static lung volumes, while the total lung capacity was unchanged after this inhalation. Airway resistance decreased and specific airway conductance increased after all doses. Ventilation and flows were better after doses of 0.15 and 0.25 mg than after 0.08 mg. The intrapulmonary gas distribution improved only after inhalation of 0.25 and 0.15 mg. The currently recommended dose of 0.08 mg seems to be suboptimal for dilatation of both small and large airways

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“…Quando usado isoladamente a sua ação broncodilatadora é fraca, por isso recomenda-se a sua associação com os simpaticomiméti-cos a cada 4 horas na asma aguda grave ou até a cada hora em alguns casos [30][31][32] . A dose recomendada é de 125 a 250 µg/dose em crianças abaixo de quatro anos e 250 a 500µg em crianças acima de quatro anos ou 5-7 µg/kg (1 ml da solução tem 250 µg) 33 .…”

Section: Brometo De Ipatrópiounclassified