Metered‐dose inhaler ipratropium bromide in moderate acute asthma in children: A single‐blinded randomised controlled trial

Abstract

In children with acute asthma of moderate severity who are treated with adequate doses of salbutamol and prednisolone, the addition of IB is not significantly associated with a reduction in admission rates. There is a significantly higher rate of adverse effects if IB is given. IB should be reserved for children with severe asthma exacerbations.

Metered‐dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non‐randomized, observational study

“…Similarly, only a few studies have shown the effectiveness of IB‐MDI with a spacer for AAE in pediatric patients compared to a large body of evidence supporting treatments with nebulized IB. While an insufficient dosage of IB‐MDI might be the cause of these results, it was assumed that the drug delivery method was the main factor because 80 μg per dose of IB was administered to children aged 4 or 5 years and 160 μg per dose was administered to children aged ≥6 years both of which are considered to be adequate dosages according to the official guidelines of the Australian Asthama Handbook . Furthermore, although much research demonstrating the benefits of delivery via MDI with a spacer has recently been published worldwide, MDI use in the ED setting in Japan is still uncommon.…”

“…While an insufficient dosage of IB-MDI might be the cause of these results, it was assumed that the drug delivery method was the main factor because 80 g per dose of IB was administered to children aged 4 or 5 years and 160 g per dose was administered to children aged 6 years both of which are considered to be adequate dosages according to the official guidelines of the Australian Asthama Handbook. 10,12 Furthermore, although much research demonstrating the benefits of delivery via MDI with a spacer has recently been published worldwide, MDI use in the ED setting in Japan is still uncommon. Thus, IB inhalation via MDI with a spacer is assumed to be less effective than nebulized IB in treating pediatric patients with asthma exacerbation and respiratory distress in the pediatric emergency care setting in Japan.…”

“…A previous study conducted in Japan using 40 μg per dose failed to demonstrate effectiveness in treating pediatric patients with moderate to severe asthma . A randomized controlled trial in Australia using 80–160 μg per dose of pMDI‐IB also failed to reduce the admission rate of pediatric patients with AAE . However, this study did not include patients with the severe exacerbation; thus, the study findings were limited to patients with moderate asthma.…”

“…11 A randomized controlled trial in Australia using 80-160 g per dose of pMDI-IB also failed to reduce the admission rate of pediatric patients with AAE. 12 However, this study did not include patients with the severe exacerbation; thus, the study findings were limited to patients with moderate asthma. Therefore, it is still unclear whether pMDI-IB is effective in patients with the severe exacerbation, and the use of IB is dependent on the physicians' preference as no evidence on MDI-IB for AAE is currently available in Japan.…”

Safety of Atrovent® CFC-free inhaler: respiratory events reported from an observational cohort study in England

“…It was observed that switchers from Atrovent ® CFC MDI were more likely to be adults, have an indication of COPD and have moderate/severe disease. Due to the pathological differences between asthma and COPD alone, patients would experience different events, but additionally age and disease severity can also create different event profiles …”