[Use of ipratropium bromide by inhalation in the treatment of acute asthma in children. Clinical experience]

Abstract

Clinical experience. Anticholinergic drugs, notably atropine, have long been known to be potent bronchodilators, but their use was limited by systemic absorption and significant side effects. Ipratropium bromide has no systemic anticholinergic action, but maintains the local anticholinergic action on the tracheobronchial tree. In 1984, we observed that in children with acute asthma, treated aggressively with frequent doses of nebulized beta 2 adrenergics, a significant degree of airway obstruction remained, and did not improve with further doses of beta 2 agonists. We postulated that vagal bronchomotor tone might contribute to this problem and that further improvement could be obtained with the use of ipratropium bromide. Ipratropium was shown to be useful in pediatric asthma in the early 1980s. There appeared to be an age difference in the response to the medication. A dose-response curve for nebulized ipratropium was determined. The optimal dose was found to be > 75 micrograms. Repeated studies and extensive experience demonstrated safety and few side effects. In 1984 we studied the effect of adding ipratropium after one hour of treatment with a regimen of frequent nebulized salbutamol in children with acute asthma. We found a slight but significant further improvement in FEV1, beginning one hour after administration of ipratropium. Further studies confirmed these findings, when using two doses of combined ipratropium/fenoterol an hour apart or every 40 minutes for three doses. One study using ipratropium every eight hours failed to show a change, confirming the need to use the medication more frequently. For the past six years, we have been using a protocol that incorporates ipratropium in the treatment of acute asthma in children. (ABSTRACT TRINCATED AT 250 WORDS)