EFFICACY OF ADDING NEBULIZED IPRATROPIUM BROMIDE TO NEBULIZED ALBUTEROL THERAPY IN ACUTE BRONCHIOLITIS

Nebulized ipratropium bromide is thought to be synergistic with albuterol in therapy for acute childhood asthma. Because the efficacy of ipratropium in bronchiolitis is uncertain and some infants with bronchiolitis do not respond to nebulized albuterol alone, the following study was undertaken. In this double-blind, placebo-controlled trial, 69 infants between 6 weeks and 24 months of age who exhibited the first episode of acute bronchiolitis were randomly assigned to receive either nebulized albuterol (0.15 mg/kg per dose) and ipratropium bromide (250 mug per dose) (group A, n = 36) or nebulized albuterol and normal saline (placebo) (group B, n = 33) for two doses, 1 hour apart. The two groups were comparable at baseline. Both therapies resulted in clinically significant improvement. However, the addition of ipratropium resulted in no additional benefit with respect to decrease in the respiratory rate (mean down 10.6/min vs down 8.6/min, P = .86), accessory muscle score (range 0 through 3) (down 0.92 vs down 0.82, z = -0.44), wheeze score (range 0 through 3) (down 0.94 vs 0.85, z = -0.20), oxygen saturation (up 0.25% vs up -0.33%, P = .86), or hospitalization rate (17 vs 10). The number of ''nonresponders'' and ''clear responders'' was also very similar in both groups. No toxicity was noted. The increase in heart rate was mild and similar in both groups (up 6.7 vs up 11.1). The power of the study to detect a difference between the two treatment groups in the respiratory rate change greater-than-or-equal-to 8/min is greater than 90%. It is concluded that the addition of nebulized ipratropium bromide appears to offer no further clinical benefit compared with albuterol alone in moderately severe acute bronchiolitis.