Archive for the ‘Asthma’ Category


Nebulized Ipratropium in the Treatment of Acute Asthma: DISCUSSION part 2

Apr 18, 2011 Author: Walter Mcneil | Filed under: Asthma

Our study has shown no advantage in giving salbu­tamol and ipratropium separately rather than together. Clinical convenience may therefore dictate that the drugs should be given together. However, our results also suggest that the addition of ipratropium to salbu­tamol provides no additional benefit over a single agent given alone. Combination salbutamol/ipratro- pium was not superior to either agent alone at one hour. When given second, ipratropium was not supe­rior to saline solution after combination. Similar conclusions were drawn from a study of eight nonacute asthmatic and bronchitic subjects. The change in PEFR which we found after saline solution is probably due to a continuing or “carry-over” effect of the salbutamol/ipratropium combination administered 60 minutes earlier, but we cannot exclude a direct effect of saline solution upon peak flow.

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Nebulized Ipratropium in the Treatment of Acute Asthma: DISCUSSION

Apr 17, 2011 Author: Walter Mcneil | Filed under: Asthma

DISCUSSION

We have observed no difference produced in the improvement in PEFR over a 150-minute period in three groups of patients with acute asthma treated with inhaled salbutamol and ipratropium bromide given sequentially or in combination. It is possible that a type 2 error has occurred to account for the failure to show any difference between the groups. At 150 minutes, this study had a power of 80 percent to detect a difference of 63 L/min between the groups; in order to detect a 25 L/min difference at the 80 percent level, 170 patients in each group would be needed. These figures imply that, if such a difference exists between the treatment groups, the study would detect the difference eight times out of ten. This suggests one of three alternative explanations for our results; either the lack of difference in treatment effect between the three groups is a real phenomenon, or that if the study were to be repeated, the difference would be detected, or that the difference in treatments is too small to be detected with the numbers of subjects used.

This is the largest single-center study of its type of which we are aware and serves to highlight the difficulties inherent in performing such a study in order to detect relatively small treatment differences between groups. More importantly, if a difference does exist between these treatments, it is small, implying that one would need to treat many patients with both drugs in order to benefit a few.

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Nebulized Ipratropium in the Treatment of Acute Asthma: RESULTS

Apr 16, 2011 Author: Walter Mcneil | Filed under: Asthma

A total of 177 patients were entered into the study. Of those, 117 completed the study protocol in full, 40 in group A, 41 in group B, and 36 in group C. Sixty subjects were excluded for varying reasons. Forty one patients were either given the wrong trial preparation, or the full number of peak flow measurements were not made, documentation was inadequate, or peak flow readings showed unacceptable variation (>10 per­cent), suggesting poor technique. Eleven patients improved symptomatically following the first nebuli- zation and refused to receive the second treatment (three from group A, four each from groups В and C). Eight were withdrawn by the attending physicians because of worsening asthma (three each from groups A and B, two from group C). One of this latter group was withdrawn after deteriorating acutely while re­ceiving nebulized ipratropium.

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Nebulized Ipratropium in the Treatment of Acute Asthma: METHODS

Apr 15, 2011 Author: Walter Mcneil | Filed under: Asthma

All patients presenting to the Emergency Department of the Royal Perth Hospital with acute asthma were entered into the study. Acute asthma was defined as dyspnea and wheeze in known asthmatic patients with deterioration of their usual symptoms and/or pulmonary (unction or those with a compatible history and clinical findings subsequently demonstrated following the study to have asthma. The PEFR was taken as the best of three readings recorded by a Wright peak flow meter, the same instrument being used throughout the study.

Other inclusion criteria were age between 16 and 70 years and the ability to perform repeated peak flow readings. Exclusion criteria were glaucoma and prostatism. The study design was as follows:

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Nebulized Ipratropium in the Treatment of Acute Asthma

Apr 14, 2011 Author: Walter Mcneil | Filed under: Asthma

Nebulized Ipratropium in the Treatment of Acute Asthma

Following the introduction of the newer anticholin- ergic antimuscarinic agents, a number of studies have investigated the use of such drugs in the treat­ment of acute asthma. Ipratropium is the most widely used of these newer agents, and it has been the most widely investigated, although the number of studies supporting its use is small.

Ipratropium has been shown to be an effective bronchodilator medication in acute asthma. Three studies have suggested that sequential use of both an adrenoceptor agonist and an antimuscarinic agent is superior to one agent given alone, although there was conflicting evidence as to whether salbutamol should be given first in the sequence or last.

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