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:

The patients received two nebulized treatments at an interval of one hour, with measurements of PEFR before, and 15 and 60 minutes after each treatment. The study was double-blind and randomized, and there were three treatment groups as follow:

(A) salbutamol (5 mg) followed by ipratropium (0.5 mg) at one hour.
(B) ipratropium followed by salbutamol at one hour.
(C) salbutamol with ipratropium, followed by isotonic saline solution (as placebo) after one hour.

The best of three peak flow readings was recorded by a Wrights peak flow meter, the same instrument being used in all patients. The aerosols were delivered from a nebulizer (Inspiron Mini-neb), driven by wall oxygen at a rate of 8 to 10 L/min. Each nebulized solution was made up to 4 ml with isotonic saline solution by the hospital pharmacy. If considered necessary by the attending physi­cians, patients were given intravenous aminophylline and hydrocor­tisone. Patients were withdrawn from the study if they became too sick to continue, or if they declined to receive the second nebulized treatment.
canadian antibiotics

Statistical analysis was by paired Students f-test for data within groups, and by unpaired Students f-test for data between groups. The mean AUC was calculated for each group by trapezoidal integration, and the results compared by the unpaired Students t- test.