Cydulka Rita K, Emerman Charles L, Muni Anthony
Department of Emergency Medicine, MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH 44109, USA.
J Asthma. 2010 Dec;47(10):1094-100. doi: 10.3109/02770903.2010.517337. Epub 2010 Nov 1.
The National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 guidelines advise the addition of ipratropium bromide to short-acting β-agonist therapy for the treatment of patients with severe acute asthma exacerbation.
This was a prospective, double-blind, randomized, controlled study involving 141 adults, presenting to two EDs with acute severe asthma exacerbation. Patients were treated using a standardized pathway with levalbuterol plus ipratropium or levalbuterol alone. Primary outcomes were changes from baseline in the percentage of predicted forced expiratory volume in 1 second (FEV₁) at 30 minutes and 60 minutes after completion of treatment. Secondary outcomes included hospitalization and relapse rates. Occurrence of adverse events was recorded.
Sixty-seven patients in the levalbuterol plus ipratropium group and 74 patients in the levalbuterol group completed the study. Overall, there was no significant difference in the improvement in percent predicted FEV₁ between the two groups at 30 minutes [difference in change between study groups at 30 minutes: 1% (95% CI: ?3 to 2%) or at 60 minutes: 3% (95% CI: 1-6%)] No difference was noted in hospitalization rates between the treatment groups [combination therapy group, 33%; single therapy group, 47%, difference: -14% (95% CI: -30 to 20%)]. Post-hoc analysis revealed that patients receiving ipratropium in addition to levalbuterol were 1.5 times more likely to experience side effects (palpitations) than patients treated with levalbuterol alone (RR 1.5; 95% CI: 1.2-1.9) No differences in relapse rates were noted between the groups. Post-hoc analysis revealed more side effects in patients receiving levalbuterol plus ipratropium.
We were unable to demonstrate superiority of adding ipratropium to levalbuterol in alleviating obstruction as measured by FEV₁ or in decreasing the need for hospitalization among adult patients presenting to the ED with acute severe asthma exacerbation.
国家哮喘教育与预防计划（NAEPP）专家小组报告3指南建议，在短效β受体激动剂治疗基础上加用异丙托溴铵，用于治疗严重急性哮喘加重患者。
这是一项前瞻性、双盲、随机对照研究，纳入了141名因急性严重哮喘加重就诊于两家急诊科的成年人。患者采用标准化治疗方案，使用沙丁胺醇加异丙托溴铵或仅使用沙丁胺醇进行治疗。主要结局指标为治疗结束后30分钟和60分钟时，预测第1秒用力呼气容积（FEV₁）百分比相对于基线的变化。次要结局指标包括住院率和复发率。记录不良事件的发生情况。
沙丁胺醇加异丙托溴铵组67例患者和沙丁胺醇组74例患者完成了研究。总体而言，两组在30分钟时预测FEV₁百分比改善方面无显著差异[研究组在30分钟时变化差异：1%（95%CI：-3%至2%）]，60分钟时为3%（95%CI：1%-6%）。治疗组之间住院率无差异[联合治疗组为33%；单药治疗组为47%，差异：-14%（95%CI：-30%至20%）]。事后分析显示，除沙丁胺醇外还接受异丙托溴铵治疗的患者出现副作用（心悸）的可能性是仅接受沙丁胺醇治疗患者的1.5倍（RR 1.5；95%CI：1.2-1.9）。两组复发率无差异。事后分析显示，接受沙丁胺醇加异丙托溴铵治疗的患者副作用更多。
对于因急性严重哮喘加重就诊于急诊科的成年患者，我们无法证明在沙丁胺醇基础上加用异丙托溴铵在改善FEV₁所衡量的气道阻塞或降低住院需求方面具有优越性。
