Hossain A S, Barua U K, Roy G C, Sutradhar S R, Rahman I, Rahman G
Department of Medicine, Dhaka Community Medical College & Hospital, Dhaka, Bangladesh.
Mymensingh Med J. 2013 Apr;22(2):345-52.
The use of nebulized Ipratropium bromide, quaternary anticholinergic bronchodilators in combination with beta-agonist for the treatment of acute asthma in adults is controversial. In a view of different recommendation the present study is undertaken in Bangladeshi patients. Combination of inhaled Ipratropium bromide and Salbutamol provides greater bronchodilatation than mono therapy with Salbutamol alone in acute severe asthma. Patients of severe asthma (PEFR <50% of predicted) were enrolled into control group (Salbutamol only) and case (Salbutamol + Ipratropium bromide) group. After measurement of peak expiratory flow, patient received 3 doses of 2.5 mg Salbutamol (n=40) only or 3 doses of both 2.5mg Salbutamol and 500mcg Ipratropium bromide at an interval of 20 minutes (n=40) through a jet nebulizer. Peak flow was reassessed 30 & 60 minutes after treatment. Peak flow at baseline was similar in two groups. Then at 30 minutes after nebulization, the mean±SD percentage increase in peak flow was greater in combination group (60.01±35.01%) than Salbutamol group (44.47±25.03%) with difference of 16% (p=0.025). At 60 minutes the percentage increase in peak flow was about 32% greater in combination group than Salbutamol group (94.44±33.70% vs. 62.57±29.26%, p=0.000) and combination group reached percentage predicted peak flow more than 60% while Sabutamol group did not. Ipratropium Bromide and Salbutamol nebulized combinedly have better bronchodilating effect than Salbultamol alone in acute severe asthma.
雾化吸入异丙托溴铵（一种季铵类抗胆碱能支气管扩张剂）与β受体激动剂联合用于治疗成人急性哮喘存在争议。鉴于不同的推荐意见，本研究在孟加拉国患者中开展。在急性重度哮喘中，吸入异丙托溴铵和沙丁胺醇联合使用比单独使用沙丁胺醇单一疗法能提供更大程度的支气管扩张。重度哮喘患者（呼气峰值流速[PEFR]<预测值的50%）被纳入对照组（仅使用沙丁胺醇）和病例组（沙丁胺醇+异丙托溴铵）。在测量呼气峰值流速后，患者通过喷射雾化器仅接受3剂2.5毫克沙丁胺醇（n = 40），或接受3剂2.5毫克沙丁胺醇和500微克异丙托溴铵，间隔20分钟（n = 40）。治疗后30分钟和60分钟重新评估峰值流速。两组基线时的峰值流速相似。雾化后30分钟，联合组峰值流速的平均±标准差百分比增加值（60.01±35.01%）高于沙丁胺醇组（44.47±25.03%），差值为16%（p = 0.025）。在60分钟时，联合组峰值流速的百分比增加值比沙丁胺醇组高约32%（94.44±33.70%对62.57±29.26%，p = 0.000），联合组达到预测峰值流速百分比超过60%，而沙丁胺醇组未达到。在急性重度哮喘中，异丙托溴铵和沙丁胺醇联合雾化比单独使用沙丁胺醇具有更好的支气管扩张效果。
