Qureshi F, Pestian J, Davis P, Zaritsky A
Division of Pediatric Emergency Medicine, Children's Hospital of the King's Daughter, Eastern Virginia Medical School, Norfolk 23507, USA.
N Engl J Med. 1998 Oct 8;339(15):1030-5. doi: 10.1056/NEJM199810083391503.
Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma, but their effect on hospitalization rates is uncertain.
We conducted a randomized, double-blind, placebo-controlled study of 434 children (2 to 18 years old) who had acute exacerbations of moderate or severe asthma treated in the emergency department. All the children received a nebulized solution of albuterol (2.5 or 5 mg per dose, depending on body weight) every 20 minutes for three doses and then as needed. A corticosteroid (2 mg of prednisone or prednisolone per kilogram of body weight) was given orally with the second dose of albuterol. Children in the treatment group received 500 microg (2.5 ml) of ipratropium bromide with the second and third doses of albuterol; children in the control group received 2.5 ml of normal saline at these times.
Overall, the rate of hospitalization was lower in the ipratropium group (59 of 215 children [27.4 percent]) than in the control group (80 of 219 [36.5 percent], P=0.05). For patients with moderate asthma (indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale), hospitalization rates were similar in the two groups (ipratropium: 8 of 79 children [10.1 percent]; control: 9 of 84 [10.7 percent]). For patients with severe asthma (defined as a peak expiratory flow rate of <50 percent of the predicted value or an asthma score of 12 to 15), the addition of ipratropium significantly reduced the need for hospitalization (51 of 136 children [37.5 percent], as compared with 71 of 135 [52.6 percent] in the control group; P=0.02).
Among children with a severe exacerbation of asthma, the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate.
异丙托溴铵等抗胆碱能药物可改善哮喘急性加重患者的肺功能，但其对住院率的影响尚不确定。
我们对434名年龄在2至18岁、在急诊科接受中度或重度哮喘急性加重治疗的儿童进行了一项随机、双盲、安慰剂对照研究。所有儿童每20分钟接受一次沙丁胺醇雾化溶液（每剂2.5或5毫克，根据体重而定），共三剂，然后按需给药。在第二剂沙丁胺醇时口服给予皮质类固醇（每千克体重2毫克泼尼松或泼尼松龙）。治疗组儿童在第二剂和第三剂沙丁胺醇时接受500微克（2.5毫升）异丙托溴铵；对照组儿童在这些时间接受2.5毫升生理盐水。
总体而言，异丙托溴铵组的住院率（215名儿童中的59名[27.4%]）低于对照组（219名中的80名[36.5%]，P=0.05）。对于中度哮喘患者（呼气峰值流速为预测值的50%至70%或哮喘评分为15分制中的8至11分），两组的住院率相似（异丙托溴铵组：79名儿童中的8名[10.1%]；对照组：84名中的9名[10.7%]）。对于重度哮喘患者（定义为呼气峰值流速<预测值的50%或哮喘评分为12至15分），添加异丙托溴铵显著降低了住院需求（136名儿童中的51名[37.5%]，对照组135名中的71名[52.6%]；P=0.02）。
在哮喘严重加重的儿童中，在沙丁胺醇和皮质类固醇治疗中添加异丙托溴铵可显著降低住院率。
