To determine if the addition of ipratropium bromide (
IB) by metered‐dose inhaler in moderate acute asthma in children affects hospital admission rates when compared with inhaled salbutamol and oral prednisolone alone. Methods
A prospective, single‐blinded, randomised, controlled, equivalence trial in a tertiary paediatric emergency department. Patients aged 2–15 years with acute, moderate asthma were randomised to two groups, one receiving salbutamol, prednisolone and
IB, the other receiving only salbutamol and prednisolone. The managing doctor was blinded to treatment. Admission rates were compared, and less than 15% difference was accepted as statistically equivalent. Results
Recruitment ran from
June 2007 until January 2011. Three hundred forty‐seven subjects were analysed. The admission rate in the IBgroup was 70.1% (122/174) compared with 64.2% (111/173) in the non‐ IBgroup. The absolute difference of +5.9% (95% confidence interval −4.0% to 15.8%) is not statistically equivalent but does not show a statistically significant decrease in admission rates when IBwas given. Adverse effects were more prevalent in the IBgroup, at 13.2% (23/174), compared with 4.6% (8/173) in the non‐ IBgroup, a relative risk of 2.86 (95% confidence interval 1.31–6.21). Conclusion
In children with acute asthma of moderate severity who are treated with adequate doses of salbutamol and prednisolone, the addition of
IBis not significantly associated with a reduction in admission rates. There is a significantly higher rate of adverse effects if IBis given. IBshould be reserved for children with severe asthma exacerbations.