The Science Journal of the American Association for Respiratory Care

1998 OPEN FORUM Abstracts

COMPARISON OF ALBUTEROL VS ALBUTEROL WITH IPRATROPIUM IN PEDIATRIC ASTHMA PATIENTS REQUIRING HOSPITALIZATION

Timothy R. Myers RRT. Daniel Craven MD, Carolyn Kercsmar MD and Robert Chatburn RRT. Rainbow Babies & Childrens Hospital and Case Western Reserve University, Cleveland, OH.

Objective: A double-blind, randomized, placebo controlled study to determine if the addition of ipratropium to nebulized albuterol in children hospitalized with acute asthma would alter clinical and post discharge outcomes. Participants: Asthmatic children (ages 1-16 with IRB approval), admitted to an asthma care unit. Methodology: All patients were treated using an asthma care path, consisting of standard assessment criteria (wheeze, air exchange, accessory muscle usage, oximetry and respiratory rate) and treatment (2.5 mg albuterol in saline) at prescribed intervals. Frequency of assessment / treatment was decreased in a step-wise manner dependent on meeting a predefined criteria. At admission, patients' were randomized to standard care path aerosol therapy (control) or study aerosol therapy (consisting of 250 micrograms of ipratropium mixed in every other albuterol aerosol). Patients that failed to respond to treatment received an intensification protocol (5 mg albuterol mixed with 500 micrograms ipratropium, and 0.01 mg/kg SC epi) and returned to an assessment frequency of Q2h. Phone surveys were administered to track post discharge outcomes. Percentages were compared by Fisher Exact Test and distributions by chronic disease severity were compared by Chi Square test. Results: Demographic and outcome variables are shown as raw numbers, means (± SD) or percentages. No patients required intensive care.

Control Study p value

Demographics 101 102

Age 4.8(±3.8) 5.4(4.3) 0.31

Gender (male) 66% 73% 0.36

Race (caucasian) 23% 17% 0.29

Chronic Disease Severity

Class 0.55

Mild 33 32

Moderate 10 17

Severe 49 44

Unknown 9 9

Inpatient Outcomes

Length of Stay (days) 1.84(±0.81) 1.92(±0.80) 0.50

Total Treatments 10.9(±5.2) 11.8(±6.2) 0.25

Study / Placebo

Treatments 4.5(±2.3) 4.9(±2.6) 0.18

Intensification

Percentage 11% 16% 0.41

Oxygen Requirement 34% 31% 0.77

Hospital Cost / Case $1,448(±$583) $1,486(±$543) 0.65

Post Discharge Outcomes

Days of Wheezing 2.8(±3.2) 2.6(±2.7) 0.69

Nocturnal Symptoms 1.4(±2.8) 1.2(±2.0) 0.57

Absenteeism 3.6(±2.6) 4.0(±2.6) 0.47

Conclusion: The addition of ipratropium to nebulized albuterol in children hospitalized with acute asthma using this protocol has no impact on clinical, financial or post discharge outcomes. However; the addition of ipratropium would increase the pharmacology costs to the hospital.

The 44th International Respiratory Congress Abstracts-On-Disk®, November 7 - 10, 1998, Atlanta, Georgia.

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