Ipratropium bromide (IB, Atrovent) is most efficacious in improving symptoms and preventing hospital admissions due to severe asthma exacerbations when used early and aggressively. Even in patients with mild to moderate exacerbations, there is also benefit in symptom reduction, decreased number of treatments and duration of treatment, and improved lung function.
The National Asthma Education and Prevention Program (NAEPP) consensus recommends multidose protocol of IB every 20 minutes (either 250 or 500 Kg per dose) for 3 doses, during the initial management of severe exacerbations. For those institutions who prefer to give IB by metered dose inhaler (18 Kg per puff, with face mask and spacer for children younger than 4 years),
Bottom line:
Give ipratropium bromide (atrovent) early and aggressively to decrease hospitalization rates in severe asthma exacerbation.
References:
1. Dotson K et al. Ipratropium bromide for acute asthma exacerbations in the emergency setting. PediatrEmergCare. 2009 Oct;25(10):687-92; Review.
2. National Asthma Education and Prevention Program. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (Summary Report 2007). In: BusseW, ed. J Allergy Immunol. 2007;120(5):S94Y138. National Institutes of Health National Heart Lung, and Blood Institute.
