Emerg Med J 18:118 doi:10.1136/emj.18.2.118
  • Best evidence topic report

Salbutamol and ipratropium in COPD

  1. Magnus Harrison,
  2. Ross Murphy
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK

      Report by Magnus Harrison, Clinical Research Fellow Search checked by Ross Murphy, Senior Clinical Fellow

      Clinical scenario

      A 59 year old man presents with an exacerbation of COPD. You wonder whether it is better to nebulise salbutamol or ipratropium bromide alone, or a combination of the two.

      Three part question

      In [patients presenting with an acute exacerbation of COPD] is nebulisation of [a beta 2 agonist alone, ipratropium bromide alone or a combination of the two] more effective at [controlling and improving symptoms].

      Search strategy

      Medline 1966–11/00 using the OVID interface. {{[(exp chronic disease OR exp hospitals, chronic disease OR AND (exp lung disease, obstructive OR] OR exp emphysema OR exp pulmonary emphysema OR OR exp bronchitis OR OR exp OR OR airway} AND ( or} AND (exp ipratropium OR ipratropium OR OR OR exp. muscarinic antagonist OR exp brochodilators agents OR OR exp albuterol OR OR beta 2 OR exp terbutaline) AND (exp nebulisers OR OR exp respiratory therapy OR NOT (exp child OR OR exp paediatrics OR LIMIT to human AND english.

      Search outcome

      Altogether 162 papers found of which 157 were irrelevant or of insufficient quality. The remaining five papers are shown in table 3.

      Table 3


      There are five randomised trials that address the three part question. All of the studies are of reasonable quality.

      Clinical bottom line

      Initial treatment can be either salbutamol or ipratropium nebulisers alone. There is no evidence to suggest that using both has additional benefit.

      Report by Magnus Harrison, Clinical Research Fellow Search checked by Ross Murphy, Senior Clinical Fellow


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      Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


      0.5% - 43% response rate
      3% - 41% response rate
      10% - 16% response rate

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