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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 chronic.mp) AND (exp lung disease, obstructive OR obstructive.mp)] OR exp emphysema OR exp pulmonary emphysema OR emphysema.mp OR exp bronchitis OR bronchitis.mp OR exp COPD.mp OR COAD.mp OR airway obstruction.mp)} AND (acute.mp or exacerbation.mp)} AND (exp ipratropium OR ipratropium bromide.mp OR atrovent.mp OR antimuscarinic.mp OR exp. muscarinic antagonist OR exp brochodilators agents OR bronchodilators.mp OR exp albuterol OR salbutamol.mp OR beta 2 agonist.mp OR exp terbutaline) AND (exp nebulisers OR vaporises.mp OR exp respiratory therapy OR nebulisers.mp) NOT (exp child OR children.mp OR exp paediatrics OR paediatric.mp) 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

      Comments

      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

      References


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