Ipratropium bromide: a bit of a wheeze? ▸

Administration of ipratropium bromide has become standard care in UK prehospital practice for acute severe or life-threatening asthma. This retrospective “before and after” USA study examined prehospital and emergency department records 6 months before and after the introduction of prehospital ipratropium. No statistically significant differences were observed between pre-nebuliser and post-nebuliser values for the salbutamol (n = 192) and the salbutamol with ipratropium bromide (n = 179) groups for heart rate (p = 0.474), blood pressure (p = 0.523), respiratory rate (p = 0.055), arterial oxygen saturation (p = 0.581) and clinical improvement rates (p = 0.944). Also, no significant differences were observed for those admitted from emergency departments (p = 0.596) and those being discharged (p = 0.713). Although these results suggest that there was no benefit in combining salbutamol and ipratropium, the study has severe limitations. Patients were not randomly allocated to treatment groups, and the limited sample size risked a type II error. Other outcome variables, such as changes in peak flow rate, may have …