Newer Effective Treatment for Adult Acute Asthmatics with a Multi-Dose Regimen of Ipratropium Bromide Plus Salbutamol Using Metered Dose Inhalers with a Spacer Device in Emergency Department

Aim of the study: To test the effectiveness of combined ipratropium bromide and salbutamol for treatment of adult patients with severe acute asthma Type of study: This single-blind randomized controlled study was conducted in Emergency Department of National Institute Diseases of Chest and Hospital, Dhaka from July 05 to Dec 06. Materials and Methods: Total 100 Adult patients ( 18 yrs) of acute asthma with FEV1 30%- 50% ofpredictive value were included in this study and two groups are done in randomized manner from random table. 51 patients (Study group) received a multi-dose regime of salbutmol and ipratropium bromide delivered by a metered dose inhaler (MDI) through a spacer device and 49 patients (control group) received similar doses of salbutmol by a metered dose inhaler (MDI) through an identical spacer device. Forced Expiratory Volume in Ist second (FEV1), Peak Expiratory Flow (PEF), Saturation of oxygen (S02), Respiratory rate (RR), Heart Rate (HT) that were recorded in a preformed questionnaire before starting treatment and at 30 minutes interval for I Ahrs. All data were analyzed with a SPSS PC plus software package and unpaired t test was done during analysis Results: Age of study group was 31.9 ± 11.3 (mean ± SD) and control group was 32.5 ± 13.7 (mean ± SD). The difference was not statistically significant (p= 0.82). Mean pre-treatment FEVt PEFR, SO, in study group vs control group was 39.8 % (± 4.8) TO 38.6 (± 4.5), 137.2 L/min. (± 32.8) vs 127.4 L/min (± 32.0) and 94.5%. (± 2.8) vs 93.4% (± 2.3). The differences of pre-treatment values was not statistically significant (P=0.5). After intervention, mean FEV1 values were 60% (SD, ± 8.7), 71.4%, (SD, ± 7.1), 80.5 %,(SD ± 7.3) in study group and 49.1% ± 6.4, 57.3% ±6.6 and 62.4 %± 10.6 (Mean ± SD) in control group at 30 milts, at 60 mins and at 90 mins respectively. The differences in FEV1 improvement is significant (P 005) at all the three stages. Similarly, significant improvement of PEFR, S02, Respiratory rate, Heart rate was also seen at all three stages after intervention. Conclusion: The addition of ipratropium bromide to salbutamol demonstrated significant improvement over salbutamol alone in the treatment of adult acute asthmatics.