Salbutamol 100micrograms/dose / Ipratropium 20micrograms/dose inhaler

ObjectivesTo review the efficacy of nebulised magnesium sulfate (MgSO4) in acute asthma in children.MethodsThe authors searched Medline, Embase, Web of Science and Cochrane Library for randomised controlled trials (RCTs) published until 15 December 2023. RCTs were included if they compared the efficacy and safety of nebulised MgSO4 as a second-line agent in children presenting with acute asthma exacerbation. A random-effects meta-analysis was performed, and the Risk of Bias V.2 tool was used to assess the biases among them.Results10 RCTs enrolling 2301 children with acute asthma were included. All trials were placebo controlled and administered nebulised MgSO4/placebo and salbutamol (±ipratropium bromide). There was no significant difference in Composite Asthma Severity Score between the two groups (6 RCTs, 1953 participants; standardised mean difference: -0.09; 95% CI: -0.2 to +0.02, I2=21%). Children in the MgSO4 group have significantly better peak expiratory flow rate (% predicted) than the control group (2 RCTs, 145 participants; mean difference: 19.3; 95% CI: 8.9 to 29.8; I2=0%). There was no difference in the need for hospitalisation, intensive care unit admission or duration of hospital stay. Adverse events were minor, infrequent (7.3%) and similar among the two groups.ConclusionsThere is low-certainty evidence that nebulised MgSO4 as an add-on second-line therapy for acute asthma in children does not reduce asthma severity or a need for hospitalisation. However, it was associated with slightly better lung functions. The current evidence does not support the routine use of nebulised MgSO4 in paediatric acute asthma management.Prospero registration numberCRD42022373692.

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IntroductionPediatric critical asthma is one of the most common pediatric illnesses in children admitted to the pediatric ward and pediatric intensive care unit (PICU). Adjunct intravenous (IV) bronchodilators are often used when initial management with systemic corticosteroids and inhaled short-acting beta agonists (SABA) fail to provide improvement in a patient's clinical condition. While the recent guidelines gave recommendations for the use of different IV bronchodilators compared to placebo, it did not include ranking on which one should be used as first-line or second-line agent. The aim of this network meta-analysis is to determine the effect of IV bronchodilators on patient-centered outcomes and rank medications based on their effectiveness in these outcomes.MethodsA systematic review was conducted using three databases MEDLINE, Embase, and CINAHL to identify randomized control trials examining the use of IV magnesium sulfate (MgSO4), IV methylxanthines (aminophylline or theophylline), IV SABA (salbutamol, terbutaline) in pediatric critical asthma patients. Bayesian network metanalytic framework was used to compare the interventions. Results are reported as odds ratio (OR) or mean difference (MD) and 95% Credible Interval (CrI).ResultsTwelve trials (n = 852) were included in the network meta-analysis. Largest reduction in hospital length of stay (LOS), PICU admission, and PICU LOS were noted with IV MgSO4; (MD: -3.1 days, 95% CrI: -6.9 days to 0.13 days), (OR 0.21; 95% CrI 0.02, 1.3), and (MD: -4.0 days, 95% CrI: -7.1 days to -1.2 days) respectively. IV MgSO4 was ranked first in three outcomes of interest with Surface Under the Cumulative Ranking curve (SUCRA) of 0.884 for hospital LOS, 0.919 for PICU admission, and 0.957 for PICU LOS. For preventing intubation, IV SABA was ranked the highest (SUCRA 0.995), but the only study with IV SABA had zero intubation events. In a sensitivity analysis that excluded studies with zero events, the intubation rate was lowest with IV MgSO4 (OR 0.10; 95% CrI 0.003, 0.88) and it was ranked the best treatment (SUCRA 0.921).ConclusionsIn this network meta-analysis comparing different IV adjunct bronchodilators, IV MgSO4 was ranked first followed by IV SABA, and then IV methylxanthines. Given these findings and the favorable safety profile, ease of use, and low cost, IV MgSO4 appears most promising the first adjunct IV bronchodilator, however, further large high-quality trials are still needed before it can be endorsed as routine first-line agent.

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Background A combination of ipratropium bromide (IB) and salbutamol is commonly used to treat asthma in children and adolescents; however, there has been a lack of consistency in its usage in clinical practice. Objective To evaluate the efficacy and safety of IB + salbutamol in the treatment of asthma in children and adolescents. Methods The MEDLINE, Embase, and Cochrane Library as well as other Chinese biomedical databases (including China Biological Medicine Database, Chinese National Knowledge Infrastructure, Chongqing VIP, and Wanfang Chinese language bibliographic database) were systematically searched from the date of database inception to 02/09/2019 for randomized controlled trials in children and adolescents (≤18 years) with asthma who received IB + salbutamol or salbutamol alone. The primary outcomes included hospital admission and adverse events. A random effects model with a 95% confidence interval (CI) was used. Subgroup analysis was performed according to age, severity of asthma, and co-interventions with other asthma controllers. This study was registered with PROSPERO. Results Of the 637 studies that were identified, 55 met the inclusion criteria and involved 6396 participants. IB + salbutamol significantly reduced the risk of hospital admission compared with salbutamol alone (risk ratio [RR] 0.79; 95% CI 0.66–0.95; p = 0.01; I2 = 40%). Subgroup analysis only showed significant difference in the risk of hospital admission in participants with severe asthma exacerbation (RR 0.71; 95% CI 0.60–0.85; p = 0.0001; I2 = 0%) and moderate-to-severe exacerbation (RR 0.69; 95% CI 0.50–0.96; p = 0.03; I2 = 3%). There were no significant differences in the risk of adverse events between IB + salbutamol group and salbutamol alone group (RR 1.77; 95% CI 0.63–4.98). Conclusion IB + salbutamol may be more effective than salbutamol alone for the treatment of asthma in children and adolescents, especially in those with severe and moderate to severe asthma exacerbation. Future prospective research on these subgroup population are needed.

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Background: Acute attacks of childhood bronchial asthma can be life-threatening if not timely and appropriately managed. This study aimed to compare the mean pulmonary asthma score in salbutamol alone versus salbutamol combined with ipratropium bromide for managing childhood acute asthma. Methods: This single-blind, parallel-group, randomized controlled trial was performed at the Pediatric Medicine department, The Children’s Hospital & the Institute of Child Health, Multan, from January 1, 2024, to June 30, 2024. A total of sixty children of 2–15 years with an acute asthma episode were consecutively enrolled after parental consent. Exclusions included congenital pulmonary/cardiac malformations, bronchopulmonary dysplasia, cystic fibrosis, bronchiolitis obliterans, and imminent respiratory failure. Patients were randomly divided into group A and group B treatment groups. Group A received nebulization of 0.5% salbutamol alone, while Group B received salbutamol with ipratropium bromide. Pulmonary Asthma Score (PAS) was assessed on presentation and after 4 hours. Descriptive statistics are run using SPSS. PAS after 4 hours of treatment between the groups was compared through a t-test, and a p-value <0.05 was taken as significant. Results: The mean age was 8.6 ± 2.8 years with equal gender distribution. Baseline PAS was comparable (10.2 ± 1.2 vs 10.6 ± 1.2, p = 0.295). After 4 hours, overall PAS declined to 7.4 ± 1.6, with significantly lower scores in the combination group (6.3 ± 1.2) versus salbutamol alone (8.4 ± 1.2, p < 0.001). Stratified analysis confirmed these results except among children on montelukast (p = 0.846). Conclusion: Nebulization with salbutamol plus ipratropium bromide significantly reduces PAS at 4 hours compared to salbutamol alone in acute pediatric asthma.

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Objectives: There is a scarcity of pharmacological treatments that efficiently address lung injury in individuals experiencing acute respiratory distress syndrome (ARDS). Early inhaled corticosteroids and ipratropium may reduce pulmonary inflammation and injury of the lungs, minimizing the risk of ARDS. Method: This is a double-blinded randomized control trial conducted on patients at risk of ARDS. Patients were randomly allocated into two groups; the intervention group (63 patients) were administered aerosolized budesonide and ipratropium bromide, and the control group (56) were administered a placebo every eight hours for five days. Alteration in oxygen saturation divided by inspired oxygen (Fio2) (S/F) after five days was the primary outcome. Secondary outcomes included ARDS occurrence, mechanical ventilation (MV) requirement, hospital stay duration, and mortality rates. Results: Of the 604 screened, only 119 patients were included. The intervention group (63 patients) S/F ratio recovered versus the fall of the control group. Both groups had similar organ dysfunction and 28-day mortality. The intervention group had significantly (p Conclusions: The administration of inhaled budesonide and ipratropium bromide improved oxygenation, as assessed by the S/F ratio, and significantly reduced the rate of ARDS development and the requirement of MV versus the control group. Larger multi-center trials including diverse patient populations are needed to validate these results.

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BackgroundWhile guidelines recommend intravenous magnesium (IVMg) for refractory pediatric acute asthma, evidence for benefit is scant and disparate. IVMg therapy is resource-intensive and can cause hypotension. To determine if IVMg alters the exacerbation course, it must be given early, and the clinical effect measured at the peak effect of routine co-interventions.Primary aimIn children with acute asthma remaining in moderate-severe respiratory distress after initial ED therapy, to determine if early IVMg therapy is associated with a significantly greater improvement in respiratory distress at 2 hours after starting IVMg, compared to placebo.HypothesisIVMg will yield significantly greater Pediatric Respiratory Assessment Measure (PRAM) improvement of ≥1.0 point than placebo.Study designA randomized double-blind placebo-controlled trial in 6 Canadian pediatric EDs of otherwise healthy children 2-17 years old with acute asthma and PRAM ≥5 after initial 1 hour therapy with systemic corticosteroids and 3 inhaled salbutamol ± ipratropium treatments.InterventionIVMg sulfate (75 mg/kg, max 2.5 g) or normal saline placebo over 30 minutes.Primary outcomePRAM 2 hours post-intervention start. Secondary: PRAM ≤3 at 2 hours; change in PRAM and vital signs over 3 hours; hospitalization; asthma re-visits by 72 hours.Sample sizeWith 192 patients, a two-sided test and alpha 0.05 have 80% power to achieve statistical significance if IVMg yields a difference in PRAM changes ≥1.0 point between groups.Primary analysisStudent's t test comparing a difference in PRAM changes between groups.Expected outcomesThis trial will clarify if there is an incremental clinical benefit of IVMg in pediatric refractory asthma. A positive result will establish a proven routine standard of care for this indication; a negative result will lead to de-implementation of IVMg which may also lead to cost savings.StatusEnrolling at SickKids and McMaster, start of other sites pending. No results generated yet.Study titleMagnesium Trial in Acute Asthma in Emergency Department.

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Abstract Background Chronic Obstructive Pulmonary Disease (COPD) represents a major global health burden. While most COPD trials focus on acute exacerbations, there is limited evidence in stable COPD. Prior research on nebulized furosemide was also predominantly in exacerbated COPD patients. Objective We aimed to evaluate the impact of adding nebulized furosemide as adjuvant therapy to conventional treatments in patients with very severe stable COPD. Methods We conducted a triple-blinded, crossover, randomized controlled trial at Alexandria University Hospital Chest Clinic. Patients with stable COPD were randomized to receive either nebulized furosemide or saline plus salbutamol-ipratropium, with crossover after a washout period. Spirometry was performed at baseline and after each treatment. Results 92 patients completed the trial. Compared to saline, furosemide significantly improved FVC, FEV1, and FEV1/FVC ratio. Furosemide increased FVC by 9.42% versus 5.83% with saline (p 

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