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Is Ipratropium Bromide useful in children with moderate Asthmatic Crisis? Experience of a Pediatric Emergency Department
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  • F. Javier Brincau-García,
  • Irene Comino-Hidalgo,
  • Irene Gil-Angel,
  • María Escobar Castellanos,
  • Rafael Marañón,
  • Ana Jové-Blanco
F. Javier Brincau-García
Hospital Materno Infantil Gregorio Maranon

Corresponding Author:[email protected]

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Irene Comino-Hidalgo
Hospital Materno Infantil Gregorio Maranon
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Irene Gil-Angel
Hospital Materno Infantil Gregorio Maranon
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María Escobar Castellanos
Hospital Materno Infantil Gregorio Maranon
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Rafael Marañón
Hospital Materno Infantil Gregorio Maranon
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Ana Jové-Blanco
Hospital Materno Infantil Gregorio Maranon
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Abstract

INTRODUCTION: The treatment of moderate asthmatic exacerbations in children is controversial, specifically concerning whether ipratropium bromide (IB) should be combined with beta-2-short agonist and corticosteroids. In 2021, in our hospital, the use of IB was discontinued in moderate asthma exacerbation in our Pediatric Emergency Department (PED). OBJECTIVE: Compare the admission rate, average length of stay in the PED, Pulmonary Score (PS) at discharge, and revisits before and after discontinuing the use of IB in moderate asthmatic exacerbations. METHODS: single-center, retrospective, cohort study. Patients from 6 to 16 years who attended the PED with moderate asthmatic crisis (Pulmonary Score [PS]: 4-6) were included. Medical records were consulted in two periods: Cohort 1 (children received inhaled salbutamol, ipratropium bromide (IB) and systemic glucocorticoids, 01/09/2018-01/09/2019) and Cohort 2 (treatment with salbutamol and systemic glucocorticoids, 01/09/2021-01/09/2022) The relationship between the use of IB and the outcome variables was analyzed: admission rate and revisits (Chi-square), PED length of stay and PS score at discharge (Student’s T test). Multivariable analysis was performed to evaluate the potential association between variables and predictive factors for admission. RESULTS: 351 patients were included: 174 (49.6%) in Cohort 1 and 177 (50.4%) in Cohort 2. IB was not associated with admission rate (15 [8.6%] in Cohort 1 vs 7 [4%] in Cohort 2; p0.07), median stay in the PED (2.33hours [SD:0.66] vs 2,46 hours [SD:0.85], p0.207), Pulmonary Score at discharge (0,78 [SD:0.85] vs 0,92 [SD:0.79]; p0.137) nor revisits (25 [14,5%] vs 14 [7,9%]; p0.052); p0.207). CONCLUSION: IB does not seem useful in moderate asthmatic exacerbations.