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Ipratropium

Dose:

  • Nebulized, single, intermittent
    • 500 mcg every 20 minutes PRN X 3 doses with the single dose nebulized albuterol treatment
  • Nebulized, continuous
    • 1500 mcg/hour X 1 hour with the 1-hour continuous albuterol treatment

Key Result:
We concur with the (GINA, 2018) guideline and recommend IB be used in conjunction with albuterol and corticosteroids in patients with severe asthma exacerbations, or exacerbations that do not respond to initial therapy. This recommendation is based on high quality evidence that the addition of IB decreases hospital admissions in the population (OR = 0.6, 95% CI [0.45, 0.60]), and moderate quality evidence that the change from baseline forced expiratory volume in 1 second, percent  predicted (FEV1, % predicted) at 60 minutes past the IB treatment is greater (Mean difference = 10.08, 95% CI [6.25, 13.92].

For additional information click here for the Ipratopium Critically Appraised Topic (CAT)

References:
GINA. (2018). Global Strategy of Asthma Management and Prevention.

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.