Although inhaled ipratropium has been demonstrated to be beneficial in the ED setting, the NHLBI guidelines1 reviewed 2 studies in children that have failed to demonstrate any benefit of adding ipratropium once the patient is hospitalized. Children with a pulse oximetry reading below 92% to 94% often require hospitalization.1 Children younger than 5 years are generally unable to perform spirometry or peak flow testing. Infants have a higher risk of respiratory failure, and their response to inhaled ß2-agonist therapy is more unpredictable, so careful monitoring is essential.
If the child responds poorly to initial therapy and requires admission, ipratropium should be continued in the inpatient setting.
1. National Asthma Education and Prevention Program. Expert panel report 3: guidelines for the diagnosis and management of asthma (EPR-3 2007). NIH Publication No. 08–4051. Bethesda (MD): U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; 2007. Available at www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm. Accessed 22 Jul 2008.
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Updated 9/22/08 nvf