From the descriptive synthesis, IB + salbutamol showed significant improvement on pulmonary function at 120 mins after treatment regarding the predict % FEV1 and absolute FEV1. The substantial heterogeneity may be explained by the different treatment durations among the five studies in the meta-analysis. Regarding the subgroup analysis, there was a significant difference in hospital admission according to severity of illness (test for subgroup differences: 2 = 12.79, df = 5, p = 0.03, I2 = 60.9%). Ask your doctor or pharmacist for more information. Since this last publication, there have been numerous studies published, and thus, this systematic review and meta-analysis was performed to update the evidence comparing salbutamol alone with IB + salbutamol for identifying the impact of the combination treatment in children and adolescents with asthma. We performed subgroup analysis to determine whether age, severity of asthma, and co-intervention influenced the effect of IB + salbutamol treatment on hospital admission. Five studies were considered to be at high risk of bias, one of which was due to random sequence generation [23], two due to blinding setting [17,24] and the other two due to selective reporting on predefined outcomes [12,25]. Zhimin Chen, The analyses of patients age, severity of asthma, and co-interventions were conducted with subgroup data from original studies and resulted consistent conclusion with 2013 review [14]. If you are using the inhaler, your medication will come in cartridges. consort randomized exacerbation salbutamol nebulizer ipratropium Moreover, 23 studies reported that the treatment duration of IB + salbutamol was less than 120 minutes (median = 60 minutes), 18 studies reported that treatment duration ranged between 3 days and 40 weeks (median = 7 days); and 14 studies did not report treatment duration (S5 Appendix). If you already have narrow angle glaucoma, your condition may worsen. Three trials reported a number of zero on adverse events in both intervention and comparison groups [35,36,40]. Place the mouthpiece in your mouth and close your lips around it. tell your doctor if you have or have ever had glaucoma (an eye condition); difficulty urinating; a blockage in your bladder; a prostate (a male reproductive gland) condition; seizures; hyperthyroidism (condition in which there is too much thyroid hormone in the body); high blood pressure; an irregular heartbeat; diabetes; or heart, liver, or kidney disease. Hold your breath for 10 seconds or as long as you comfortably can. In China, asthma affects 3% of children 14 years of age and the prevalence of childhood asthma has increased by 50% over the past 10 years [2]. uncontrollable shaking of a part of the body, swelling of the eyes, face, lips, tongue, throat, hands, feet, ankles, or lower legs, sore throat, fever, chills, and other signs of infection. Yes In addition, the true heterogeneity in intervention effects may also be a potential source of asymmetry. Data extraction was independently performed by two reviewers. Data were synthesized and analyzed using RevMan version 5.3 [16]. Although IB does not seem to be very efficient in controlling asthma, several studies have demonstrated that a combination of IB and SABAs is associated with fewer hospitalizations and greater improvement in peak expiratory flow (PEF) and forced expiratory volume in one second (FEV1) compared with SABA alone in children and adolescents with moderate-to-severe asthma exacerbation [1015]. Store the medication at room temperature and away from excess heat and moisture (not in the bathroom). Resources, The .gov means its official. [9], "DailyMed - ipratropium bromide and albuterol sulfate inhalant", "Albuterol / ipratropium Use During Pregnancy", "Ipratropium and Albuterol - FDA prescribing information, side effects and uses", "Albuterol; Ipratropium - Drug Usage Statistics", "Phase Out of Combivent Inhalation Aerosol - Questions and Answers", Consumer Medication Information from PubMed, Beclometasone/formoterol/glycopyrronium bromide, Budesonide/glycopyrronium bromide/formoterol, Fluticasone furoate/umeclidinium bromide/vilanterol, Indacaterol/glycopyrronium bromide/mometasone, Octatropine methylbromide (anisotropine methylbromide), 3-Quinuclidinyl thiochromane-4-carboxylate, Scopolamine butylbromide (hyoscine butylbromide), Nicotinic acetylcholine receptor modulators, Acetylcholine metabolism/transport modulators, https://en.wikipedia.org/w/index.php?title=Ipratropium_bromide/salbutamol&oldid=1089447903, Chemical pages without DrugBank identifier, Drugs that are a combination of chemicals, Wikipedia medicine articles ready to translate, Creative Commons Attribution-ShareAlike License 3.0, This page was last edited on 23 May 2022, at 21:09. e0237620. What should I know about storage and disposal of this medication? However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Then repeat these steps three more times. Also tell your doctor if you are taking any of the following medications or if you have stopped taking them within the past 2 weeks: antidepressants such as amitriptyline amoxapine; clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); or monoamine oxidase (MAO) inhibitors such as isocarboxazid (Marplan), phenelzine (Nardil), tranylcypromine (Parnate), and selegiline (Eldepryl, Emsam, Zelapar). Lin Tong, Since the last systematic review published in 2013 [14], a considerable number of new studies evaluating the efficacy and safety of IB + salbutamol compared with those of salbutamol alone for the treatment of asthma exacerbation in children and adolescents have been published. Assessment of the full text at second-level screening removed another 32 records. Practice using the inhaler or nebulizer while he or she watches. Combined inhaled beta-agonist and anticholinergic agents for emergency management in adults with asthma. Be careful not to touch the piercing element inside of the base. The Eggers test indicated the presence of funnel plot asymmetry for hospital admission (t = -2.404, p = 0.03), but not for relapse rate (t = -0.851, p = 0.42) (S12 Appendix). Repeat steps 4-6 until you see a spray coming out of the inhaler. You can press the inhaler against a hard surface to be sure it is inserted correctly. Is the Subject Area "Asthma" applicable to this article? There is a lack of consistency in clinical practice regarding the treatment of asthma exacerbation in children and adolescents. This branded product is no longer on the market. https://doi.org/10.1371/journal.pone.0237620.g003, https://doi.org/10.1371/journal.pone.0237620.t001. (2021) Combination of ipratropium bromide and salbutamol in children and adolescents with asthma: A meta-analysis. Therefore, a descriptive synthesis of aforementioned outcomes was performed instead. Patients of severe asthma (PEFR <50% of predicted) were enrolled into control group (Salbutamol only) and case (Salbutamol + Ipratropium bromide) group. One study [23] was not included in the meta-analysis because it reported a number of zero on hospital admission in intervention and comparison groups. There was no limitation of language. Consistent with previous systematic review [14], nausea, vomiting, and tremors were listed as secondary outcomes because of the direct treatment-related effects of salbutamol or ipratropium bromide. Of the 1061 studies that were identified, 55 met the inclusion criteria and involved 6396 participants. It is also important information to carry with you in case of emergencies. In addition, the treatment dosage, frequency and duration were varied in trials which may be a potential source of heterogeneity. If you do not use your inhaler for more than 21 days, you will need to follow steps 4-7 to prime the inhaler again. Copyright, 2022. Ipratropium bromide/salbutamol, is sold under the brand name DuoNeb as a nebulized solution,[1] is a combination medication used to treat chronic obstructive pulmonary disease (COPD). Finally, 55 RCTs were included. Twist off the top of the vial and squeeze all of the liquid into the reservoir of the nebulizer. However, the review found no effect of age and co-intervention (such as steroid or standard care) on the hospital admission rate to treatment. Thirdly, the applicability of results from the present review should be concluded with caution. if you are having surgery, including dental surgery, tell the doctor or dentist that you are using albuterol and ipratropium inhalation. [3] In 2019, it was the 151st most commonly prescribed medication in the United States, with more than 4million prescriptions. The significant improvement on predict % FEV1 at 60 mins after treatment of IB + salbutamol was observed only in one study. 
These RCTs involved 6396 participants and met the inclusion criteria for this review (Fig 1) (for full references, refer to S4 Appendix). Additionally, there were no significant differences in the age subgroup (2 = 1.16, df = 2, p = 0.56, I2 = 0%) or the co-intervention subgroup (2 = 0.73, df = 3, p = 0.87, I2 = 0%) (for details, refer to S7 Appendix). If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911. Albuterol and ipratropium combination works by relaxing and opening the air passages to the lungs to make breathing easier. Before you use albuterol and ipratropium inhalation for the first time, read the written instructions that come with the inhaler or nebulizer. 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. government site. and transmitted securely. Disclaimer, National Library of Medicine To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location one that is up and away and out of their sight and reach. The included 55 RCTs (53 published trials and 2 unpublished trials [21,22]) were from both developing and developed countries, including Australia, China, Canada, Chile, Greece, India, Mexico, Pakistan, Spain, Turkey, Thailand, the United Kingdom, and the United States. Yes Cochrane Database Syst Rev. Each cartridge of albuterol and ipratropium inhalation spray is designed to provide 120 inhalations. Before No, Is the Subject Area "Receptor antagonist therapy" applicable to this article? The initial electronic database search identified a total of 1056 references. Call your doctor if your symptoms worsen, if you feel that albuterol and ipratropium inhalation no longer controls your symptoms, or if you find that you need to use extra doses of the medication more often. MeSH Then at 30 minutes after nebulization, the meanSD percentage increase in peak flow was greater in combination group (60.0135.01%) than Salbutamol group (44.4725.03%) with difference of 16% (p=0.025). For more information about PLOS Subject Areas, click Additionally, there was no significant difference in oxygen saturation (p = 0.18, very low quality evidence), need for extra medication (repeated bronchodilator treatments (p = 0.32, moderate quality evidence), systemic corticosteroids (p = 0.41, moderate quality evidence)), and relapse rate (p = 0.85, moderate quality evidence) between the two groups (S9 Appendix). Memon BN, Parkash A, Ahmed Khan KM, Gowa MA, Bai C. Am J Med. An electronic search for studies published up to September 2020 using the MeSH descriptor asthma, respiratory sounds, bronchial spasm, bronchoconstriction, bronchial hyperreactivity, respiratory hypersensitivity, ipratropium, albuterol, salbutamol, child, preschool, and pediatrics were conducted using the following databases: MEDLINE, Embase, Cochrane Library, China Biological Medicine Database, Chinese National Knowledge Infrastructure, Chongqing VIP, and Wanfang Chinese language bibliographic database (S2 Appendix). Any dispute was resolved by mutual consensus with a third investigator. However, none of the other three outcomes showed significant differences between the two groups (p > 0.05) with moderate or low-quality evidence (S10 Appendix). Use the missed dose as soon as you remember it. The https:// ensures that you are connecting to the To start, take the inhaler out of the box, and keep the orange cap closed. Formal analysis, Studies were rated on each variable as low risk, high risk, or unclear risk of bias. Contrary to the review by Griffiths (2013) [14], the increase in lung function observed with the combined treatment was not associated with an increase in oxygen saturation. A random effects model with a 95% confidence interval (CI) was used. The differences may also affect the applicability of the present review results. The inhaler that comes with albuterol and ipratropium spray is designed for use only with a cartridge of albuterol and ipratropium. Among them, one study reported dyspnea scores with moderate quality evidence [43]; one reported respiratory distress scores with moderate quality evidence [44]; five reported wheeze scores with low quality evidence [12,4143,45]; two reported asthma scores with very low quality evidence [11,29]; two reported wheezing sound scores with very low quality evidence [41,43]; one reported cough scores with low quality evidence [43]; and one reported clinical scores based on clinical examination, activity, and speech with low quality evidence [46], with three of them significantly favoring IB + salbutamol therapy [11,42,43]. Continuous scales of measurement were expressed as a mean difference. Secondary outcomes included pulmonary function (including percentage change from baseline of predicted % forced expiratory volume in one second [FEV1]; percentage change from baseline of FEV1; and change from baseline in respiratory resistance); clinical score (as defined by original studies, including accessory muscle, asthma, cough, dyspnea, wheeze, wheezing sound, and daytime/night-time symptoms scores); oxygen saturation; need for extra medication (including systemic corticosteroids and repeated bronchodilators); specific adverse events (including dry mouth, nausea, vomiting, and tremor); and relapse rate (defined as a return visit within a certain time that was predefined by original studies). Based on reporting in the remaining five trials [30,33,3739], 65 out of 349 participants had adverse events in the IB + salbutamol group, and 47 out of 348 participants had adverse events in the salbutamol alone group. See the FDA's Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program. After evaluating the titles and abstracts at first-level screening, 87 records were included. Asthma is the most common chronic disease among children and is estimated to affect 300 million individuals worldwide [1]. Subgroup analysis only showed significant difference in the risk of hospital admission in participants with severe asthma exacerbation (RR 0.73; 95% CI 0.600.88; p = 0.0009; I2 = 4%) and moderate-to-severe exacerbation (RR 0.69; 95% CI 0.500.96; p = 0.03; I2 = 3%). Resources, Affiliation Firstly, because of the different diagnostic criteria of childhood asthma, the external validity of the studies is quite poor. Publication bias was analyzed using funnel plots and Eggers test for outcomes when there were more than 10 studies. 2017 Jan 11;1(1):CD001284. 
However, contrary to the findings of Griffiths (2013) [14], IB + salbutamol showed no significant reduction in the risk of hospital admission in patients with co-intervention of steroid. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. The results of meta-analysis on these five trials (with 697 participants) [30,33,3739] showed no significant differences on the incidence of adverse events between the compared groups (RR 1.77; 95% CI 0.634.98; p = 0.28; I2 = 77%, Fig 4). 
The site is secure. The very low to high quality of evidence indicated that future well-designed double-blind RCTs with large sample are needed for research on evaluating the effectiveness of IB + salbutamol treatment for asthma in children and adolescents. It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. Never use it to inhale any other medication, and do not use any other inhaler to inhale the medication in a cartridge of albuterol and ipratropium. Do not let anyone else use your medication. tell your doctor and pharmacist if you are allergic to ipratropium (Atrovent), atropine (Atropen), albuterol (Proventil HFA, Ventolin HFA, Vospire ER), levalbuterol (Xoponex), any other medications, or any of the ingredients in albuterol and ipratropium solution or spray. Therefore, future studies may be suggested to explore the most appropriate treatment dosage and duration for children and adolescents with asthma. The study reported respiratory resistance at 60 and 120 min [19,28] showed no significant difference between IB + salbutamol and salbutamol alone groups. The most recent systematic review comparing IB + SABA and SABA alone for the treatment of acute asthma in children and adolescents was published in 2013 and reported a combined treatment benefit as evidenced by a decrease in the risk of hospital admission and improved lung function and clinical scores [14]. For more information about PLOS Subject Areas, click According to the moderate to very low quality of evidence, it could be suggested that further well-conducted and adequately powered RCTs with double-blind settings, large sample size, and standardized outcome measures are needed to evaluate the effectiveness of IB + salbutamol in treatment of asthma in children and adolescents. Follow the manufacturer's directions carefully and ask your doctor or pharmacist if you have any questions about cleaning your inhaler or nebulizer. [6] It is available as a generic medication. Writing review & editing, * E-mail: [emailprotected] (ZC); [emailprotected] (LF). Yes Peng Gao, Consistent with previous systematic reviews [14,50], IB + salbutamol could significantly improve the predicted % and absolute % change in FEV1 at both 60 and 120 minutes after treatment compared with salbutamol alone. In case of overdose, call the poison control helpline at 1-800-222-1222. No, Is the Subject Area "Randomized controlled trials" applicable to this article? Subgroup analysis was performed for primary outcomes based on the following characteristics: 1) age (<6, 6 years); 2) severity of disease (mild, moderate, severe, mild-to-moderate, or moderate-to-severe, as defined by original studies); and 3) presence of combined co-intervention (with steroid, without steroid, or with standard care, as defined by original studies) (for details, refer to S3 Appendix). Do not use more or less of it or use it more often than prescribed by your doctor. [2][3][4] It contains ipratropium (an anticholinergic) and salbutamol (albuterol, a 2-adrenergic agonist). Yes Albuterol and ipratropium may cause other side effects. This review was informed by and reported using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [1618] (S1 Appendix). 8600 Rockville Pike Click through the PLOS taxonomy to find articles in your field. In a view of different recommendation the present study is undertaken in Bangladeshi patients. Another explanation could be the updated search date. Do not use the inhalation spray more than six times in 24 hours. significantly salbutamol sal cardiology 2004 Feb;71(2):121-4. doi: 10.1007/BF02723090. Put the rest of the vials back into the pouch until you are ready to use them. Writing original draft, Affiliation FOIA All characteristic information was collected based on reported data from original studies. A random effects model was used to calculate pooled effect estimates comparing the outcomes between the intervention and control groups. [2], Common side effects include sore throat, muscle cramps, and nausea. Clipboard, Search History, and several other advanced features are temporarily unavailable. After you use all 120 doses, the inhaler will lock and will not release any more medication, There is a dose indicator on the side of the inhaler that keeps track of how much medication is left in the cartridge. tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements and herbal products you are taking or plan to take. The previous review reported a wider range of intervention that included all types of combined inhaled anticholinergics and SABAs, which may have included studies focused on terbutaline. When the pointer on the dose indicator enters the red area, the cartridge contains enough medication for 7 days and it is time to refill your prescription so that you will not run out of medication. To evaluate the efficacy and safety of IB + salbutamol in the treatment of asthma in children and adolescents. Press the dose release button. Although the subgroup analyses might have contained overlap and non-randomized participants, the result could probably suggest the benefits in children and adolescents with severe asthma exacerbation (RR 0.71; 95% CI 0.600.85) and moderate-to-severe asthma exacerbation (RR 0.69; 95% CI 0.500.96), which is consistent with the results of a previous systematic review [14]. https://doi.org/10.1371/journal.pone.0237620.g001. Two independent assessors conducted quality assessment, and any disagreement was settled by reaching a consensus or consulting a third researcher. The differences in methodological quality might be a potential source of funnel plot asymmetry in hospital admission. Department of Pharmacy, The Childrens Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, Zhejiang, China, Roles Quality analysis was performed on the basis of aforementioned methods and tools. The combination of albuterol and ipratropium is used to prevent wheezing, difficulty breathing, chest tightness, and coughing in people with chronic obstructive pulmonary disease (COPD; a group of diseases that affect the lungs and airways) such as chronic bronchitis (swelling of the air passages that lead to the lungs) and emphysema (damage to the air sacs in the lungs). [2] Other side effects may include bronchospasm, allergic reactions, and upper respiratory tract infections. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients. Keep this medication in the container it came in, tightly closed, and out of reach of children. 
American Society of Health-System Pharmacists, Inc. Disclaimer, U.S. Department of Health and Human Services, Put the inhaler together before you use it for the first time. The frequency of IB + salbutamol treatment ranged from every 10 minutes to every 24 hours. 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 earliest record date to September 2020 for randomized controlled trials in children and adolescents (18 years) with asthma who received IB + salbutamol or salbutamol alone. Concomitant bronchodilator therapy and ipratropium bromide. Sit in a comfortable, upright position and turn on the compressor. No, Is the Subject Area "Systematic reviews" applicable to this article? Consistent with the findings of Castro-Rodriguez (2015) [50], patient age did not alter the effect of IB + salbutamol on reduction of the risk of hospital admission. The inhaler is now primed and ready for use. In sensitivity analysis omitting enrolled studies in turn, the results remained consistent across different analyses, which suggested that the findings were reliable and robust (for details, refer to S11 Appendix).
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