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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 J+Pediatr+Pharmacol+Ther
2015 ; 20
(1
): 66-9
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Continuous Inhalation of Ipratropium Bromide for Acute Asthma Refractory to
?2-agonist Treatment
#MMPMID25859173
Koumbourlis AC
; Mastropietro C
J Pediatr Pharmacol Ther
2015[Jan]; 20
(1
): 66-9
PMID25859173
show ga
To present the case of a patient with persistent bronchospasm, refractory to
treatment with ?2-agonists, that resolved promptly with continuous inhalation of
large dose (1000 mcg/hr) ipratropium bromide, and to discuss the possibility of
tolerance to ?2-agonists as the cause for his failure to respond to adrenergic
medications. The patient had received multiple doses of albuterol, as well as
subcutaneous terbutaline (0.3 mg), intravenous magnesium sulfate (1 g) and
intravenous dexamethasone (10 mg) prior to his admission to the intensive care
unit. He remained symptomatic despite systemic intravenous steroids, continuous
intravenous terbutaline (up to 0.6 mcg/kg/min), and continuous nebulized
albuterol (up to 20 mg/hr for 57 hr) followed by 49 hours of continuous
levalbuterol (7 mg/hr). Due to the lack of response, all ?2-agonists were
discontinued at 106 hours post-admission, and he was started on large dose
ipratropium bromide (1000 mcg/hr) by continuous nebulization. Clinical
improvement was evident within 1 hour and complete resolution of his symptoms
within 4 hours. Continuous inhalation of large dose ipratropium bromide may be an
effective regimen for the treatment of patients hospitalized with acute asthma
who are deemed to be nonresponsive and/or tolerant to ?2-agonist therapy.