Decreased duration of emergency department treatment of chronic obstructive pulmonary disease exacerbations with the addition of ipratropium bromide to β-agonist therapy

Mahesh Shrestha, Terence O'Brien, Robert Haddox, H. Scott Gourlay, Gary Reed

Research output: Contribution to journalArticle

36 Scopus citations


Study objectives: To determine the benefit of the addition of ipratropium bromide to β-agonist therapy of acute exacerbations of chronic obstructive pulmonary disease. Design: The trial was randomized and double blinded. Setting: The study was conducted in the emergency department of Parkland Memorial Hospital, a busy, inner-city, county hospital. Interventions: Patients were treated in the medicine emergency department with either the standard regimen of nebulized isoetharine, 0.5 mL of a 1% solution (5.0 mg) diluted to 2.0 mL with normal saline every hour (control group) or with the same regimen plus ipratropium bromide, 54 μg (three puffs) after the first isoetharine treatment and 36 μg (two puffs) after the second and fourth (experimental group). A placebo metered-dose inhaler used in the same manner as the ipratropium blinded the study to both the patients and medical personnel. Measurements and main results: The group treated with the addition of ipratropium (30) was discharged from the ED an average of 91 minutes (P < .05) sooner than the control group (25) and required on the average one less isoetharine treatment (P < .05). The pulmonary functions tested, forced expiratory volume in the first second, and the forced vital capacity were the same in the two groups initially and on discharge, as identical discharge criteria were used in each group. Conclusion: The addition of ipratropium to standard β-agonist treatment of chronic obstructive pulmonary disease exacerbations shortens the duration of treatment required in the ED.

Original languageEnglish (US)
Pages (from-to)1206-1209
Number of pages4
JournalAnnals of emergency medicine
Issue number11
StatePublished - Nov 1991



  • chronic obstructive pulmonary disease
  • ipratropium bromide
  • β-agonists

ASJC Scopus subject areas

  • Emergency Medicine

Cite this