Phase I, Placebo-Controlled, Blinded Pilot Study of Ipratropium in Children Admitted to the ICU With Status Asthmaticus

A Phase I, Single Center, Placebo-Controlled, Blinded Pilot Study of Ipratropium Bromide in Children Admitted to the Intensive Care Unit With Status Asthmaticus

This study is a Phase I study to investigate the addition of inhaled Ipratropium bromide to standard therapy in the treatment of severe asthma attacks in children admitted to the Pediatric Intensive Care Unit. Half of the subjects will receive inhaled Ipratropium, and half will receive an inhaled placebo.

Status asthmaticus is an acute exacerbation of asthma that often requires treatment in a pediatric intensive care unit (PICU). Standard therapies for status asthmaticus include corticosteroids and bronchodilators, typically albuterol. Ipratropium bromide is also a bronchodilator, but has a different mechanism of action than albuterol. The addition of Ipraropium to children in the Emergency Room with severe asthma exacerbations improves outcomes, so many PICU doctors treat patients with status asthmaticus with Ipratropium. However, two studies of children hospitalized in the general wards of the hospital (not the PICU) show that the addition of Ipratropium to standard care does not effect clinical outcomes. This study is a first step towards determining in Ipratropium is helpful in PICU patients (like it is in ER patients) or if it not helpful (like it is in general ward patients).

Inclusion Criteria:

• Admission to the PICU
• Treatment with continuous albuterol via the Asthma Carepath
• Enrollment occurred within 4 hours of starting continuous albuterol in the PICU
• Treatment with systemic corticosteroids by the clinical team

Exclusion Criteria:

• First episode of wheezing that prompted treatment with bronchodilators by medical personnel
• Prior enrollment in this study
• Patients with chronic lung disease requiring routine home oxygen use
• Allergy to inhaled ipratropium or inhaled saline
• Positive pressure ventilation (via an endotracheal tube or a non-invasive mask [e.g. CPAP (continuous positive airway pressure) or BiPAP])
• Pregnancy
• Tracheostomy
• Age < 2 years
• Age > 17 years
• Patient with pulmonary hypertension requiring daily therapy
• Patient with cyanotic congenital heart disease
• Cystic fibrosis