Ipratropium does indeed reduce admissions to hospital with severe asthma

Editor—We agree with Plotnick and Ducharme that inhaled anticholinergics should be added to β₂ agonists for treating acute asthma in childhood and adolescence.¹ In a follow up to our original study² we conducted a large (434 children) prospective double blind study in children with moderate or severe asthma treated with two doses of ipratropium bromide.³ Briefly, we found that the rate of admission to hospital was reduced from 52.6% to 37.5% in children with severe asthma. Thus, 6.6 children with severe asthma (95% confidence interval 3.7 to 29.4) would need to be treated with ipratroprium to avoid one admission to hospital. Ipratropium had no effect on the rate of admission of children with moderate asthma. Our study therefore strengthens the authors’ conclusions regarding the use of ipratropium bromide in acute asthma.