Cook 1985.

Methods	Randomised double‐blind parallel group trial. Method of randomisation not reported Emergency Department setting No intention to treat population
Participants	N = 48 (Group 1: 16; Group 2: 16; Group 3: 16). 26 M/22 F. Mean age 6.6 years (age range 18 months to 12 years). 3 withdrawals due to requirement of IV therapy (1 from each group) Inclusion criteria: moderately severe acute asthma based on clinical presentation Exclusion criteria: patients deemed to require IV therapy
Interventions	All treatments were administered via a Hudson nebuliser driven by oxygen (flow rate 8 L/min) Group 1: ipratoprium bromide (0.025%) 1 mL i.e. 250 mcg (1 to 4 years); 1.5 mL i.e. 375 mcg (5 to 8 years); 2 mL i.e. 500 mcg (9 to 12 years) Group 2: fenoterol (0.5%) 0.125 mL i.e. 625 mcg (1 to 4 years); 0.25 mL i.e. 1250 mcg (5 to 8 years); 0.5 mL i.e. 2500 mcg (9 to 12 years) Group 3: ipratropium bromide + fenoterol (same dosage as above) Duration 2 hours. Repeat nebulisations at 2‐hourly intervals until stable enough to return to inhaled or oral medication
Outcomes	Repeat nebulisation; pulse rate; respiratory rate; clinical rating of wheeze; air entry; respiratory distress; overall index of response to treatment
Notes	Plotnick and Ducharme contacted trialists and established that allocation concealment was adequate. Different volumes of trial medication were given according to age of the participants in each treatment group. The trial was described as 'double‐blind' and it was not reported how the blinding of the trialists to the treatment was maintained
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Not reported
Allocation concealment (selection bias)	Unclear risk	Not reported
Blinding (performance bias and detection bias) All outcomes	Low risk	All doses administered blind