Use of inhaled/nebulised ipratropium bromide in addition to standard first-line treatment with inhaled/nebulised short-acting beta 2-agonist and systemic steroid in the management of acute asthma exacerbations: a systematic review and meta-analysis of randomised controlled trials
Bibliographic record
Abstract
Background The role of inhaled/nebulised ipratropium bromide (IB) in asthma is unclear. Aims To assess the efficacy and safety of inhaled/nebulised IB for asthma management in children. Methods We searched MEDLINE, EMBASE, CINAHL, the Cochrane Central Register of Controlled Trials and the Web of Science until July 2024. We included randomised controlled trials (RCTs) and followed international guidelines for reporting systematic reviews. Outcomes included morbidity, escalation of care, length of hospital stay, mortality, adverse events and lung function. Results We included 24 studies (total participants n=3238). The hospitalisation rate (risk ratio (RR) 0.84, 95% CI 0.70 to 1.00, I ² 30%), hospital stay in hours (MD 1.75, 95% CI −0.87 to 4.36, I ² 15%) and paediatric intensive care (PICU) admission (RR 0.91, 95% CI 0.35 to 2.32, I ² 0%) were similar. The hospitalisation rate was lower in patients who received IB nebuliser (RR 0.76, 95% CI 0.64 to 0.90, I ² 0%). The asthma severity score was significantly better in the IB group (MD −0.38, 95% CI −0.63 to −0.12, I 2 59%). No serious adverse events were reported. Conclusion This review found high-certainty evidence that the IB nebuliser leads to a lower hospitalisation rate. However, when inhaled/nebulised IBs were analysed together, the hospitalisation rate was similar, with moderate certainty evidence. IB improved asthma clinical scores, with low certainty evidence. No difference was reported in other prespecified outcomes. Considering the current evidence and safety profile, inhaled/nebulised IB needs to be considered as an additional treatment for acute asthma exacerbation. PROSPERO registration number CRD42023405023.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.024 |
| Meta-epidemiology (narrow) | 0.003 | 0.002 |
| Meta-epidemiology (broad) | 0.028 | 0.035 |
| Bibliometrics | 0.006 | 0.006 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.001 |
| Research integrity | 0.003 | 0.002 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".