Combination inhaler treatment in emergency departments may reduce admissions for asthma attacks

Using a combination of two inhaled drugs to open the airways may modestly reduce the need to admit an adult with asthma attack to hospital, though the underlying evidence is weak | NIHR Signal

The first-line treatment for an asthma attack is an inhaled β2 agonist, like salbutamol. This Cochrane review compared emergency department treatment with this drug alone, or combined with an inhaled short-acting anticholinergic, like ipratropium bromide.

Pooled results from 16 trials included found that combination therapy would mean about 65 fewer patients per 1000 are admitted to hospital. As most underlying trials were conducted outside the NHS, the admission rates are likely to be quite different in the UK.

Short-term minor adverse effects were more common with combined therapy.

The evidence suggests combination treatment is most effective in severe attacks and this is consistent with current UK guideline recommendations.

Asthma places a large burden on the NHS and reducing hospital admissions may spare resources. Further study could usefully explore the optimal drug dose and delivery method in a UK setting.

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