Nebulised salbutamol with and without ipratropium bromide in acute airflow obstruction

Lancet. 1989 Jun 24;1(8652):1418-20. doi: 10.1016/s0140-6736(89)90126-8.


103 patients with acute airflow obstruction (56 asthma, 47 chronic obstructive pulmonary disease [COPD]) completed a double-blind trial of nebulised bronchodilator treatment in a hospital accident and emergency department. Each patient was randomised to receive either 10 mg of salbutamol nebuliser solution in 2 ml of saline or 10 mg of salbutamol in 2 ml (0.5 mg) of preservative-free ipratropium bromide. Peak flow rate (PFR) was recorded before treatment and 1 hour after beginning nebulised treatment. In 23 asthmatic patients given salbutamol alone PFR rose by a mean 31% 1 hour after treatment whereas in 33 such patients given combined treatment it rose by a mean 77% (95% confidence interval for the difference 8-84%). Patients whose PFR was below 140 l/min at entry gained maximum benefit from the combined treatment. For COPD patients the PFR rise was almost identical for both treatments. In acute asthma the immediate PFR response to a mixture of salbutamol and ipratropium bromide was better than the response to nebulised salbutamol alone. For COPD patients, the two treatments were of equal benefit.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Albuterol / administration & dosage*
  • Albuterol / therapeutic use
  • Asthma / drug therapy*
  • Asthma / physiopathology
  • Atropine Derivatives / administration & dosage*
  • Clinical Trials as Topic
  • Double-Blind Method
  • Drug Evaluation
  • Drug Therapy, Combination
  • Humans
  • Ipratropium / administration & dosage*
  • Ipratropium / therapeutic use
  • Lung Diseases, Obstructive / drug therapy*
  • Lung Diseases, Obstructive / physiopathology
  • Middle Aged
  • Nebulizers and Vaporizers
  • Peak Expiratory Flow Rate
  • Random Allocation


  • Atropine Derivatives
  • Ipratropium
  • Albuterol