human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Twenty-eight infants admitted to Exequiel González Cortes Children 's Hospital because of acute wheezing ( AW ) were r and omly assigned to three study groups . Fenoterol ( FNT ) , ipratropium bromide ( IB ) , and placebo were administered respectively to children in the different groups by means of metered dose inhalers ( MDI ) with spacers , using doses of 3 puffs every hour , for 4 hours . The degree of bronchial obstruction was assessed clinical ly and scored with the single-blind method every hour prior to each treatment . The criterion of a bronchodilator effect was a significant decrease in the degree of bronchial obstruction at subsequent scorings . The scores of the three groups were compared using the Student 's t test for matched sample s. The same test was also applied to the independent sample s for determining the superiority of one treatment , FNT or IB , over the other . The results indicated a significant decrease in the scores of the groups receiving FNT and IB ( P less than 0.05 ) ; this did not occur in the group in which placebo was used . FNT produced a more rapid and sustained effect  than IB ( P less than 0.05 ) . Significant bronchodilator effect was obtained in infants with AW  when repeated doses of FNT or IB were administered with MDI and spacers . This effect was significantly greater in the group treated with FNT A multi-center , double-blind , 90-day study compared an ipratropium bromide metered-dose inhaler ( 40 microgram four times a day ) with a metaproterenol metered-dose inhaler ( 1,500 micrograms four times a day ) in 164 patients with asthma ; of the 144 patients who completed the study , 71 received ipratropium and 73 received metaproterenol . Our results suggest that both drugs were equally effective bronchodilators . Although the shape of the pulmonary function response curves suggested that ipratropium has different bronchodilator kinetics than metaproterenol ( in that it has a slower onset of action and a more prolonged duration ) , comparison of the areas under the curves for the two drugs showed that there was no statistical difference between ipratropium or metaproterenol . The only significant side effects noted with ipratropium were cough and exacerbation of symptoms ; no anticholinergic side effects were noted Thirty seven children with acute asthma were given nebulised ipratropium or placebo 30 minutes after their first dose of salbutamol and eight hourly thereafter . There were no significant differences between the two groups in clinical scores , peak expiratory flow rates , length of stay in hospital , or the need for oral steroids OBJECTIVE To determine whether the addition of inhaled ipratropium bromide to inhaled albuterol and systemic corticosteroid therapy was more efficacious than inhaled albuterol and systemic corticosteroids alone in the inpatient treatment of acute asthma exacerbations in children . DESIGN Double-blind , r and omized , placebo-controlled trial . SETTING Pediatric inpatient unit of a tertiary urban hospital . PARTICIPANTS Eighty children ( aged 1 - 18 years ) hospitalized because of an acute asthma exacerbation . INTERVENTION Children were r and omized to receive either nebulized ipratropium bromide , 250 microg , or nebulized isotonic sodium chloride solution , 1 mL. All children received albuterol and systemic corticosteroids . MAIN OUTCOME MEASURES The primary outcome variable was a vali date d clinical asthma score , measured at baseline and every 6 hours for 36 hours . Secondary outcome measures included the forced expiratory volume in 1 second , the oxygen saturation , the number of doses of inhaled study drug , the time to an inhaled drug-dosing interval of 4 hours , and the length of the hospital stay . RESULTS There were no differences between groups on baseline characteristics . The intention-to-treat analysis , using repeated- measures analysis of variance , showed no significant ( P = .07 ) difference between the groups in the clinical asthma score over time . There were also no significant differences between groups on secondary outcomes . CONCLUSION The addition of nebulized ipratropium bromide to nebulized beta(2)-agonist and corticosteroid therapy in the treatment of children hospitalized because of asthma ( following intensive emergency department treatment ) confers no extra benefit BACKGROUND Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma , but their effect on hospitalization rates is uncertain . METHODS We conducted a r and omized , double-blind , placebo-controlled study of 434 children ( 2 to 18 years old ) who had acute exacerbations of moderate or severe asthma treated in the emergency department . All the children received a nebulized solution of albuterol ( 2.5 or 5 mg per dose , depending on body weight ) every 20 minutes for three doses and then as needed . A corticosteroid ( 2 mg of prednisone or prednisolone per kilogram of body weight ) was given orally with the second dose of albuterol . Children in the treatment group received 500 microg ( 2.5 ml ) of ipratropium bromide with the second and third doses of albuterol ; children in the control group received 2.5 ml of normal saline at these times . RESULTS Overall , the rate of hospitalization was lower in the ipratropium group ( 59 of 215 children [ 27.4 percent ] ) than in the control group ( 80 of 219 [ 36.5 percent ] , P=0.05 ) . For patients with moderate asthma ( indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale ) , hospitalization rates were similar in the two groups ( ipratropium : 8 of 79 children [ 10.1 percent ] ; control : 9 of 84 [ 10.7 percent ] ) . For patients with severe asthma ( defined as a peak expiratory flow rate of < 50 percent of the predicted value or an asthma score of 12 to 15 ) , the addition of ipratropium significantly reduced the need for hospitalization ( 51 of 136 children [ 37.5 percent ] , as compared with 71 of 135 [ 52.6 percent ] in the control group ; P=0.02 ) . CONCLUSIONS Among children with a severe exacerbation of asthma , the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate STUDY OBJECTIVE To determine the effect of adding the nebulized anticholinergic drug ipratropium bromide to st and ard therapy compared with st and ard therapy alone for acute severe asthma ( peak expiratory flow rate [ PEFR ] < 50 % of predicted ) in children presenting to the emergency department . METHODS Ninety children aged 6 to 18 years were r and omly assigned to two groups in a prospect i ve , double-blind , placebo-controlled study performed in the ED of an urban children 's hospital . All children received nebulized albuterol solution ( .15 mg/kg ) every 30 minutes , and all received oral steroids with the second dose of albuterol . Children in group 1 received ipratropium bromide ( 500 micrograms/dose ) with the first and third dose of albuterol those in group 2 received saline placebo instead of ipratropium .  Pulmonary functions ( PEFR and 1-second forced expiratory volume [ FEV1 ] ) and physiologic measurements were assessed every 30 minutes up to 120 minutes . By chance , the baseline values for percent of predicted PEFR and FEV1 differed between the two groups . Therefore a multivariate model accounting for both time and baseline effects was used to compare the response between groups . RESULTS On average , and adjusting for baseline measures , children in the ipratropium group had a significantly greater improvement in percent of predicted PEFR than did children in the placebo group at 60 minutes ( P = .02 ) , 90 minutes ( P = .002 ) , and 120 minutes ( P < .0001 ) . The improvement in percent predicted FEV1 was significantly greater for children in the ipratropium group only at 120 minutes ( P = .013 ) . Nine children ( 20 % ) from the ipratropium group and 14 ( 31.1 % ) from the control group were admitted ( P = .33 , chi 2 ) . There were no significant adverse effects attributable to the ipratropium , and there was no relation between ipratropium use and changes in pulse , respiratory rate , blood pressure , or oxygen saturation . CONCLUSION We detected significant improvement in pulmonary function studies over 120 minutes in children with severe asthma who were given nebulized ipratropium combined with albuterol and oral steroids , compared with children who received the st and ard therapy . Further study is needed to determine whether early use of ipratropium decreases the need for hospitalization A study was performed to compare the efficacy and safety of two therapeutic regimens for the treatment of children presenting to the emergency department with acute asthma . A regimen of inhaled salbutamol alone was compared to inhaled salbutamol combined with ipratropium bromide .  Twenty-five children ranging in age from 5 to 15 years were enrolled in the study . Children with FEV1 less than or equal to 55 % predicted were eligible to participate in the study . Subjects were r and omized in a double-blind fashion into one of two treatment groups . Both groups received an initial dose of salbutamol by nebulizer of 150 micrograms/kg ( 0.03 cc/kg ) , followed by six consecutive doses of 50 micrograms/kg ( 0.01 cc/kg ) at 20-minute intervals . In one group of subjects , 250 micrograms ( 1.0 ml ) of ipratropium bromide respirator solution was added to the salbutamol administered at the time of the initial inhalation , and at 40 and 80 minutes , whereas the remaining subjects received a placebo with salbutamol at those times . Formal one-way statistical ANOVA with change in percent predicted FEV1 as a response variable confirmed there was a statistically significant difference at all time points caused by drug regimen during the 150-minute observation period . There was no significant difference in side effects reported in the two groups . Significant additional bronchodilation achieved with salbutamol and ipratropium bromide together indicates that there is likely a substantial cholinergic element to the bronchospasm observed in acute exacerbations of asthma in the pediatric age group The effect of adding ipratropium bromide to treatment with beta-2-adrenoceptor agonists was studied in 13 asthmatic children in a double-blind cross-over trial . In the acute phase of the study inhalation of salbutamol 0.1 mg/kg followed by inhalation of 0.25 mg of ipratropium bromide was found to improve pulmonary function variables to a significantly greater extent than salbutamol followed by placebo . The combined therapy also provided significantly better protection than salbutamol plus placebo against exercise-induced asthma . Maintenance treatment with ipratropium bromide ( two inhalations four times daily , 20 micrograms per inhalation ) in combination with oral terbutaline and aerosolized salbutamol did not alleviate asthmatic symptoms or pulmonary function variables to a degree beyond that achieved with the beta-stimulants alone . There were no side effects associated with the ipratropium bromide treatment . These data suggest that higher doses of ipratropium bromide than are presently used should be tested for maintenance treatment of chronic asthma Twenty-four consecutive patients admitted to hospital with severe acute asthma were studied . Eleven were given 10 mg salbutamol by nebulizer followed 2 hours later by 500 micrograms of nebulized ipratropium bromide . These patients had a greater response in PEFR than 13 patients given two doses of 10 mg salbutamol 2 hours apart Ipratropium bromide was given to patients admitted to hospital with acute asthma . A cumulative-dose-response technique in six patients showed that 500 micrograms given by nebuliser produced a maximal increase in peak expiratory flow rate . This dose of ipratropium bromide was included in a regimen in which it was given either two hours before or two hours after nebulised salbutamol to 22 patients .  Ipratropium bromide given on admission was as effective as nebulised salbutamol . The two drugs in sequence produced greater bronchodilatation than either used alone , and the mean peak expiratory flow rate rose by 96 % in four hours . Thus giving ipratropium bromide in addition to salbutamol in severe asthma enhances the bronchodilator effect . Further studies are needed to determine whether the same effect may be obtained by giving two maximal doses of salbutamol two hours apart Objective . To determine if the addition of ipratropium bromide to the emergency department ( ED ) treatment of childhood asthma reduces time to discharge , number of nebulizer treatments before discharge , and the rate of hospitalization . Methods . Patients > 12 months of age were eligible if they were to be treated according to a st and ardized ED protocol for acute asthma with nebulized albuterol ( 2.5 mg/dose if weight < 3 
    Output:
    
agent
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Twenty-eight infants admitted to Exequiel González Cortes Children 's Hospital because of acute wheezing ( AW ) were r and omly assigned to three study groups . Fenoterol ( FNT ) , ipratropium bromide ( IB ) , and placebo were administered respectively to children in the different groups by means of metered dose inhalers ( MDI ) with spacers , using doses of 3 puffs every hour , for 4 hours . The degree of bronchial obstruction was assessed clinical ly and scored with the single-blind method every hour prior to each treatment . The criterion of a bronchodilator effect was a significant decrease in the degree of bronchial obstruction at subsequent scorings . The scores of the three groups were compared using the Student 's t test for matched sample s. The same test was also applied to the independent sample s for determining the superiority of one treatment , FNT or IB , over the other . The results indicated a significant decrease in the scores of the groups receiving FNT and IB ( P less than 0.05 ) ; this did not occur in the group in which placebo was used . FNT produced a more rapid and sustained effect  than IB ( P less than 0.05 ) . Significant bronchodilator effect was obtained in infants with AW  when repeated doses of FNT or IB were administered with MDI and spacers . This effect was significantly greater in the group treated with FNT A multi-center , double-blind , 90-day study compared an ipratropium bromide metered-dose inhaler ( 40 microgram four times a day ) with a metaproterenol metered-dose inhaler ( 1,500 micrograms four times a day ) in 164 patients with asthma ; of the 144 patients who completed the study , 71 received ipratropium and 73 received metaproterenol . Our results suggest that both drugs were equally effective bronchodilators . Although the shape of the pulmonary function response curves suggested that ipratropium has different bronchodilator kinetics than metaproterenol ( in that it has a slower onset of action and a more prolonged duration ) , comparison of the areas under the curves for the two drugs showed that there was no statistical difference between ipratropium or metaproterenol . The only significant side effects noted with ipratropium were cough and exacerbation of symptoms ; no anticholinergic side effects were noted Thirty seven children with acute asthma were given nebulised ipratropium or placebo 30 minutes after their first dose of salbutamol and eight hourly thereafter . There were no significant differences between the two groups in clinical scores , peak expiratory flow rates , length of stay in hospital , or the need for oral steroids OBJECTIVE To determine whether the addition of inhaled ipratropium bromide to inhaled albuterol and systemic corticosteroid therapy was more efficacious than inhaled albuterol and systemic corticosteroids alone in the inpatient treatment of acute asthma exacerbations in children . DESIGN Double-blind , r and omized , placebo-controlled trial . SETTING Pediatric inpatient unit of a tertiary urban hospital . PARTICIPANTS Eighty children ( aged 1 - 18 years ) hospitalized because of an acute asthma exacerbation . INTERVENTION Children were r and omized to receive either nebulized ipratropium bromide , 250 microg , or nebulized isotonic sodium chloride solution , 1 mL. All children received albuterol and systemic corticosteroids . MAIN OUTCOME MEASURES The primary outcome variable was a vali date d clinical asthma score , measured at baseline and every 6 hours for 36 hours . Secondary outcome measures included the forced expiratory volume in 1 second , the oxygen saturation , the number of doses of inhaled study drug , the time to an inhaled drug-dosing interval of 4 hours , and the length of the hospital stay . RESULTS There were no differences between groups on baseline characteristics . The intention-to-treat analysis , using repeated- measures analysis of variance , showed no significant ( P = .07 ) difference between the groups in the clinical asthma score over time . There were also no significant differences between groups on secondary outcomes . CONCLUSION The addition of nebulized ipratropium bromide to nebulized beta(2)-agonist and corticosteroid therapy in the treatment of children hospitalized because of asthma ( following intensive emergency department treatment ) confers no extra benefit BACKGROUND Anticholinergic medications such as ipratropium improve the pulmonary function of patients with acute exacerbations of asthma , but their effect on hospitalization rates is uncertain . METHODS We conducted a r and omized , double-blind , placebo-controlled study of 434 children ( 2 to 18 years old ) who had acute exacerbations of moderate or severe asthma treated in the emergency department . All the children received a nebulized solution of albuterol ( 2.5 or 5 mg per dose , depending on body weight ) every 20 minutes for three doses and then as needed . A corticosteroid ( 2 mg of prednisone or prednisolone per kilogram of body weight ) was given orally with the second dose of albuterol . Children in the treatment group received 500 microg ( 2.5 ml ) of ipratropium bromide with the second and third doses of albuterol ; children in the control group received 2.5 ml of normal saline at these times . RESULTS Overall , the rate of hospitalization was lower in the ipratropium group ( 59 of 215 children [ 27.4 percent ] ) than in the control group ( 80 of 219 [ 36.5 percent ] , P=0.05 ) . For patients with moderate asthma ( indicated by a peak expiratory flow rate of 50 to 70 percent of the predicted value or an asthma score of 8 to 11 on a 15-point scale ) , hospitalization rates were similar in the two groups ( ipratropium : 8 of 79 children [ 10.1 percent ] ; control : 9 of 84 [ 10.7 percent ] ) . For patients with severe asthma ( defined as a peak expiratory flow rate of < 50 percent of the predicted value or an asthma score of 12 to 15 ) , the addition of ipratropium significantly reduced the need for hospitalization ( 51 of 136 children [ 37.5 percent ] , as compared with 71 of 135 [ 52.6 percent ] in the control group ; P=0.02 ) . CONCLUSIONS Among children with a severe exacerbation of asthma , the addition of ipratropium bromide to albuterol and corticosteroid therapy significantly decreases the hospitalization rate STUDY OBJECTIVE To determine the effect of adding the nebulized anticholinergic drug ipratropium bromide to st and ard therapy compared with st and ard therapy alone for acute severe asthma ( peak expiratory flow rate [ PEFR ] < 50 % of predicted ) in children presenting to the emergency department . METHODS Ninety children aged 6 to 18 years were r and omly assigned to two groups in a prospect i ve , double-blind , placebo-controlled study performed in the ED of an urban children 's hospital . All children received nebulized albuterol solution ( .15 mg/kg ) every 30 minutes , and all received oral steroids with the second dose of albuterol . Children in group 1 received ipratropium bromide ( 500 micrograms/dose ) with the first and third dose of albuterol those in group 2 received saline placebo instead of ipratropium .  Pulmonary functions ( PEFR and 1-second forced expiratory volume [ FEV1 ] ) and physiologic measurements were assessed every 30 minutes up to 120 minutes . By chance , the baseline values for percent of predicted PEFR and FEV1 differed between the two groups . Therefore a multivariate model accounting for both time and baseline effects was used to compare the response between groups . RESULTS On average , and adjusting for baseline measures , children in the ipratropium group had a significantly greater improvement in percent of predicted PEFR than did children in the placebo group at 60 minutes ( P = .02 ) , 90 minutes ( P = .002 ) , and 120 minutes ( P < .0001 ) . The improvement in percent predicted FEV1 was significantly greater for children in the ipratropium group only at 120 minutes ( P = .013 ) . Nine children ( 20 % ) from the ipratropium group and 14 ( 31.1 % ) from the control group were admitted ( P = .33 , chi 2 ) . There were no significant adverse effects attributable to the ipratropium , and there was no relation between ipratropium use and changes in pulse , respiratory rate , blood pressure , or oxygen saturation . CONCLUSION We detected significant improvement in pulmonary function studies over 120 minutes in children with severe asthma who were given nebulized ipratropium combined with albuterol and oral steroids , compared with children who received the st and ard therapy . Further study is needed to determine whether early use of ipratropium decreases the need for hospitalization A study was performed to compare the efficacy and safety of two therapeutic regimens for the treatment of children presenting to the emergency department with acute asthma . A regimen of inhaled salbutamol alone was compared to inhaled salbutamol combined with ipratropium bromide .  Twenty-five children ranging in age from 5 to 15 years were enrolled in the study . Children with FEV1 less than or equal to 55 % predicted were eligible to participate in the study . Subjects were r and omized in a double-blind fashion into one of two treatment groups . Both groups received an initial dose of salbutamol by nebulizer of 150 micrograms/kg ( 0.03 cc/kg ) , followed by six consecutive doses of 50 micrograms/kg ( 0.01 cc/kg ) at 20-minute intervals . In one group of subjects , 250 micrograms ( 1.0 ml ) of ipratropium bromide respirator solution was added to the salbutamol administered at the time of the initial inhalation , and at 40 and 80 minutes , whereas the remaining subjects received a placebo with salbutamol at those times . Formal one-way statistical ANOVA with change in percent predicted FEV1 as a response variable confirmed there was a statistically significant difference at all time points caused by drug regimen during the 150-minute observation period . There was no significant difference in side effects reported in the two groups . Significant additional bronchodilation achieved with salbutamol and ipratropium bromide together indicates that there is likely a substantial cholinergic element to the bronchospasm observed in acute exacerbations of asthma in the pediatric age group The effect of adding ipratropium bromide to treatment with beta-2-adrenoceptor agonists was studied in 13 asthmatic children in a double-blind cross-over trial . In the acute phase of the study inhalation of salbutamol 0.1 mg/kg followed by inhalation of 0.25 mg of ipratropium bromide was found to improve pulmonary function variables to a significantly greater extent than salbutamol followed by placebo . The combined therapy also provided significantly better protection than salbutamol plus placebo against exercise-induced asthma . Maintenance treatment with ipratropium bromide ( two inhalations four times daily , 20 micrograms per inhalation ) in combination with oral terbutaline and aerosolized salbutamol did not alleviate asthmatic symptoms or pulmonary function variables to a degree beyond that achieved with the beta-stimulants alone . There were no side effects associated with the ipratropium bromide treatment . These data suggest that higher doses of ipratropium bromide than are presently used should be tested for maintenance treatment of chronic asthma Twenty-four consecutive patients admitted to hospital with severe acute asthma were studied . Eleven were given 10 mg salbutamol by nebulizer followed 2 hours later by 500 micrograms of nebulized ipratropium bromide . These patients had a greater response in PEFR than 13 patients given two doses of 10 mg salbutamol 2 hours apart Ipratropium bromide was given to patients admitted to hospital with acute asthma . A cumulative-dose-response technique in six patients showed that 500 micrograms given by nebuliser produced a maximal increase in peak expiratory flow rate . This dose of ipratropium bromide was included in a regimen in which it was given either two hours before or two hours after nebulised salbutamol to 22 patients .  Ipratropium bromide given on admission was as effective as nebulised salbutamol . The two drugs in sequence produced greater bronchodilatation than either used alone , and the mean peak expiratory flow rate rose by 96 % in four hours . Thus giving ipratropium bromide in addition to salbutamol in severe asthma enhances the bronchodilator effect . Further studies are needed to determine whether the same effect may be obtained by giving two maximal doses of salbutamol two hours apart Objective . To determine if the addition of ipratropium bromide to the emergency department ( ED ) treatment of childhood asthma reduces time to discharge , number of nebulizer treatments before discharge , and the rate of hospitalization . Methods . Patients > 12 months of age were eligible if they were to be treated according to a st and ardized ED protocol for acute asthma with nebulized albuterol ( 2.5 mg/dose if weight < 3 
    Output:
    