Prospective Testing Bronchial Obstruction Reversibility in Preterm Children: Inhaled betamimetics versus parasympatholytics

Although bronchial obstruction reversibility was observed in many preterm children with chronic lung disease (CLD), research on comparing individual bronchodilators and their combination is lacking. <bold>Aim:</bold> To compare the reversibility of bronchial obstruction in children with CLD after application of salbutamol, ipratropium and ipratropium combined with fenoterol. We hypothesised that a combined inhalation will result in the highest improvement. Three bronchodilators at different checkups were tested in a random order. Baseline and post-interventional spirometry were compared for each drug. <bold>Results:</bold> Baseline spirometry data were collected from 52 children with CLD (mean age 9.5 years, range 4-18; 33 boys), confirming bronchial obstruction with mean baseline Z-scores for forced expiratory flow [FEF]: FEF75 -2.12, FEF50 -2.74, FEF25 -2.28, and FEF25-75-2.51; forced expiratory volume in one second -2.36, forced vital capacity [FVC] -1.74 and peak expiratory flow -1.71. Following the administration of salbutamol, ipratropium, and ipratropium combined with fenoterol, significant improvements were observed in all spirometric parameters (p<0.000), except for FVC. The highest improvement of FEF25-75 and FEF75 z-score was observed after inhalation of ipratropium compared to salbutamol (p<0.005 and p<0.0017, respectively), but the difference between the combination of ipratropium plus fenoterol over ipratropium alone was not statistically significant (p<0.998 and p<0.54; ANOVA repeated measures). Our findings suggest the potential superiority of ipratropium as a bronchodilator in children with CLD and its role in the acute and chronic management of CLD.