PICO Search Strategy for Nebulized Ipratropium Bromide with Salbutamol in Pre-hospital Setting for Children with Acute Asthma Exacerbation

This PICO search strategy focuses on the effectiveness of nebulized ipratropium bromide with salbutamol in pre-hospital setting for children with acute asthma exacerbation. The study conducted on the basis of the children of the age group in between 2 to 14 years old who visited the emergency room. The result showed that ipratropium bromide had a significant effect on the improvement of asthma score but no remarkable difference in improvement of expiratory flow rate. Therefore, the combination of nebulized ipratropium bromide and salbutamol is more effective in case of child with severe asthma exacerbation which associates with significant reduction of asthma score.

PICO Search Strategy worksheet
1. Write out your (clinical) question
Is nebulized ipratropium bromide with salbutamol is more effective than Nebulized salbutamol
in pre hospital setting for the patient ?
2. Define your question into concepts/parts using PICO
P: Population/Problem: Children with the age group of 16 years suffering from acute asthma
exacerbation
I: Intervention/Phenomenon of Interest: treatment with nebulizer ipratropium bromide with
salbutamol
C: Comparison: Nebulized salbutamol alone
O: Outcome : FEV1 increased, decreases functional residual capacity
3. List the main concepts/parts of the question in the first line.
P I O
Children with asthma Nebulized salbutamol Increase of FEV1 ( forced
expiratory volume 1)
Adults more than age group of
16 years

4. Select limits that may pertain to your search
You can often limit your database search with these
Age- 16 Languages- English Publication Year- 2013 – 2018
Databas
e
Truncation Symbol Wildcard Symbol
ProQuest Nebuliz* Nebulize?
Salbutam*l Salbut?mol
EBSCO
(MEDLINE, CINAHL &
PsycInfo)
Nebulizer* Salbut?mol
Ipratropium brom*de ipratropium Bromide?
Informit
(Health & Society, Health
Sciences)
Ipratropium brom*de
Asthma* Asthm?
Abstract of the paper:

Children with asthma the application of nebulized ipratropium bromide with salbutamol
is more effective than Nebulized salbutamol in the pre-hospital setting. It is more effective in
case of the adult but in children a remarkable improvement observed. Ipratropium bromide
reduces bronchospasm with minimal cardiovascular effect in individuals (Memon et al. 2016). It
improves the pulmonary function when combined with salbutamol.
The final search strategy is:
Using key words such as asthma, children with asthma, nebulized sulbutamol,
effectiveness ipratropium bromide with salbutamol in databases such as Medline, CINAHL
ProQuest results were obtained.
Question type:
Therapy
Therapy
Is nebulized ipratropium bromide with salbutamol is more effective than Nebulized salbutamol
in pre hospital setting for the patient ?
Analysis:
The participants chosen for conducting this study was randomized. The study conducted
on the basis of the children of the age group in between 2 to 14 years old who visited the
emergency room. The participant size was calculated on the basis of the frequency of asthma
disease. Approximately 200 patients have participated in the study. Patients were randomly
allocated into two groups. A ( Salbutamol) group B (Salbutamol + ipratropium bromide).

Researchers are also blinded to the group allocation. Groups are similar at the baseline. All of the
participants were accounted for at the completion of the study and follow up complete. The study
has enough participants to minimize the effect of chance on the outcome. However, the result
would be more accurate with observation for a more extended period. Moreover, the study was
conducted on the number of patients. Moreover, in this study the intention to treat analyzed was
used in order to obtain accurate result. In this study, the result showed that ipratropium bromide
had a significant effect on the improvement of asthma score but no remarkable difference in
improvement of expiratory flow rate. Therefore, the combination of nebulized ipratropium
bromide and salbutamol is more effective in case of child with severe asthma exacerbation which
associates with significant reduction of asthma score.

Reference :
Memon, B.N., Parkash, A., Khan, K.M.A., Gowa, M.A. and Bai, C., 2016. Response to
nebulized salbutamol versus combination with ipratropium bromide in children with acute severe
asthma. JPMA. The Journal of the Pakistan Medical Association, 66(3), pp.243-246.