Use of anticholinergic bronchodilation in children

Ipratropium bromide is a quaternary ammonium anticholinergic bronchodilator with minimal systemic absorption across the blood-airway barrier. Ipratropium bromide has become primary therapy for the treatment of adults with chronic bronchitis, but its use in children has been limited. Ipratropium bromide can be safely used in the management of acute bronchiolitis, recognizing that most infants do not appear to respond to any bronchodilator medication. When used with a β-agonist bronchodilator for the therapy of acute childhood asthma, ipratropium bromide appears to provide bronchodilation beyond that achieved by either agent used alone. There are insufficient published data to determine the appropriate use of ipratropium bromide in infants with bronchopulmonary dysplasia, although many of those symptomatic after the age of 6 months seem to benefit from either ipratropium bromide or β-agonists. As ipratropium bromide has no intrinsic anti-inflammatory properties, its role in the chronic therapy of asthma and related disorders is still unclear.