Role of Ipratropium bromide in management of Thunderstorm asthma

Abstract

Epidemic thunderstorm asthma has been reported to have occurred around twenty times over the past three decades in locations around the world. Thunderstorm asthma events are characterized by a significant increase in asthma presentations, which on occasion can overwhelm local medical services and result in fatalities. Thunderstorm asthma (TA) typically presents during an aeroallergen season in individuals, sensitized to perennial rye grass pollen (RGP) in Australia, in combination with meteorological factors such as thunderstorms and lightning activity. Short acting beta agonist (SABA) only treatment is sub-optimal therapy for prevention of asthma exacerbations. The combined treatment includes inhaled corticosteroids (ICS) and SABA but is found to be contentious. So the present review focuses on suitable alternative, short acting muscarinic antagonist (SAMA), Ipratropium bromide and its efficacy on the management of allergic asthma. Salbutamol induces bronchodilation rapidly but it elicits profound cardiovascular event as the side effects. Meanwhile, ipratropium also has equivalent effect of salbutamol with low side effect profile. Ipratropium also minifies the asthmatic response to grass pollen, allergen induced bronchoconstriction. Further, it also reduces allergen induced early and late asthmatic response and also inhibits the response towards histamine inhalation. In this regard, ipratropium may be considered as a suitable agent in the management of thunderstorm asthma and future trials are highly warranted. Keywords: Thunderstorm asthma, grass pollen, rye grass, short acting beta agonist, Ipratropium bromide