TOPLINE

Most school-aged children born premature with chronic lung disease of immaturity showed reversible airway obstruction after at least one inhaled bronchodilator. However, responses varied by drug, and about 1 in 4 responded only to a single agent.

METHODOLOGY

• Researchers conducted a cross-sectional study to compare the effects of three inhaled bronchodilators on lung function in 55 children (mean age, 12.6 years; 34 boys) born premature with chronic lung disease and bronchial obstruction.
• Each child attended three visits and received all treatments in random order: salbutamol (four puffs of 100 μg), ipratropium bromide (four puffs of 20 μg), and a fenoterol/ipratropium combination (four puffs of 50 μg/20 μg). All medications were given via a metered‑dose inhaler with a spacer.
• Researchers measured lung function using spirometry before and after administering each drug. They repeated the test 15 minutes after administering salbutamol and 30 minutes after administering ipratropium bromide and the fenoterol/ipratropium combination.
• A positive response was defined as an increase in forced expiratory volume in 1 second (FEV₁) greater than 10% of the child's predicted value.
• Children were also categorized by spirometry phenotype as having either a prematurity-associated obstructive pattern or a prematurity-associated preserved-ratio impaired pattern.

TAKEAWAY

• Overall, 48 children (87%) showed a positive response to at least one bronchodilator agent; response rates were 56.4% for salbutamol, 58.2% for ipratropium bromide, and 65.5% for the combination, with no significant difference between salbutamol and the combination.
• About 1 in 4 children improved after using only a single drug: 9.1% responded only to salbutamol, 5.5% only to ipratropium bromide, and 9.1% only to the combination. Those with the preserved ratio impaired phenotype tended to favor the combination, but that trend was not statistically significant.
• The improvements in FEV₁ did not differ significantly between the three treatments either by phenotype or drug-phenotype interaction.
• Responses to ipratropium bromide were significantly more frequent in those with the obstructive phenotype than in those with the preserved ratio impaired phenotype (67.4% vs 25.0%; P = .008); salbutamol and the combination had similar response rates across phenotypes.

IN PRACTICE

“These findings highlight the need for individualized bronchodilator testing, as exclusive response to a single agent would be missed with a uniform approach. Although no single bronchodilator showed clear superiority, our results underscore the potential role of anticholinergic therapy alongside beta-2 agonists,” the authors of the study wrote.

SOURCE

The study was led by Yotam Ophir, Charles University, Prague, Czech Republic. It was published online on July 16, 2026, in Pediatric Pulmonology.

LIMITATIONS

The absence of impulse oscillometry, a sensitive method for assessing small airway function, limited the evaluation of bronchodilator effects on peripheral airways. The sample size was modest and drawn from a single center. Finally, the cross-sectional design precluded conclusions about long-term therapeutic effects.

DISCLOSURES

The study was supported by MZ ČR DRO VFN64165 and Univerzita Karlova (Cooperation, Pediatrics) and an internal grant from the General University Hospital in Prague. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.