Abstract
BackgroundShort-acting β2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. Either intermittent or continuous delivery has been considered safe and efficient. The comparative efficacy of these two modalities is inconclusive. We aimed to compare these two modalities as the first-line treatments.MethodsAn efficacy research with a retrospective cohort study design was conducted. Hospital records of children with severe asthma exacerbation admitted to Hat Yai Hospital between 2015 and 2017 were retrospectively collected. Children initially treated with continuous salbutamol 10 mg per hour or intermittent salbutamol 2.5 mg per dose over 1–4 h nebulization were matched one-to-one using the propensity score. Competing risk and risk difference regression was applied to evaluate the proportion of children who succeeded and failed the initial treatment. Restricted mean survival time regression was used to compare the length of stay (LOS) between the two groups.ResultsOne-hundred and eighty-nine children were included. Of these children, 112 were matched for analysis (56 with continuous and 56 with intermittent nebulization). Children with continuous nebulization experienced a higher proportion of success in nebulization treatment (adjusted difference: 39.5, 95% CI 22.7, 56.3, p < 0.001), with a faster rate of success (adjusted SHR: 2.70, 95% CI 1.73, 4.22, p < 0.001). There was a tendency that LOS was also shorter (adjusted mean difference − 9.9 h, 95% CI -24.2, 4.4, p = 0.176).ConclusionContinuous SABA nebulization was more efficient than intermittent nebulization in the treatment of children with severe asthma exacerbation.
Highlights
Asthma exacerbation is one of the most common causes of hospitalization among children
One hundred and eighty-nine children were included in this study, 60 were initially treated with continuous nebulization and 129 with intermittent nebulization
According to our results, children with severe asthma exacerbation who were initially treated with continuous nebulization showed a significantly higher rate of treatment success and a lower chance of treatment failure and requirement of escalation to a more aggressive therapy compared to children who were treated with intermittent nebulization
Summary
Asthma exacerbation is one of the most common causes of hospitalization among children. It was observed that severe asthma exacerbation is increasing in children with asthma [1,2,3]. Intermittent nebulization with shortacting β2-agonist (SABA), salbutamol 0.15–0.3 mg per kg, every one to 4 hours is the current first-line recommendation for hospitalized children with asthma exacerbation [4, 5]. Children with severe asthma exacerbation may have suboptimal responses to first-line treatment and eventually require an escalation to more aggressive therapy (eg, continuous nebulization, intravenous salbutamol, or intravenous magnesium sulfate). The results are asthma complications, prolonged hospital stays, and increased expenditures [3, 7, 8]. Short-acting β2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. We aimed to compare these two modalities as the first-line treatments
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