Continuous Salbutamol Research Articles

Efficacy of a loading dose of IV salbutamol in children with severe acute asthma admitted to a PICU: a randomized controlled trial

The optimal dose regimen for intravenous (IV) treatment in children with severe acute asthma (SAA) is still a matter of debate. We assessed the efficacy of adding a salbutamol loading dose to continuous infusion with salbutamol in children admitted to a pediatric intensive care unit (PICU) with SAA. This multicentre, placebo-controlled randomized trial in the PICUs of four tertiary care children’s hospitals included children (2–18 years) with SAA admitted between 2017 and 2019. Children were randomized to receive either a loading dose IV salbutamol (15 mcg/kg, max. 750 mcg) or normal saline while on continuous salbutamol infusion. The primary outcome was the asthma score (Qureshi) 1 h after the intervention. Analysis of covariance models was used to evaluate sensitivity to change in asthma scores. Serum concentrations of salbutamol were obtained. Fifty-eight children were included (29 in the intervention group). Median baseline asthma score was 12 (IQR 10–13) in the intervention group and 11 (9–12) in the control group (p = 0.032). The asthma score 1 h after the intervention did not differ significantly between the groups (p = 0.508, β-coefficient = 0.283). The median increase in salbutamol plasma levels 10 min after the intervention was 13 μg/L (IQR 5–24) in the intervention group and 4 μg/L (IQR 0–7) in the control group (p = 0.001). Side effects were comparable between both groups.Conclusion: We found no clinical benefit of adding a loading dose IV salbutamol to continuous infusion of salbutamol, in children admitted to the PICU with SAA. Clinically significant side effects from the loading dose were not encountered.What is Known:• Pediatric asthma guidelines struggle with an evidence-based approach for the treatment of SAA beyond the initial steps of oxygen suppletion, repetitive administration of inhaled β2-agonists, and systemic steroids.• During an SAA episode, effective delivery of inhaled drugs is unpredictable due to severe airway obstruction.What is New:• This study found no beneficial effect of an additional loading dose IV salbutamol in children admitted to the PICU.• This study found no clinically significant side effects from the loading dose.

Continuous versus intermittent short-acting \u03b22-agonists nebulization as first-line therapy in hospitalized children with severe asthma exacerbation: a propensity score matching analysis

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.

ABSTRACT 387

Background and aims: Asthma is very common in pediatric admissions and its confusing with acute bronchiolitis in infants because of the similarity of signs and symptoms. Treatment of acute bronchiolitis may include the use of nasal CPAP. Aims: To describe the occurance of neck and upper chedt emphysema post nasal cpap use in an infant. Methods: Case report of subcutaneous emphysema post nCPAP in asthmatic infant and resolution aftrr discontinue CPAP and starting intravenous and continuous salbutamol nebulization. Results: The use of nCPAP in asthmatic infants may lead to air leak syndrome such as subcutaneous emphysema. Proper history taking revealed the history of recurrent wheezy chest responding to asthma therapy and when asthma treatment optimized the clinical condition improved and emphysema resolved. Conclusions: The use of nasal CPAP in asthmatic infant may lead to subcutaneous emphysema.

Anaphylaxis: Clinical concepts and research priorities

Anaphylaxis is a severe immediate-type hypersensitivity reaction characterized by life-threatening upper airway obstruction bronchospasm and hypotension. Although many episodes are easy to diagnose by the combination of characteristic skin features with other organ effects, this is not always the case and a workable clinical definition of anaphylaxis and useful biomarkers of the condition have been elusive. A recently proposed consensus definition is ready for prospective validation. The cornerstones of management are the supine position, adrenaline and volume resuscitation. An intramuscular dose of adrenaline is generally recommended to initiate treatment. If additional adrenaline is required, then a controlled intravenous infusion might be more efficacious and safer than intravenous bolus administration. Additional bronchodilator treatment with continuous salbutamol and corticosteroids are used for severe and/or refractory bronchospasm. Aggressive volume resuscitation, selective vasopressors, atropine (for bradycardia), inotropes that bypass the beta-adrenoreceptor and bedside echocardiographic assessment should be considered for hypotension that is refractory to treatment. Management guidelines continue to be opinion- and consensus-based, with retrospective studies accounting for the vast majority of clinical research papers on the topic. The clinical spectrum of anaphylaxis including major disease subgroups requires clarification, and validated scoring systems and outcome measures are needed to enable good-quality prospective observational studies and randomized controlled trials. A systematic approach with multicentre collaboration is required to improve our understanding and management of this disease.

CONTINUOUS SALBUTAMOL INFUSION OVER 17 WEEKS TO PRE-EMPT PREMATURE LABOUR

CONTINUOUS SALBUTAMOL INFUSION OVER 17 WEEKS TO PRE-EMPT PREMATURE LABOUR

Continuous and intermittent salbutamol tablet administration in asthmatic children

We studied 22 asthmatic children aged seven years two months to thirteen years eight months over a four-month period. Each child received two months continuous and two months intermittent salbutamol tablets using a double-blind cross-over technique. No significant clinical differences were found between the two treatment regimens as judged by daily diary card scores. Daily PEFRs (both a.m. and p.m.) were significantly higher ( P < 0.05) when the children were receiving continuous salbutamol and this was more obvious in the eleven children under ten years old. Lung function tests performed monthly in hospital showed no significant differences between the two treatment regimens.

Continuous and intermittent salbutamol tablet administration in asthmatic children

We studied 22 asthmatic children aged seven years two months to thirteen years eight months over a four-month period. Each child received two months continuous and two months intermittent salbutamol tablets using a double-blind cross-over technique. No significant clinical differences were found between the two treatment regimens as judged by daily diary card scores. Daily PEFRs (both a.m. and p.m.) were significantly higher (P < 0.05) when the children were receiving continuous salbutamol and this was more obvious in the eleven children under ten years old. Lung function tests performed monthly in hospital showed no significant differences between the two treatment regimens.