Salbutamol Nebulization Research Articles

Safety and Efficacy of 2.5 mg and 1.25 mg Nebulized Salbutamol Compared with Placebo on Transient Tachypnea of the Newborns: A Triple-Blind Phase II/III Parallel Randomized Controlled Trial.

Background: To evaluate the safety and efficacy of 2.5 and 1.25 mg nebulized salbutamol on Transient Tachypnea of the Newborn (TTN) compared with placebo. Methods: We conducted a triple-blind, phase II/III parallel randomized controlled trial in two university-affiliated hospitals with neonatal intensive care units. Newborns with a confirmed diagnosis of TTN, with gestational age >35 weeks and gestational weight >2 kg were included. Cases of asphyxia, meconium aspiration syndrome, and persistent pulmonary hypertension were excluded. Ninety eligible patients were randomly allocated in three intervention groups (2.5 mg salbutamol, 1.25 mg salbutamol, and placebo), and a single-dose nebulized product was prescribed 6 hours after the birth. Safety outcomes included postintervention tachycardia, hyperglycemia, hypokalemia, and changes in blood pressure. To evaluate the efficacy, the duration of postintervention tachypnea, TTN clinical score, and clinical and paraclinical respiratory indices were assessed. Parents, Outcome assessors, and data analyzer were blind to the intervention. Results: There was no adverse reaction, including tachycardia, hypokalemia, and jitteriness. Both groups of salbutamol recipients showed significant improvement regarding respiratory rate, TTN clinical score, and oxygenation indices compared with the placebo (p-values <0.001). Nonstatistically significant higher hospital stay was observed in the placebo group. Single 2.5 mg salbutamol nebulization showed a little better outcome than the dose of 1.25 mg, although we could not find statistical superiority. Conclusion: The newly applied single high dose of 2.5 mg nebulized salbutamol is safe in treating TTN and leads to notable faster improvement of respiratory status without any considerable adverse reaction. Registry code: IRCT20190328043133N1.

Стан вивчення поліморфізму окремих генів у виникненні бронхіальної астми

The study of the polymorphism of individual genes is the basis of both preventive medicine and is used in the selection of adequate therapy. Polymorphism of individual candidate genes in bronchial asthma (BA) is studied taking into account many personal characteristics and the influence of environmental factors. Aim - to analyze the status of the study of the role of polymorphism of β2-adrenoceptors (ADRβ2) in the pathogenesis of bronchial asthma in children and to compare them with our own findings. Materials and methods. The results of research on polymorphism of individual genes in children with BA, which includes the PubMed database, were analyzed. An in-depth study of the anamnesis data (disease, life, hereditary), a complex clinical and laboratory examination of children (n=101) of school age with BA was carried out (the average age was: for boys 11.15±0.48 years; for girls - 10.63±0.7 years). Patients were diagnosed with BA in accordance with the GINA recommendations of the current revision. Determination of the Arg16Gly polymorphism of the ADRβ2 gene (rs 1042713) was performed by the polymerase chain reaction method followed by restriction enzyme analysis. The obtained data were processed in the Statsoft STATISTICA software package. Mean values were given as (M±m), Student's test was used for comparison. Results. The assessment of the frequency of polymorphism of the Arg16Gly gene in BA established that two variants prevailed in boys: Arg16Gly and Gly16Gly; at that time, the Gly16Gly genotype prevailed among girls, which, according to individual studies, is associated with good effectiveness of the applied therapy (nebulization of salbutamol). Mutations in the ADRβ2 gene in patients with BA were twice as frequent in the Arg16Gly genotype and three times as frequent in the Gln27Glu genotype, in contrast to healthy children. Such a polymorphism affects the functional activity of ADRβ2, the occurrence and course of BA. Conclusions. The Arg16Gly polymorphism of the ADRβ2 gene in children with BA largely determines the sensitivity of ADRβ2 to the applied exacerbation therapy and the effectiveness of basic treatment. In patients with the Gly16Gly genotype, most researchers note the good clinical effectiveness of both fast broncholytic drugs (β2 short-acting agonists) and basic anti-inflammatory drugs. The diagnosed homozygous Arg16Arg genotype of the ADRβ2 gene mostly accompanies the uncontrolled (or partially controlled) course of asthma in children. The revealed features of the Arg16Gly polymorphism of the ADRβ2 gene will help the doctor to draw up an adequate treatment plan, which is based on the genetically determined sensitivity of ADRβ2 receptors to medical preparations. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the author.

A CASE REPORT ON ATYPICAL PRESENTATION OF CONGENITAL ADRENAL HYPERPLASIA

We report a case of 52-day old infant presented to casualty with complaint of failure to gain weight,10-day history of regurgitation of feeds, poor acceptance of feed and lethargy from one day, not passed urine in last 8hours. On examination baby had tachycardia with signs of dehydration, blood gas shows metabolic acidosis with serum sodium- 124meq/l, serum potassium- 6.2meq/l. A probable diagnosis of failure to thrive with severe sepsis, inborn errors of metabolism (IEM), and CAH was considered and baby was treated with intravenous fluids, antibiotics, calcium gluconate, salbutamol nebulisation and hydrocortisone. Following the above interventions, babys hydration status and ECG changes improved. The diagnosis of CAH was considered as 17- hydroxyprogesterone levels were elevated. Genetic analysis was not done due to patients economic constraints and baby was discharged with oral Hydrocortisone, Fludrocortisone and table salt (Nacl). Currently baby is thriving well with adequate weight gain.

Measuring of cardiac electrical system function among salbutamol inhaled children – A cohort study

Background: Salbutamol is widely recognized as an effective rescue therapy for acute asthma attacks. However, the usage of inhaled β2-agonists, including salbutamol, has been related to an amplified hazard of cardiovascular disease, as suggested by several studies. Despite this association, there is an absence of sufficient facts regarding the cardiac electrophysiological possessions of inhaled β2-agonists in children. Aim and Objectives: The present study was to explore the cardiac electrophysiological effects of inhaled salbutamol in children. By examining the specific impact of salbutamol on cardiac electrophysiology, this study aimed to contribute valuable insights into the potential cardiovascular effects of inhaled β2-agonists in the pediatric population. Materials and Methods: This cohort study involved 130 individuals of both sexes, levels in age from 1 to 12 years. Salbutamol nebulization was administered to the children at a dosage of 0.15 mg/kg/dose, mixed with normal saline at a ratio of 1:3, using a nebulizer. Cardiac parameters including heart rate, T axis, P axis, QTc interval, QRS axis, QRS interval, and PR interval were recorded before and after nebulization using a computerized electrocardiogram (ECG). Results: The outcomes of the work presented that following nebulization, there was a major rise in heart rate and a notable decline in the PR interval, T axis, and P axis. However, no analytical significant deviations were observed in the QRS axis, QTc interval, and QRS interval. Conclusion: The study demonstrates that within a time frame of 5–15 min after inhaling a single standard dose of salbutamol, significant changes in the ECG parameters occur. These changes in cardiac electrophysiology may contribute to an amplified occurrence of arrhythmias in some patients getting salbutamol treatment. It is important to note that the frequent use of high doses of salbutamol for asthmatic exacerbations may potentially lead to more severe cardiac adverse effects.

Comparison of 3% Normal Saline Nebulization versus Steroid Nebulization in the Treatment of Bronchiolitis

Background: Bronchiolitis is a leading cause of hospitalization in infants. This study aimed to compare the efficacy of 3% normal saline nebulization with steroid nebulization in the treatment of bronchiolitis. Methods: Conducted at the Department of Pediatrics, Mardan Medical Complex, Mardan from November 15, 2022, to March 15, 2023, this randomized controlled trial involved 60 infants aged 3 to 12 months diagnosed with bronchiolitis. They were equally randomized into two groups: Group-A received 3% normal saline nebulization, while Group-B was treated with steroid and salbutamol nebulization, administered three times daily. Efficacy assessments were made at 0, 12, 24, 48, and 72 hours using the respiratory distress assessment instrument. The primary outcome was defined as the number of patients discharged from the hospital within ≤ 72 hours after starting treatment. The chi-square test was used for statistical comparison, with p ≤0.05 considered significant. Results: The mean±SD age in the study was 6.91±2.41 months, with a gender distribution of 55% male and 45% female. The study revealed that a significantly higher number of infants in Group-A were discharged from the hospital within ≤ 3 days compared to Group-B (90% vs 63.33%, p=0.01). Additionally, Group-A had a significantly shorter mean length of hospital stay (2.76±0.51 days) compared to Group-B (3.58±0.82 days, p=0.00). Conclusion: Nebulization with 3% normal saline was found to be significantly more effective than steroid nebulization in reducing the severity of bronchiolitis and the duration of hospitalization in infants aged between 3-12 months.

Value of Adding Nebulized Magnesium Sulphate to Rescue Medications in Acute Exacerbation of Chronic Obstructive Pulmonary Disease in Patients Admitted to Emergency Room

Abstract Introduction Chronic Obstructive Pulmonary Disease (COPD) is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases, Nebulized magnesium is attractive as a therapeutic option because it is easily administered, relatively cheap and has minimal side effects. In light of some evidence for an effect when nebulized in severe exacerbations of asthma, the similarities between asthma and chronic obstructive pulmonary disease (COPD) (especially with regard to bronchodilator therapy) and the practical advantages of administration via nebuliser, we sought to focus on the nebulized route of delivery in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Objective The aim of this work was to evaluate the effect of administration of nebulized magnesium sulphate in the management of acute exacerbations of chronic obstructive pulmonary disease. Patient and methods The study was conducted upon 100 patients with acute exacerbation of COPD randomly divided into two groups, 50 patients for each group who admitted to emergency room with acute exacerbation of Chronic Obstructive Pulmonary Disease in Mansoura chest diseases hospital From January 2019 to June 2019, All patients randomly divided into two groups, Patients of group A: included 50 patients received 2.5 mg salbutamol (2.5 ml), mixed with 500 mg isotonic magnesium sulphate(5 ml), Patients of group B: included 50 patients received 2.5 mg salbutamol mixed with 2.5 ml isotonic saline. Treatment for all patients were given via nebulizer. Results There were no significant differences between group I who received nebulized magnesium sulphate + salbutamol and group II who received nebulized salbutamol regarding pulmonary functions (FEV1, FVC and FEV1/FVC), before and after treatment. After treatment there is a significant increase in O2 saturation, PO2 and Serum Mg(more in group I who received nebulized magnesium sulphate + salbutamol than group II who received nebulized salbutamol) and no significant difference between the two groups as regard PH, PCO2, HCO3, and CRP. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, and O2 Saturation after treatment and no significant change in PH, PCO2, HCO3, serum Mg and CRP, in patients received salbutamol nebulizer. There is significant change in pulmonary functions ( FEV1, FVC and FEV1/FVC), PO2, O2 Saturation and serum Mg after treatment and no significant change in PH, PCO2, HCO3, and CRP in patients received Magnesium sulphate + salbutamol nebulizer. Conclusion Adding nebulized magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV1, FVC&amp;FEV1/FVC. Nebulized magnesium sulphate+ salbutamol provides nearly equal response to nebulized salbutamol in the treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease in adults. So we do not recommend routine using of nebulizeld magnesium sulphate as an adjuvant to salbutamol treatment in the setting of AECOPD.

Effects of acupuncture on pulmonary function and airway smooth muscle spasm in asthma rats

To observe the effects of acupuncture at "Kongzui" (LU 6) and "Yuji" (LU 10) on the latent period of inducing asthma, pulmonary function and the expression of endothelin-1 (ET-1) and metallothionein-2 (MT-2) in asthma rats, and to explore the possible mechanism of acupuncture in alleviating airway smooth muscle spasm and improving the acute attack of asthma. A total of 40 male SD rats of SPF-grade were randomly divided into a normal group, a model group, a medication group and an acupuncture group, 10 rats in each group. Except for the normal group, ovalbumin sensitization method was used to establish the asthma model in the other 3 groups. Salbutamol nebulization was adopted in the medication group, while acupuncture was applied at bilateral "Kongzui" (LU 6) and "Yuji" (LU 10) in the acupuncture group. The intervention was given once a day for 14 days in the two groups. The latent period of inducing asthma and pulmonary function were observed, the levels of ET-1 and tumor necrosis factor (TNF)-α in serum and bronchoalveolar lavage fluid (BALF) were detected by ELISA method, the morphology of the airway was observed by Masson staining, the ultrastructure of the airway smooth muscle was observed by transmission electron microscopy, the mRNA and protein expression of ET-1 and MT-2 in lung tissue was detected by real-time PCR and Western blot methods. Compared with the normal group, in the model group, the latent period of inducing asthma was shortened (P<0.01); the airway resistance (RL) was increased while the dynamic compliance (Cdyn) was decreased (P<0.01, P<0.05); the levels of ET-1 and TNF-α in serum and BALF were increased (P<0.01); collagen fibers and collagen depositions were found around the bronchi, airway smooth muscle was thickened, the cell damage was severe and mitochondria were swollen; the mRNA and protein expression of ET-1 was increased while the mRNA and protein expression of MT-2 was decreased (P<0.01). Compared with the model group, in the acupuncture group, the latent period of inducing asthma was prolonged (P<0.05), the RL was decreased while the Cdyn was increased (P<0.01, P<0.05). Compared with the model group, in the medication group and the acupuncture group, the levels of ET-1 and TNF-α in serum and BALF were decreased (P<0.01, P<0.05); collagen fibers and collagen depositions around the bronchi were reduced, the thickened airway smooth muscle was lightened, the cell damage was improved; the mRNA and protein expression of ET-1 was decreased while the mRNA and protein expression of MT-2 was increased (P<0.01). Compared with the medication group, the mRNA expression of MT-2 was increased in the acupuncture group (P<0.05). Acupuncture at "Kongzui" (LU 6) and "Yuji" (LU 10) can improve the pulmonary function and alleviate the airway smooth muscle spasm in rats with asthma. Its mechanism may be related to the down-regulation of ET-1 expression and up-regulation of MT-2 expression.

Covid-19 Infection on Asthma in an Immunocompromised Child: A Rare and Unusual Case

Introduction: Autoimmune lymphoproliferative syndrome is an immune system deficiency secondary to a disorder of lymphocyte homeostasis, the diagnosis of which is based on major and minor criteria. The combination of Asthma and COVID 19 has been described in numerous studies and several information has been disseminated on the presumed risk factors for COVID-19. Among these, the idea has emerged that people with autoimmune diseases have a higher risk of infection with COVID 19. The objective of our study is to assess the severity of COVID 19 infection in a patient with underlying pathologies. Observation: We report the case of an 8-year-old patient known to be asthmatic and followed for autoimmune lymphoproliferative syndrome since the age of 6 years. The patient presented to the Pediatric Infectious Diseases Department with exacerbation of asthma due to Covid-19 infection. She presented with wheezing dyspnea associated with fever and dry cough and was found to have febrile respiratory distress with wheezing rales on auscultation and signs of respiratory struggles requiring salbutamol nebulization. The evolution was marked by the improvement of dyspnea and cough with regression of fever after a therapy combining inhaled corticosteroids, antibiotics and hydroxychloroquine. Conclusion: This case study demonstrated that the occurrence of COVID 19 in an asthmatic and immunocompromised child was benign, and highlighted the dual benefit of hydroxychloroquine on COVID infection as well as on autoimmune lymphoproliferative syndrome.

Comparison of Effects of Salbutamol Inhalation with Continuous Positive Airway Pressure and Bubble Continuous Positive Airway Pressure Alone in the Management of Severe Transient Tachypnea of the Newborn

Objective: To find the frequency of known risk factors in cases of severe transient tachypnea of the newborn (TTN) and to measure the effect of inhaled Salbutamol to bubble CPAP on required treatment duration.&#x0D; Study Design: Quasi-experimental study.&#x0D; Place and Duration of Study: Neonatal Intensive Care Unit, Combined Military Hospital, Malir Cantt, Karachi Pakistan, from Nov 2019 to Jun 2020.&#x0D; Methodology: A total of 60 cases of severe TTN, labelled on a predefined criterion were included in the study. The sample was randomized into two groups using an alternate sampling technique. Group-A was treated with bubble CPAP alone, while in Group-B, inhaled Salbutamol was added. The response was measured regarding the time taken to settle respiratory distress.&#x0D; Results: Out of 60 cases, 54(90.0%) were delivered through Caesarean section. A total of 9(15.0%) cases were born prematurely. Polycythemia was found in 10(16.6%) cases. Maternal asthma and gestational diabetes frequency were 8(13.33%) and 12(20.0%), respectively. A significant reduction was seen in the duration of respiratory distress in the study population receiving bubble CPAP with inhaled Salbutamol in the first 24 hours of illness (p-value&lt;0.001).&#x0D; Conclusion: Caesarean section is the most significant risk factor for developing TTN. Adding Salbutamol nebulization to bubble CPAP resulted in an earlier settlement of respiratory distress.

Role of Salbutamol in The Management of Transient Tachypnea of the Newborn: A Comparative Prospective Study

Objective: To compare the outcome of Salbutamol nebulization with normal saline (placebo) in transient tachypnea of the newborn.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Neonatal Medicine, Military Hospital Rawalpindi, from Jan 2017 to Mar 2018.&#x0D; Methodology: Sixty term neonates with respiratory rate &gt;60 breaths/min and transient tachypnea of newborn score of ≥4 were enrolled. They were randomly allocated to two equal groups. Group-1 received Salbutamol nebulization (0.15 mg/kg) while Group-2 received normal Saline (placebo) nebulization.&#x0D; Results: The mean gestational age was 38.31±1.28 weeks, while the average birth weight was 2.97±0.27 kg. The mean change in transient tachypnea of newborn score with Salbutamol nebulization was 5.63±1.22, while 0.63±1.54 with normal Saline nebulization. Likewise, the mean change in respiratory rate with Salbutamol was 9.80±2.05, while -3.73±2.57 with normal saline.&#x0D; Conclusion: This study demonstrated nebulized Salbutamol as an effective tool in reversing transient tachypnea of newborns with decreasing respiratory rate compared to normal saline nebulization (placebo).

Comparison of Hypertonic Saline vs Salbutamol in Normal Saline Nebulization in Children with Bronchiolitis

Background: Main stay of treatment of acute Bronchiolitis is general supportive care, such as oxygenation, aspiration of respiratory tract secretions, and hydration therapy. Recent research indicates that breathed hypertonic saline is a potential treatment. Objective: To compare the mean length of hospital stay and clinical bronchiolitis score of salbutamol nebulized in normal saline versus hypertonic saline in children with acute bronchiolitis. Material and methods Study Design: Randomized controlled design Setting: Department of pediatrics, Fatima Memorial Hospital, Lahore. Duration of Study: 6 months after approval of the study i.e. from 12th April 2017 to 12th October 2017. Data Collection Procedure: Relevant parameters were identified, and the CBSS was computed. Using random tables, cases were divided among two groups and given salbutamol or hypertonic saline nebs. The length of stay was determined. The Clinical Bronchiolitis Severity Score (CBSS) was recorded based on various variables. Version 17 of the statistical package for social sciences was used for statistical analysis. Result: Patients in the salbutamol group had a mean age of 13.56.66 months, while those in the hypertonic saline group had a mean age of 12.46.58 months. In the group receiving salbutamol, there were 29 males and 31 females. There were 32 men and 28 women in the hypertonic saline group. After 24 hours, the mean CBSS in the salbutamol group was 6.132.47, whereas in the hypertonic saline group, it was 4.881.75. After 24 hours of treatment, the difference in CBSS was significant between the two groups (P0.05). The mean duration of hospitalization was 3.920.81 days with salbutamol and 3.050.77 days with the hypertonic group. In both groups, there was a marked difference in duration of hospital stay (P0.05). Conclusion: Thus, hypertonic saline was more effective than salbutamol in reducing the CBSS score and duration of hospital stay. Keywords: Hospital Stay, Clinical Bronchiolitis Score, Nebulized Salbutamol, Normal Saline, Hypertonic Saline, Children, Acute Bronchiolitis.

Continuous Versus Intermittent Nebulization of Salbutamol in Acute Severe Asthma

Introduction: 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. Objectives: The main objective of the study is to find the continuous versus intermittent nebulization of salbutamol in acute severe asthma. Material and methods: This randomized control trial study was conducted pulmonology department of DHQ Hospital Faisalabad and the duration of this study was from January 2019 to July 2019. Data was collected with the permission of ethical committee of hospital. The data was collected through random sampling technique. Patients were allocated by means of random table to receive salbutamol either by continuous or intermittent nebulization. Results: The data was collected from 100 asthma patients of both genders. The mean age of patients continuous nebulization was 34.56±2.34 years and in intermittent nebulization 39.89±4.76 years. Hypoxemia was present in all patients with a mean PaO2 is 198±78 mmHg in continuous nebulization. Demographic and clinical values are presented in table 01. Practical implication: We can easily apply this method in hospital treatment of continuous and intermittent nebulization of salbutamol in acute severe asthma. Conclusion: It is concluded that there is no difference in continuous and intermittent nebulization of salbutamol in acute severe asthma. In this regard, repeated nebulizations of salbutamol at 20-minute intervals should be regarded as almost identical to continuous nebulization. keywords: Nebulization, Intermittent, Patients

Comparison of Effectiveness of Nebulized N-Acetylcysteine Solution (Mucolytic Therapy), Nebulized Salbutamol and Nebulized Ipratropium Bromide In Treatment of Children with Acute Bronchiolitis

Background: Bronchiolitis is a viral mediated disease that results in acute inflammation in the lower respiratory tract. It occurs in infants and children under 2 years of age. The vast majority of infants’ experience at least 01 episode of bronchiolitis and 2-3% of all infants can be hospitalized for bronchiolitis in the 1st year. With an increasing rate having risen by an average of 1.8% annually in European country and a small percentage even need critical care. Children who are hospitalized for bronchiolitis currently only receive fluid replacement, additional oxygen and respiratory support. Bronchiolitis is most common motivator for hospital admissions in many nations. Respiratory syncytial virus (RSV) is most common virus causes bronchiolitis, and also causes infections during the winter months. Objective: To determine the comparison of effectiveness of nebulized N-acetylcysteine solution (mucolytic therapy), nebulized salbutamol and nebulized ipratropium bromide in treatment of children with acute bronchiolitis at a tertiary care hospital. Materials &amp; Methods: All patients who fulfilled the inclusion criteria and visited to Baqai Medical University Hospital, Karachi from April 17, 2019 to October 16, 2019 were included in this Prospective Randomized Control Trial (lottery method). Informed consent was taken after explaining the procedure, risks and advantages of the study. Children from either gender having provisional diagnosis of acute bronchiolitis between 2 to 24 months of age were included and divided in three groups in our study. Each group obtained three treatments every day, introduced at intervals of eight hours for three days. Patients had been tested on admission, at 8 hours and every morning for severity of disease. For assessing improvement, scientific severity score turned into used to peer the effectiveness of nebulized N-acetylcysteine solution (mucolytic therapy), nebulized salbutamol and nebulized ipratropium bromide in bronchiolitis. All the collected data were entered into the proforma attached at the end and used electronically for research purpose. Results: 81 study cases of these, 44 (54.3%) were males while 37 (45.7%) were females. Our study cases mean age in Nebulized N-acetylcysteine was 9.4±6.3, in Nebulized Salbutamol and Ipratropium Bromide was 10.8±6.7 and 12.0±6.6 months, respectively. In group wise comparison of clinical severity score at baseline, 8, 24 and 72 hours, highly significant difference was found among the group at baseline, 8, 24 and 72 hours i.e., P ≤ (0.05) within the groups while on the other hand non-significant difference i.e., (0.633) was showed between the group at baseline among nebulized N-acetylcysteine, nebulized salbutamol and ipratropium bromide group respectively. Conclusion: In the lights of our findings, it is to be concluded that nebulized salbutamol was more effective in improvement of clinical severity score with shorter duration of hospital stay. Furthermore, it is to be concluded that there is a need to have further studies with larger sample size in different centers in Pakistan to validate the findings of current study. Keywords: N-acetylcysteine Solution, Nebulized Salbutamol, Nebulized Ipratropium Bromide, Acute Bronchiolitis

Comparison of Efficacy of Epinephrine to Salbutamol and Ipratropium Bromide Combined in Acute Bronchiolitis

Background: Epinephrine, an alpha receptor agonist, has been suggested to be a supreme bronchodilator. A biologically active drug name Ipratropium bromide is helpful for the treatment of bronchiolitis among infants and improves on the signs and symptoms of bronchiolitis. Objective: To compare effectiveness of combined nebulized salbutamol with nebulized adrenaline and ipratropium bromide in bronchiolitis affected children in terms of mean improvement in RDAI score. Methodology: After approval from ethical committee this randomized control trial of 6 month duration is carried out by Randomization of patients in 2 groups. Group A received salbutamol (0.15mg/kg) combined with ipratropium bromide (250 micrograms per dose) with isotonic sodium chloride solution 0.9% (2 mL) and Group B received a dose of epinephrine (0.5mg/kg in concentration of 1:1000(max 5 mg), distributed by nebulizer with the help of a face mask with continuous oxygen flow at 6L/min Prior to each drug administration and at 30 mints, the researcher evaluated the condition of infant’s and records the respiratory rate, RDAI score9, heart rate and SaO2. RESULTS: Comparison of effectiveness of combined nebulized salbutamol with nebulized adrenaline and ipratropium bromide in bronchiolitis affected children in terms of mean improvement in RDAI score shows that at baseline in Group-A it was 10.73+1.59 and 10.98+1.42, p value was 0.27, it was reduced after 30 minutes of treatment in Group-A 3.23+0.52 and 2.67+0.47 in Group-B, p value was 0.001. Conclusion: We concluded that Epinephrine is better than salbutamol and ipratropium combined in terms of mean improvement in RDAI score Keywords: Bronchiolitis, children, salbutamol and ipratropium Bromide, Epinephrine.

Efficacy of nebulized hypertonic saline versus normal saline and salbutamol in treating acute bronchiolitis in a tertiary hospital: a randomized control trial

Background: Bronchiolitis is an acute seditious lesion of the lower respiratory tract. Further, than 70 cases are caused by a respiratory syncytial virus (RSV); other less common pathogens include parainfluenza, influenza, rhinovirus, adenovirus, mortal metapneumovirus, mortal Boca contagion and mycoplasma pneumonae. The aim of the study was to evaluate the efficacy of nebulized hypertonic saline in children with acute bronchiolitis in the improvement of clinical features and decreasing length of hospital stay.Methods: The study was a randomized control trial carried out in the department of paediatrics, Dhaka medical college hospital (DMCH), Dhaka between January to December 2013. A total of 100 children from 1 month to 24 months of age irrespective of sex with clinical presentation of bronchiolitis admitted in the paediatric wards of DMCH were included in the study and were randomly assigned to either 4 ml 3% hypertonic saline nebulization (group I=50) or to 4 ml normal saline and 0.4 ml salbutamol respiratory solution nebulization (group II=50). The therapy was repeated 8 hours every day for 120 hours.Results: The clinical severity scores (CS) based on respiratory rate, wheezing, chest retraction and general conditions at baseline on the first day of treatment were 9.0±1.0 in group I and 9.3±1.8 in group II (not significant). The study demonstrated that clinical severity score improved by three days but the improvement was more significant in children who received nebulized hypertonic saline (1.7±1.2) compared to those who received nebulized normal saline and salbutamol (3.5±1.8). The cases of group I required a shorter duration of oxygen therapy compared to those of group II (15±6.0 hours versus 26.4±5.4 hours; p&lt;0.05). Forty-seven patients (94%) were discharged within 72 hours of treatment in group I and 29 patients (58%) in group II. The length of hospital stay was shorter in group I 58.1±22.0 hours compared to group II 74.7±27.2 hours. None of the cases of any group encountered any side effects due to study drugs.Conclusions: 3% hypertonic saline nebulization significantly reduces clinical severity and length of hospital stay of children suffering from acute bronchiolitis in comparison to those treated by normal saline and salbutamol nebulization.

Severe lactic acidosis and persistent diastolic hypotension following standard dose of intermittent nebulized salbutamol in a child: a case report

BackgroundSalbutamol is a selective β2-receptor agonist widely used to treat asthma in both emergency and outpatient settings. However, it has been associated with a broad spectrum of side effects. Lactic acidosis and diastolic hypotension are rarely reported together following intermittent salbutamol nebulization in children, even less so at standard therapeutic doses.Case presentationWe present the case of a 12-year-old Italian boy, 34 kg body weight, who experienced a serious drug reaction during a moderate asthma exacerbation with associated dehydration (blood urea nitrogen/creatinine 0.25), following intermittent inhaled (0.2 mg at 3-hour intervals—overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg at 20-minute intervals in 60 minutes, overall 11.25 mg in our emergency department). The patient developed hyperglycemia (peak concentration 222 mg/dL), hypokalemia (lowest concentration 2.6 mEq/L), electrocardiogram alterations (corrected QT interval 467 ms), long-lasting arterial hypotension despite fluid boluses (lowest value 87/33 mmHg), and elevated blood lactate levels (peak concentration 8.1 mmol/L), following the third nebulized dose. Infections, liver dysfunction, and toxicity following other medications were ruled out. The aforementioned alterations improved within 24 hours after discontinuation of salbutamol.ConclusionsWe reinforce the message that even the use of intermittent nebulized salbutamol for acute moderate asthma can lead to severe transient complications in children. Then, healthcare providers should pay attention not only in emergency settings, to achieve prompt recognition and proper management of this adverse reaction. Careful reassessment could prevent similar reactions.

THE COMBINATION OF SALBUTAMOL NEBULIZER AND PROCATEROL ORAL TO THE INDONESIAN CHILDREN WITH PNEUMONIA

&#x0D; This study aimed to examine the effectiveness of combining salbutamol nebulizer and procaterol oral compared to only procaterol oral on the respiratory status including temperature (fever), spasm, cough, retraction and length of stay (LOS), among young children with pneumonia. This prospective cohort study included 48 consecutive sampling subjects with pneumonia in Indonesia. The subjects were classified based on the type of therapy they received: intervention group used the combination of salbutamol nebulizer and procaterol oral therapy (n = 24) and the control group used procaterol oral only (n = 24). The study of the two groups showed that the combination salbutamol nebulizer and procaterol oral was more effective than the administration of procaterol oral only with the rate of clinical change. The significant effectiveness of nebulizer salbutamol and oral procaterol to reducing respiratory status (p=0.006) and temperature (fever) (p=0.000) compared to the only procaterol oral. However, there was no significant effectiveness of nebulizer salbutamol and oral procaterol in reducing spasm (p=0.348), cough (p=0.964), retraction (p=0.666) and length of stay (LOS) (p=0.192) compared to the only procaterol oral among the Indonesian children with pneumonia.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Efficacy evaluation of budesonide nebulizer as an adjunctive medication in post-rain asthma acute phase attack.

Bronchospasm attacks occur following syndromic rainfall and are increasing due to air pollution and need effective treatments. In this study, the effect of salbutamol nebulizer in comparison with salbutamol plus budesonide nebulizer in patients referred to the emergency department with dyspnea was investigated. The trial study was conducted on 228 patients with dyspnea after the first rainfall in Ahvaz. Two groups of 114 patients have been randomly allocated. On the course of treatment, the first group received salbutamol plus budesonide nebulizer and the second group received salbutamol alone. In the experimental group, budesonide 0.5 mg with salbutamol was nebulized three times for 20 minutes. In all patients, 20, 40, and 60 minutes after the start of the intervention, forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) and vital signs of size were recorded and analyzed by SPSS and t-test. Data revealed that there were significant differences between PEFR parameters of studied. Groups in minute 40 and 60 after intervention (p = 0.000001). There was better improvement.in PEFR values in minute 40 and 60 in budesonide plus salbutamol study group. There were no significant differences for FEV1 in minute 0, 20, 40, 60 between to studied group. Also there were no significant differences for borg dyspnea scale for minute 0 and 60 between two experimented group. Respiratory rates have significant differences in minutes 20, 40 after intervention and there was better improvement for salbutamol plus budesonide group rather than sulbutamol intervention group alone.(p = 0.001142). Experiment data revealed. that due to the significant difference between PEFR and increased FEV1 in the combination of the two drugs and due to the corticosteroid effects of budesonide in reducing and preventing inflammation and swelling of the lungs, nebulizer salbutamol + budesonide has better effects on moderate breath than in nebulizer salbutamol.

Development of the Siriraj Clinical Asthma Score

Acute asthmatic attack in children commonly occurs despite the introduction of effective controllers such as inhaled corticosteroids and leukotriene modifiers. Treatment of acute asthmatic attack requires proper evaluation of attack severity and appropriate selection of medical therapy. In children, measurement of lung function is difficult during acute attack and thus clinical asthma scoring may aid physician in making further decision regarding treatment and admission. We enrolled 70 children with acute asthmatic attack with age range from 1 to 12 years (mean ± SD = 51.5 ± 31.8 months) into the study. Twelve selected asthma severity items were assessed by 2 independent observers prior to administration of salbutamol nebulization (up to 3 doses at 20 minutes interval). Decision for further therapy and admission was made by emergency department physician. Three different scoring systems were constructed from items with best validity. Sensitivity, specificity and accuracy of these scores were assessed. Inter-rater reliability was assessed for each score. Review of previous scoring systems was also conducted and reported. Three severity items had poor validity, i.e., cyanosis, depressed cerebral function, and I:E ratio (p > 0.05). Three items had poor inter-rater reliability, i.e., breath sound quality, air entry, and I:E ratio. These items were omitted and three new clinical scores were constructed from the remaining items. Clinical scoring system comprised retractions, dyspnea, O2 saturation, respiratory rate and wheezing (rangeof score 0-10) gave the best accuracy and inter-rater variability and were chosen for clinical use-Siriraj Clinical Asthma Score (SCAS). A Clinical Asthma Score that is simple, relatively easy to administer and with good validity and variability is essential for treatment of acute asthma in children. Several good candidate scores have been introduced in the past. We described the development of the Siriraj Clinical Asthma Score (SCAS) in this report and reviewed the literature on the development of clinical asthma score for use in children.

Pulmonary Arteriovenous Malformations in a 18-months-old Child: A Case Report

Pulmonary Arteriovenous Malformation (PAVM) is a cardiovascular anomaly in which an anatomic communication between the pulmonary artery and pulmonary vein is formed, resulting in an additional cardiac shunt from the right to left side. PAVM is a rare disease, reported more in females, but in newborns comparatively higher in males. Cases can vary from asymptomatic to symptomatic such as having dyspnoea, hypoxia, cyanosis, neurological symptoms. They are mostly congenital having association with Hereditary Haemorrhagic Telangiectasia (HHT). Herby, author present a case of 18-months-old female was admitted with peripheral cyanosis in the Paediatric Department. Her saturation was 76%, after admission she received three doses of salbutamol nebulisation and was kept on 3 litre oxygen until her saturation increased to around 90%. On auscultation, a murmur of grade 2/6 heard in the left axilla with clear lung fields. Chest X-ray detected a prominent lobulated opacity in the left sided lung adjacent to the heart border. An echocardiogram was done which turned out normal. Thoracic Computed Tomography (CT) scan with contrast showed a vascular malformation in the apical region of the left lower lobe. Pulmonary angiography showed multiple vascular lesions in the peripheries which was consistent with arteriovenous malformation. The child was diagnosed with PAVM. A transcatheter embolisation and coil closure of AVM was performed and postprocedure the child was stable.