Salbutamol In Children Research Articles

Salbutamol safety in children under 2 years of age with acute wheezing: a meta-analysis of randomised controlled trials

ObjectiveTo evaluate the safety of short-term use of inhaled salbutamol in children under 2 years of age with acute wheezing.Data sourcesElectronic databases (PubMed, Trip, MEDLINE) and the Cochrane Library were...

Once or consecutive administration of inhaled salbutamol in children with acute asthma exacerbation: Is an additional dose beneficial?

Although international guidelines generally recommend the back to back use of short-acting β-agonizts (SABA) within a short time in the management of acute wheezing in children with asthma, there is still uncertainty in the evidence of short term outcome. Thus, this study aimed to investigate the efficacy of back to back and single use of inhaled SABA by lung function testing. This was a prospective, double-blinded, placebo controlled study conducted in children ≥6 years of age with a history of asthma. Children who presented with an acute asthma exacerbation (AAE) with a forced expiratory volume in 1 s (FEV1) between 40% to 60% were enrolled in the study if they had a first dose to SABA response of FEV1 ≥ 12%. All children were then randomly assigned either to receive two additional doses of inhaled SABA (300 µg per dose) or placebo. Spirometric analysis included forced vital capacity (FVC), FEV1, FEV1/FVC, PEF, and FEF25-75 at baseline, 15, 30, and 45 min for each group. Oxygen saturation and heart rate were monitored during the study period. A total of 93 patients (inhaled SABA group; n = 48 vs. placebo group; n = 45) out of 110 enrolled patients completed the study. Baseline demographic characteristics of patients include age, gender, age of diagnosis, parental asthma, history of allergic rhinitis and atopic dermatitis, current asthma treatment, IgE and skin prick test were similar among groups. (p > .05) When lung function parameters were compared at each time interval during the study period, there were no statistical significance found in FVC, FEV1, FEV1/FVC, PEF and forced expiratory flow between 25% and 75% (FEF25-75) among groups. (p > .05) There were also no differences between groups for changes in heart rate and oxygen saturation. (p > .05) CONCLUSION: A single dose of inhaled SABA provides similar short term bronchodilator effect as back to back administration of inhaled SABA in children with AAE who showed an initial response to SABA of FEV1 ≥ 12%.

Comparison of doses of Nebulized Magnesium sulphate as an adjuvant treatment with salbutamol in children with Status Asthmaticus.

To compare the response between different doses of nebulized magnesium sulphate along with Salbutamol in children between two to 12 years of age with status asthmaticus. This single blinded, randomized clinical trial was carried out at the Department of Pediatrics, Dr. Ziauddin University Hospital, Karachi, Pakistan during October 2021 to September 2022. A total of 104 children aged between 2-12 years, with the diagnosis of asthma having "Pediatric Rapid Assessment Measure (PRAM)" score>4 and with reactive airways were included. Children either received three back-to-back nebulization with salbutamol solution only (n=50) or salbutamol and MgSO4 with three different doses (250mg, 500mg or 750mg) after every 20 minutes for 60 minutes. The PRAM score was used as an assessment tool to clinically score asthma. In a total of 104 children, 53 (51.0%) were girls. The mean age was 5.25±2.86 years. No statistically significant difference was found in PRAM scores at baseline (p=0.448) and at 20-minutes (p=0.072) but significant differences were observed at 40-minutes (p=0.009), 60-minutes (p=0.011), 120-minutes (p=0.010), 6-hours (=0.034), 12-hours (p=0.018), 18-hours (p=0.033) and at 24-hours (p=0.029). The reduction in PRAM scores from baseline to 24-hours following treatment among Salbutamol, Salbutamol+ MgSo4 250mg, Salbutamol+ MgSo4 500mg and Salbutamol+ MgSo4 750mg group were 6.53±1.09, 7.22±1.09, 6.85±1.43 and 7.57±1.06 respectively (p=0.007). While children with status asthmaticus managed using salbutamol, with or without nebulized MgSO4, showed improved clinical outcomes, combining salbutamol with higher dosages of nebulized MgSO4 resulted in even greater clinical improvement.Clinical Trial Registry: https://clinicaltrials.gov/ct2/show/NCT04929626.

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.

Factors associated with salbutamol overuse in bronchiolitis.

Numerous studies have shown that quality improvement methods can reduce the use of medications in the management of bronchiolitis. Our objective is to identify factors related to the overuse of salbutamol in the treatment of bronchiolitis before and after an improvement initiative. Observational study of sociodemographic and clinical factors associated with the use of salbutamol in children diagnosed with bronchiolitis. This was a secondary analysis of a prospective cohort study conducted at 135 primary care (PC) centers and eight pediatric emergency departments (ED) in the Osakidetza/Basque Health Service (Spain) in two epidemic seasons between which a bronchiolitis integrated care pathway (BICP) had been implemented: pre-intervention season from October 2018 to March 2019 and post-intervention season from October 2019 to March 2020. Generalized linear mixed models were used to estimate association of studied variables on use of salbutamol over the two seasons. Four thousand one hundred thirty-four ED attendances and 8573 PC visits were included, of which 1936 (46.8%). And 4067 (47.4%) occurred in the post-intervention period respectively. Six independent risk factors were associated with overuse of salbutamol in both seasons: age ≥ 1year, aOR 2.32 (2.01 to 2.68) in PC centers, and aOR 6.84 (4.98 to 9.39) in EDs; being seen in the last third of the bronchiolitis season, aOR 1.82 (1.51 to 2.18) in PC centers and aOR 1.78 (1.19 to 2.64) in EDs; making more than one visit to the PC center, aOR 4.18 (3.32 to 5.27) or the ED, aOR 2.06 (1.59 to 2.66); being seen by a general practitioner, aOR 1.97 (1.58 to 2.46) in PC centers; and having a more severe episode, aOR 3.01 (1.89 to 4.79) in EDs. Conclusion:There are factors associated with salbutamol overuse in children diagnosed with bronchiolitis in PC and emergency settings that persist after the deployment of quality improvement initiatives. What is Known: • Quality improvement initiatives have been shown to decrease the use of non-evidence-based treatments and testing in bronchiolitis. • The magnitude and pattern of change in the use of medications linked to the quality improvement initiatives are not uniform across the same health service. What is New: • Children diagnosed with bronchiolitis ≥ 1year of age, seen in the last third of the bronchiolitis season, attending more than once, treated by a general practitioner, and/or with more severe episodes are more likely to be treated with salbutamol. • These factors may remain present despite the implementation of improvement initiatives focused on reducing the use of medications in the management of bronchiolitis.

THE INFLUENCE OF SPELEOTHERAPY ON BRONCHI PASSAGE IN CHILDREN WITH BRONCHIAL ASTHMA USING A PHARMACO-FUNCTIONAL TEST WITH SALBUTAMOL.

The aim: To investigate the reaction of the bronchi to inhalation of salbutamol in children with different severity of bronchial asthma under the conditions of speleotherapy. Materials and methods: 40 children aged 6-15 years were examined, 20 of them had an intermittent course of the disease, 20 had a mild course, and the children were in the inter-relapse period. Determining the function of external respiration (FER) with a pharmaco-functional test (PFT) with salbutamol was carried out in the dynamics of observation before and after treatment and compared with the indicators of 40 healthy children. Speleotherapy was performed based on the children's department of the Ukrainian Allergological Hospital of the village Solotvino. Results: A decrease in increased bronchial tone and restoration of bronchial patency at all levels of the bronchi in all patients with an intermittent course of the disease and a partial decrease in bronchial hyperreactivity with the improvement of bronchial patency in children with a mild course of bronchial asthma under the influence of speleotherapy was established. Conclusions: Thus, speleotherapy contributes to a positive reaction of the bronchi to inhalation of salbutamol, which is reflected in the normalization of disturbed bronchial tone and the restoration of bronchial patency at all levels of the bronchi, in all patients with an intermittent course and partially with a mild course of the disease.

Variability of the pharmacological response in children with different ADRB2 gene polymorphisms in recurrent bronchial obstruction and bronchial asthma

To date, methods of studying the effects of drugs at the molecular-genetic level are widely used in pediatric practice. The aim of our work was to evaluate the effectiveness of the effect of β2-agonists on the clinical course of recurrent bronchial obstruction (RBO) in children, depending on the variants of polymorphism of the ADRB2 gene. The effectiveness of salbutamol in children with RBO and bronchial asthma(BA) was evaluated depending on the distribution of alleles and genotypes of the ADRB2 Argl6Gly and Gln27Glu genes according to the degree of reversibility of bronchial obstruction. In the group of children with RBO carriers of the heterozygous A/G genotype of the Arg16Gly locus and the Gln27Glu locus of the ADRB2 gene, high efficacy of salbutamol therapy as a bronchodilator was noted. At the same time, in children with RBO representatives of the G/G genotype, the effectiveness of using the drug is low. In children with BA, the change in functional activity is associated with the polymorphism of the Gln27Glu gene locus and is associated with a low therapeutic response to β2–agonists in children with the G\G mutational genotype and a good effect in carriers of the homozygous variant with the A/A genotype. Knowledge of the genotype of polymorphic variants of the ADRB2 gene will make it possible to evaluate one of the factors of predisposition and effectiveness of therapy in the recurrent course of bronchial obstruction syndrome and bronchial asthma.

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.

Effect of Salbutamol on Lung Ventilation in Children with Cystic Fibrosis: Comprehensive Assessment Using Spirometry, Multiple-Breath Washout, and Functional Lung Magnetic Resonance Imaging

Background: Inhalation therapy is one of the cornerstones of the daily treatment regimen in patients with cystic fibrosis (CF). Recommendations regarding the addition of bronchodilators, especially salbutamol are conflicting due to the lack of evidence. New diagnostic measures such as multiple-breath washout (<underline>MBW)</underline> and functional magnetic resonance imaging (MRI) have the potential to reveal new insights into bronchodilator effects in patients with CF. Objective: The objective of the study was to comprehensively assess the functional response to nebulized inhalation with salbutamol in children with CF. Methods: Thirty children aged 6–18 years with stable CF performed pulmonary function tests, MBW, and matrix pencil-MRI before and after standardized nebulized inhalation of salbutamol. Results: Lung clearance index decreased (improved) by −0.24 turnover (95% confidence interval [CI]: −0.53 to 0.06; p = 0.111). Percentage of the lung volume with impaired fractional ventilation and relative perfusion decreased (improved) by −0.79% (CI: −1.99 to 0.42; p = 0.194) and −1.31% (CI: −2.28 to −0.35; p = 0.009), respectively. Forced expiratory volume (FEV₁) increased (improved) by 0.41 z-score (CI: 0.24–0.58; p < 0.0001). We could not identify specific clinical factors associated with a more pronounced effect of salbutamol. Conclusions: There is a positive short-term effect of bronchodilator inhalation on FEV₁ in patients with CF, which is independent of ventilation inhomogeneity. Heterogeneous response between patients suggests that for prediction of a therapeutic effect this should be tested by spirometry in every patient individually.

Comparison of Salbutamol and Salbutamol with ipratropium bromide in children with exacerbation of Asthma in terms of peak expiratory flow rate (PEFR).

Objective: To compare the Salbutamol alone and Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR. Study Design: Randomized Controlled Trial. Setting: Pediatrics Emergency, KRL Hospital Islamabad. Period: 1st August 2016 to 31 January 2017. Material &amp; Methods: Group A patients were given only Salbutamol (0.15mg/kg per dose with minimum 2.5 mg, maximum 5 mg/dose). Group B was given Ipratropium Bromide supplemented Salbutamol (250 mcg/dose for &lt;20 kg while 500 mcg/dose for &gt;20kg of Ipratropium Bromide with same dose of Salbutamol as prescribed for Group A). Baseline spirometry was performed on each patient and after measurement of baseline peak expiratory flow. The outcome was measured by Peak flow meter and reassessed at 60 minutes. Results: Comparison of salbutamol alone and ipratropium bromide supplemented salbutamol in children with exacerbation of asthma in terms of PEFR shows that 40.5 + 4.28 in Group-A and 59.5 +4.75 in Group-B, P-value was calculated as 0.0001, showing a significant difference between the two groups while the difference in increase was recorded as 19%. Conclusion: We concluded that salbutamol alone is significantly less effective when compared with Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR.

To Compare the Mean Decrease in Respiratory Distress Assessment Score after Nebulization With Salbutamol Vs Epinephrine in Children With Acute Bronchiolitis

Aim: To compare the mean decrease in respiratory distress assessment score after nebulization with salbutamol vs epinephrine in children with acute bronchiolitis. Study Settings: Department of Pediatrics, Khyber Teaching Hospital Peshawar. Study design &amp; duration: Randomized Controlled Trial for six months from 13/6/2018 to 13/12/2018. Methodology: In this study, 105 patients in each group were studied. Baseline RDAI score was calculated. All the patients were randomly divided in two groups. Children in group A were Nebulized with Epinephrine (0.1 ml/kg) while children in group B were with salbutamol nebulization (5mg/ml solution) ½ml+3ml normal saline repeated every hour. All children were reassessed at the end of 4th dose (4th hour) and RDAI were recalculated for all patients. Results: In age of 2-12 months, 63% infants have nebulization with epinephrine and 70% cases with salbutamol while in age group 13-18 months, 37% cases nebulized with epinephrine and 30% infants with salbutamol. Mean±SD was 10.57±4.22 and 11.63±3.14 months respectively. Regarding sex, 60% males were nebulized with epinephrine and 53.3% with salbutamol while 40% females were nebulized with epinephrine and 46.7% cases with salbutamol. Mean RDAI at baseline was calculated as 11.57+2.21 with epinephrine and 11.3+2.14 with salbutamol and P value was 0.3695. Conclusion: Mean reduction in RDAI with epinephrine nebulization is more as compared to nebulization with salbutamol in children of acute bronchiolitis. Keywords: RDAI, nebulization, salbutamol, epinephrine, acute Bronchiolitis

Combination of ipratropium bromide and salbutamol in children and adolescents with asthma: A meta-analysis.

BackgroundA combination of ipratropium bromide (IB) and salbutamol is commonly used to treat asthma in children and adolescents; however, there has been a lack of consistency in its usage in clinical practice.ObjectiveTo evaluate the efficacy and safety of IB + salbutamol in the treatment of asthma in children and adolescents.MethodsThe MEDLINE, Embase, and Cochrane Library as well as other Chinese biomedical databases (including China Biological Medicine Database, Chinese National Knowledge Infrastructure, Chongqing VIP, and Wanfang Chinese language bibliographic database) were systematically searched from the earliest record date to September 2020 for randomized controlled trials in children and adolescents (≤18 years) with asthma who received IB + salbutamol or salbutamol alone. The primary outcomes included hospital admission and adverse events. A random effects model with a 95% confidence interval (CI) was used. Subgroup analysis was performed according to age, severity of asthma, and co-interventions with other asthma controllers. This study was registered with PROSPERO.ResultsOf the 1061 studies that were identified, 55 met the inclusion criteria and involved 6396 participants. IB + salbutamol significantly reduced the risk of hospital admission compared with salbutamol alone (risk ratio [RR] 0.79; 95% CI 0.66–0.95; p = 0.01; I2 = 40%). Subgroup analysis only showed significant difference in the risk of hospital admission in participants with severe asthma exacerbation (RR 0.73; 95% CI 0.60–0.88; p = 0.0009; I2 = 4%) and moderate-to-severe exacerbation (RR 0.69; 95% CI 0.50–0.96; p = 0.03; I2 = 3%). There were no significant differences in the risk of adverse events between IB + salbutamol group and salbutamol alone group (RR 1.77; 95% CI 0.63–4.98).ConclusionIB + salbutamol may be more effective than salbutamol alone for the treatment of asthma in children and adolescents, especially in those with severe and moderate to severe asthma exacerbation. The very low to high quality of evidence indicated that future well-designed double-blind RCTs with large sample are needed for research on evaluating the effectiveness of IB + salbutamol treatment for asthma in children and adolescents.

Comparative Study of Two Nebulized Preparations of Salbutamol in Children

Aim: Salbutamol is the main treatment for asthma attacks. It can be given via inhaler, nebulizer or oral route. Nebulization is mainly used at emergency departments. The aim of our study is to compare the clinical efficacy of two nebulized salbutamol preparations Ventolin® GSK and Asthalin® CIPLA. Methods: We conducted a prospective double blind randomized trial between April and December 2017 in which 30 children with asthma were included. Children were assigned randomly to receive nebulized Asthalin® or Ventolin®, with 15 patients included in each study arm. For each patient, oxygen saturation, presence of wheezing, retractions and thoraco-abdominal asynchrony, before and after Salbutamol nebulization were recorded. The effect of each treatment dose on oxygen saturation and respiratory rate after stratification of the initial population was analyzed. Results: Ventolin® increased oxygen saturation by 1.87% and decreased respiratory rate by 10.87 breaths per minute, while Asthalin® improved oxygen saturation by 1.8% and decreased respiratory rate by 9.53 breaths per minute. However, the difference was not significant as it was not significant for respiratory symptoms improvement and need for oxygenation and hospitalization rates. Conclusion: There is no significant difference between Ventolin® and Asthalin® when given via nebulization. Both treatments improved oxygen saturation, respiratory rate and respiratory symptoms similarly.

Population Pharmacokinetics of Intravenous Salbutamol in Children with Refractory Status Asthmaticus.

BackgroundIntravenous salbutamol is used to treat children with refractory status asthmaticus, however insufficient pharmacokinetic data are available to guide initial and subsequent dosing recommendations for its intravenous use. The pharmacologic activity of salbutamol resides predominantly in the (R)-enantiomer, with little or no activity and even concerns of adverse reactions attributed to the (S)-enantiomer.ObjectiveOur aim was to develop a population pharmacokinetic model to characterize the pharmacokinetic profile for intravenous salbutamol in children with status asthmaticus admitted to the pediatric intensive care unit (PICU), and to use this model to study the effect of different dosing schemes with and without a loading dose.MethodsFrom 19 children (median age 4.9 years [range 9 months–15.3 years], median weight 18 kg [range 7.8–70 kg]) treated with continuous intravenous salbutamol at the PICU, plasma samples for R- and S-salbutamol concentrations (111 samples), as well as asthma scores, were collected prospectively at the same time points. Possible adverse reactions and patients’ clinical data (age, sex, weight, drug doses, liver and kidney function) were recorded. With these data, a population pharmacokinetic model was developed using NONMEM 7.2. After validation, the model was used for simulations to evaluate the effect of different dosing regimens with or without a loading dose.ResultsA two-compartment model with separate clearance for R- and S-salbutamol (16.3 L/h and 8.8 L/h, respectively) best described the data. Weight was found to be a significant covariate for clearance and volume of distribution. No other covariates were identified. Simulations showed that a loading dose can result in higher R-salbutamol concentrations in the early phase after the start of infusion therapy, preventing accumulation of S-salbutamol.ConclusionsThe pharmacokinetic model of intravenous R- and S-salbutamol described the data well and showed that a loading dose should be considered in children. This model can be used to evaluate the pharmacokinetic–pharmacodynamic relationship of intravenous salbutamol in children, and, as a next step, the effectiveness and tolerability of intravenous salbutamol in children with severe asthma.Electronic supplementary materialThe online version of this article (10.1007/s40262-019-00811-y) contains supplementary material, which is available to authorized users.

Comparative Efficacy of Nebulized 7% Hypertonic Saline versus 0.9% Normal Saline with Salbutamol in Children with Acute Bronchiolitis

Background: Acute bronchiolitis is an acute viral lower respiratory tract infection of infants and is the leading cause of hospitalization of infants below 2 years of age. Being a viral disease, there is no effective treatment of this problem other than supportive care. To provide this care, both 0.9% normal saline with salbutamol and 3% hypertonic saline has been found effective. This study was undertaken to assess the efficacy of 7% hypertonic saline on recovery from acute bronchiolitis.&#x0D; Methodology: This was a randomized controlled trial, carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Bangladesh between January 2015 to December 2015. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted as acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 0.9% nebulized normal saline with salbutamol (Group-II = 45). The efficacy was determined by assessing clinical severity score and length of hospital stay. Data were analyzed using computer software SPSS version 19.&#x0D; Result: In this study the two groups were almost similar with respect to their demographic and baseline clinical severity score. After intervention the clinical severity score of both treatment modalities were reduced (Group-I(HS) were 7.9, 6.8, 3.8, 1.4, 1.33 while in Group-II(NS+ Salbutamol) score were 8.6, 7.6, 4.9, 3.11, 2.12) but the reduction was significant more in children who received 7% nebulized hypertonic saline than those who received 0.9% nebulized normal saline with salbutamol. Majority 42(93.3%) of group-I(HS) children recovered at the end of 72 hours whereas 17(37.8%) of the children of group-II (NS+ Salbutamol) recovered from the disease during the same period. Length of hospital stay was shorter in hypertonic saline group compared to normal saline with salbutamol group (56.36±12.33 hours vs71.07±13.48 hours, p&lt;.001). The patients of hypertonic saline group required a shorter duration of oxygen therapy compared to normal saline with salbutamol group (12.53±3.58) hours vs (20.25± 4.15) hours, (p=0.009).&#x0D; Conclusion: 7% hypertonic saline was found more effective than 0.9% normal saline with salbutamol in terms of reducing clinical severity, length of hospital stays and duration of oxygen therapy.&#x0D; Bangladesh J Child Health 2019; VOL 43 (2) :80-84

ADRB2 Gene Polymorphisms and Salbutamol Responsiveness in Serbian Children with Asthma.

Inhaled β2 adrenergic receptor (β2-AR) agonists are the mainstay of asthma therapy. The β2-AR protein is encoded by the ADRB2 gene and variants within this gene can have significant consequences for modulating the response to asthma therapy. This cross-sectional study performed at the University Children’s Hospital in Belgrade, included 54 children with asthma. The subjects were genotyped for ADRB2 +46A>G (Arg16Gly, rs1042713) and +79C>G (Gln27Glu, rs 1042714) polymorphisms and the association with asthma severity and response to inhaled salbutamol was examined. In Serbian asthmatic children, allele +46A was detected with a frequency of 41.7% and allele +79G was detected with a frequency of 23.1%. Allele +46G was found to be associated with a better response to inhaled salbutamol (p <0.05) and with mild form of asthma (p <0.05). Polymorphism ADRB2 +46A>G may be a determinant of asthma severity and response to salbutamol in children with asthma. We did not find any association of +79C>G polymorphisms with the asthma severity and bronchodilator response to inhaled salbutamol. The results of this study can be potentially useful for personalization of asthma treatment.

Comparative study of rotahaler with metered dose inhaler in administering salbutamol in children with bronchial asthma

Comparative study of rotahaler with metered dose inhaler in administering salbutamol in children with bronchial asthma

Clinical application of inert gas Multiple Breath Washout in children and adolescents with asthma

Children with asthma often have normal spirometry despite significant disease. The pathology of the small airways in asthma may be assessed using Multiple Breath Washout (MBW) and calculating the Lung Clearance Index (LCI). There are only few studies using MBW in children with asthma and existing data regarding bronchodilator effect are contradictory. The aim of the present pilot study was to compare LCI in asthma and controls and assess the effect of salbutamol in children with asthma on the LCI. Unselected patients with a diagnosis of asthma visiting the outpatient department of our hospital between 04-2010 and 03-2011 were recruited and compared to a healthy control group. MBW was performed as inert gas MBW using sulfurhexafluorid (SF6) as the tracer gas. Clinical data were documented and spirometry and MBW (EasyOne Pro, MBW module, NDD Switzerland) were performed before and after the use of salbutamol (200-400μg). Healthy controls performed baseline MBW only. 32 children diagnosed with asthma (4.7-17.4 years) and 42 controls (5.3-20.8) were included in the analysis. LCI differed between patients and controls, with a mean LCI (SD) of 6.48 (0.48) and 6.21 (0.38) (P=0.008). Use of salbutamol had no significant effect on LCI for the group. These pilot data show that clinically stable asthma patients and controls both have a LCI in the normal range. However, in patients the LCI is significantly higher indicating that MBW may have a role in assessing small airways disease in asthma.

Addition of intravenous beta(2)-agonists to inhaled beta(2)-agonists for acute asthma.

Inhaled beta-agonist therapy is central to the management of acute asthma. This review evaluates the benefit of an additional use of intravenous beta(2)-agonist agents. To determine the benefit of adding intravenous (IV) beta(2)-agonists to inhaled beta(2)-agonist therapy for acute asthma treated in the emergency department. Randomised controlled trials (RCTs) were identified using the Cochrane Airways Group Register which is a compilation of systematic searches of MEDLINE, EMBASE, CINAHL, and CENTRAL as well as handsearching of 20 respiratory journals. Bibliographies from included studies and known reviews were also searched. Primary authors and content experts were contacted to identify eligible studies. The search was performed in September 2012. Only RCTs were considered for inclusion. Studies were included if patients presented to the emergency department with acute asthma and were treated with IV beta(2)-agonists with inhaled beta(2)-agonist therapy and existing standard treatments versus inhaled beta(2)-agonists and existing standard treatments. Two review authors independently extracted data and confirmed their findings with corresponding authors of trials. We obtained missing data from authors or calculated from data present in the papers. We used fixed-effect model for odds ratios (OR) and for mean differences (MD) we used both fixed-effect and random-effects models and reported 95% confidence intervals (CI). From 109 potentially relevant studies only three (104 patients) met our inclusion criteria: Bogie 2007 (46 children), Browne 1997 (29 children) and Nowak 2010 (29 adults). Bogie 2007 investigated the addition of intravenous terbutaline to high dose nebulised albuterol in children with acute severe asthma, requiring intensive care unit (ICU) admission. Browne 1997 investigated the benefit of adding intravenous salbutamol to inhaled salbutamol in children with acute severe asthma in the emergency department. Nowak 2010 investigated addition of IV bedoradrine to standard care (nebulised albuterol, ipratropium and oral corticosteroids) among adults, and was reported as a conference abstract only.There was no significant advantage (OR 0.29; 95%CI 0.06 to 1.38, one trial, 29 adults) for adding IV bedoradrine to standard care (nebulised albuterol, ipratropium and oral corticosteroids) with regard to hospitalisation rates.Various outcome indicators for the length of stay were reported among the trials. Browne 1997 reported a significantly shorter recovery time (in terms of cessation of 30 minute salbutamol) for children in the IV salbutamol with inhaled salbutamol group (four hours) versus the 11.1 hours for the inhaled salbutamol group (P = 0.03). Time to cessation of hourly nebuliser was also significantly shorter (P = 0.02) for the IV plus inhaled salbutamol group (11.5 hours versus 21.2 hours), and they were ready for emergency patient discharge on average 9.7 hours earlier than the inhaled salbutamol group (P < 0.05). In a paediatric ICU study Bogie 2007 reported no significant advantage in length of paediatric ICU admission (hours) for adding IV terbutaline to nebulised albuterol (MD -12.95, 95% CI: -38.74, 12.84).Browne 1997 reported there were only six out of 14 children with a pulmonary index score above six in the IV plus inhaled salbutamol group at two hours compared with 14 of the 15 in the inhaled salbutamol group (P = 0.02)In Browne 1997 there was a higher proportion of tremor in the IV plus inhaled salbutamol group than in the inhaled salbutamol group (P < 0.02). Nowak 2010 did not report any statistically significant adverse effects associated with adding IV bedoradrine to standard care (nebulised albuterol, ipratropium and oral corticosteroids). Troponin levels were elevated in three children in the IV terbutaline + nebulised albuterol group at 12 and 24 hours in Bogie 2007 There is very limited evidence from one study (Browne 1997) to support the use of IV beta(2)-agonists in children with severe acute asthma with respect to shorter recovery time, and similarly there is limited evidence (again from one study Browne 1997) suggesting benefit with regard to pulmonary index scores; however this advantage needs to be considered carefully in relation to the increased side effects associated with IV beta(2)-agonists. We identified no significant benefits for adults with severe acute asthma. Until more, adequately powered, high quality clinical trials in this area are conducted it is not possible to form a robust evaluation of the addition of IV beta(2)-agonists in children or adults with severe acute asthma.

Response to salbutamol in children with acute asthma exacerbations

The aim of this study was to investigate response to salbutamol in children with acute asthma exacerbations in order to estimate the efficiency and safety of its administration in pediatric population. The study included 56 children with asthma (age range 5-12) who were diagnosed and treated over a period of two years. In all children, salbutamol was administered via nebulization, in doses of 1.25 mg in children aged 5-6 and 2.5 mg in children aged 7-12. Respiratory and blood parameters were monitored before and 30 minutes after salbutamol administration. In children with acute asthma exacerbations, respiratory frequency, potassium level, sodium level and PaCO2 decreased significantly after salbutamol administration, while PEF, PEF%, glycemia, PaO2 and SatO2 significantly increased. Hypokalemia due to salbutamol effect occurred in 15 (26.8%) children. Most significant improvement in oxygenation, with increase of PEF, PEF%, PaO2 and SatO2, after salbutamol administration was achieved in patients with mild acute exacerbations. Salbutamol administered via nebulization leads to the occurrence of adverse metabolic effects, hypokalemia and hyperglycemia. However, it can be safely used in the treatment of acute asthma exacerbations and demonstrates high clinical efficacy in the management of acute bronchospasm. The most effective salbutamol treatment is achieved in patients with mild exacerbations.