Salbutamol Therapy Research Articles

Spontaneous Breathing Pattern as Respiratory Functional Outcome in Children with Spinal Muscular Atrophy (SMA).

IntroductionSMA is characterised by progressive motor and respiratory muscle weakness. We aimed to verify if in SMA children 1)each form is characterized by specific ventilatory and thoraco-abdominal pattern(VTAp) during quiet breathing(QB); 2)VTAp is affected by salbutamol therapy, currently suggested as standard treatment, or by the natural history(NH) of SMA; 3)the severity of global motor impairment linearly correlates with VTAp.Materials and methodsVTAp was analysed on 32 SMA type I (SMA1,the most severe form), 51 type II (SMA2,the moderate), 8 type III (SMA3,the mildest) and 20 healthy (HC) using opto-electronic plethysmography. Spirometry, cough and motor function were measured in a subgroup of patients.ResultsIn SMA1, a normal ventilation is obtained in supine position by rapid and shallow breathing with paradoxical ribcage motion. In SMA2, ventilation is within a normal range in seated position due to an increased respiratory rate(p<0.05) with reduced tidal volume(p<0.05) secondary to a poor contribution of pulmonary ribcage(%ΔVRC,P, p<0.001). Salbutamol therapy had no effect on VTAp during QB(p>0.05) while tachypnea occurred in type I NH. A linear correlation(p<0.001) was found between motor function scales and VTAp.ConclusionA negative or reduced %ΔVRC,P, indicative of ribcage muscle weakness, is a distinctive feature of SMA1 and SMA2 since infancy. Its quantitative assessment represents a non-invasive, non-volitional index that can be obtained in all children, even uncollaborative, and provides useful information on the action of ribcage muscles that are known to be affected by the disease.Low values of motor function scales indicate impairment of motor but also of respiratory function.

Efficacy of nebulised L-adrenaline with 3% hypertonic saline versus normal saline in bronchiolitis

Background: Bronchiolitis is one of the most common respiratory diseases requiring hospitalization. Nebulized epineph­rine and salbutamol therapy has been used in different centres with varying results. Objective: The objective of the study was to compare the efficacy of nebulised adrenaline diluted with 3% hypertonic saline with nebulised adrenaline diluted with normal saline in bronchiolitis. Methods: Fifty three infants and young children with bronchiolitis, age ranging from 2 months to 2 years, presenting in the emergency department of Manikganj Sadar Hospital were enrolled in the study. After initial evaluation, patients were randomized to receive either nebulized adrenaline I .5 ml ( 1.5 mg) diluted with 2 ml of3% hypertonic saline (group I) ornebulised adrenaline 1.5 ml (1.5 mg) diluted with 2 ml of normal saline (group II). Patients were evaluated again 30 minutes after nebulization. Results: Twenty eight patients in the group I (hypertonic saline) and twenty five in groupII (normal saline) were included in the study. After nebulization, mean respiratory rate decreased from 63.7 to 48.1 (p&lt;.01), mean clinical severity score decreased from 8.5 to 3.5 (p&lt;.01) and mean oxygen satw·ation increased 94.7% to 96.9% (p&lt;.01) in group I. In group II, mean respiratory rate decreased from 62.4 to 47.4 (p&lt;.01), mean clinical severity score decreased from 7.2 to 4.1 (p&lt;.01) and mean oxygen saturation increased from 94. 7% to 96. 7% (p&lt;.01). Mean respiratory rate decreased by 16 in group I versus 14.8 (p&gt;.05) in group 11, mean clinical severity score decreased by 4.6 in group versus 3 (p&lt;.05) in group, and mean oxygen saturation increased by 2.2% and 1.9% in group and group respectively. Difference in reduction in clinical severity score was statistically significant , though the changes in respiratory rate and oxygen saturation were not statistically significant. Conclusion: The study concluded that both nebulised adrenaline diluted with 3% hypertonic saline and nebulised adrenaline with normal saline are effective in improving respiratory rate, clinical severity score and oxygen saturation in infants with bronchiolitis; and nebulised adrenaline with hypertonic saline is more effective than nebulised adrenaline with normal saline in improving clinical severity score in bronchiolitis.

Tetraparesis and Failure of Pacemaker Capture Induced by Severe Hyperkalemia: Case Report and Systematic Review of Available Literature

BackgroundIn severe hyperkalemia, neurologic symptoms are described more rarely than cardiac manifestations. We report a clinical case; present a systematic review of available literature on secondary hyperkalemic paralysis (SHP); and also discuss pathogenesis, clinical effects, and therapeutic options. Case ReportA 75-year-old woman presented to the emergency department complaining of tetraparesis. Her serum potassium level was 11.4 mEq/L. Electrocardiogram (ECG) showed a pacemaker (PMK)-induced rhythm, with loss of atrial capture and wide QRS complexes. After emergency treatment to restore cell membrane potential threshold and lower serum potassium, neurologic and ECG signs completely disappeared. An acute myocardial infarction subsequently occurred, possibly linked to tachycardia induced by salbutamol therapy. We reviewed 99 articles (119 patients). Mean serum potassium was 8.8 mEq/L. In most cases, ECG showed the presence of tall T waves; loss of PMK atrial capture was documented in 5 patients. In 94 patients, flaccid paralysis was described and in 25, severe muscular weakness; in 65 patients, these findings were associated with other symptoms. Concurrent renal failure was often documented. The most frequent treatments were dialysis and infusion of insulin and glucose. Eighty-seven percent of patients had complete resolution of symptoms. Why Should an Emergency Physician Be Aware of This?Severe hyperkalemia is always a life-threatening medical emergency, as it can precipitate fatal dysrhythmias and paralysis. SHP should be considered in the differential diagnosis of neurologic signs and symptoms of uncertain etiology, especially in a subject with kidney failure or who is taking medications that may worsen renal function. The presence of a PMK does not necessarily impede hyperkalemic cardiac toxicity.

Cardiac Troponin I Levels in Children with Acute Severe Asthma Treated with IV Salbutamol

Background: Severe acute asthma and its treatment may uncommonly result in cardiac complications such as arrhythmias and acute coronary ischaemia. Methods: We carried out a retrospective audit of 14 children treated for acute severe asthma with intravenous (IV) salbutamol at the Leicester Royal Infirmary between September 2012 and April 2013. Cardiac troponin I levels were measured at the time blood was sampled for monitoring of blood biochemistry. Results: Cardiac troponin I (CTnI) levels ranged from 20 to 4255 mg/ml; 8 children had elevated CTnI levels (>40mg/ ml) on 9 occasions. Neither total (mg/kg) salbutamol (inhaled + IV) or total (mg/kg) salbutamol IV dose correlated with blood CTnI levels. Conclusions: In most patients, raised CTnI were not associated with signs or symptoms of cardiac dysfunction. Our findings highlight the need for close cardiac monitoring of children with acute severe asthma on IV salbutamol therapy.

G.P.308: Perception of efficacy in adult patients affected by Spinal Muscular Atrophy (SMA) treated with salbutamol

One possible therapeutic approach in SMA is based on attempts at increasing the amount of SMN2-fl transcripts. Salbutamol is a well tolerated drug and it has been demonstrated to significantly increase SMN2 transcripts. Despite no significant improvement has been demonstrated in treated adult patients, they usually report a subjective improvement. The aim of this study is to better understand patient's perception of salbutamol treatment efficacy. Seven patients were enrolled (6 SMA type 3, 1 type 2; 4 ambulant), mean age 40.1years; mean disease duration 26.7years; mean treatment duration 2.4years. A mix-method (qualitative and quantitative approach) was used. Patients, treated with salbutamol for at least one year, were invited to participate. An in-depth interview was carried out to evaluate patients' perceptions of change after treatment, then patients were asked to complete the WHO Disability Assessment Schedule II (WHODAS-II) and the Fatigue Severity Scale (FSS). Patients were requested to report how they feel at the moment of interview (post-test "T1") and how they felt before starting treatment (then-test "T0"). Content analysis was performed to identify patients' main themes. Non parametric Wilcoxon test for paired samples were performed to compare WHODAS II and FSS mean scores at T0 and T1. Four main themes were identified during the interviews: improvement in patients' resistance and strength with relevant decrease of fatigue perceived; feeling of being more motivated and autonomous; slowdown of disease progression; all patients would suggest salbutamol therapy to other SMA patients. Statistically significant differences were detected for WHO DAS II scores (Summary score; Getting Around; Household Activities, sig. 0.018; 0.026, 0.024 respectively) and FSS score (sig. 0.017) between T0 and T1, with lower scores at T1. If confirmed on a larger group of patients our protocol could be useful to point out patients' perception of efficacy in clinical trials.

The Effects of Inhaled Albuterol in Transient Tachypnea of the Newborn

PurposeTransient tachypnea of the newborn (TTN) is a disorder caused by the delayed clearance of fetal alveolar fluid. β-adrenergic agonists such as albuterol (salbutamol) are known to catalyze lung fluid absorption. This study examined whether inhalational salbutamol therapy could improve clinical symptoms in TTN. Additional endpoints included the diagnostic and therapeutic efficacy of salbutamol as well as its overall safety.MethodsFrom January 2010 through December 2010, we conducted a prospective study of 40 newborns hospitalized with TTN in the neonatal intensive care unit. Patients were given either inhalational salbutamol (28 patients) or placebo (12 patients), and clinical indices were compared.ResultsThe duration of tachypnea was shorter in patients receiving inhalational salbutamol therapy, although this difference was not statistically significant. The duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment were significantly shorter in the salbutamol-treated group. No adverse effects were observed in either treatment group.ConclusionsInhalational salbutamol therapy reduced the duration of supplemental oxygen therapy and the duration of empiric antibiotic treatment, with no adverse effects. However, the time between salbutamol therapy and clinical improvement was too long to allow definitive conclusions to be drawn. Further studies examining a larger number of patients with strict control over dosage and frequency of salbutamol inhalations are necessary to better direct the treatment of TTN.

Divers’ neurobehavioral performance under 4.7 MPa: A real-time monitoring

Patients with COPD exhibit increased inspiratory work and dyspnea due to dynamic hyperinflation caused by expiratory flow limitation. Helium-oxygen mixtures (ie, heliox) have been used in treating these patients on the assumption that, by lowering airway resistance, they might be beneficial.In 22 patients with COPD, the presence of expiratory flow limitation was assessed with patients in the sitting and supine positions using the negative expiratory pressure technique, and the effects of heliox (80% He, 20% O2) on breathing pattern, expiratory flow limitation, and dynamic hyperinflation, evaluated from the change in inspiratory capacity (IC), were measured at rest and were compared with those due to inhaled salbutamol.During air breathing, 13 patients experienced flow limitation while in the sitting position and 18 experienced flow limitation while in the supine position. Neither heliox nor salbutamol therapy changed the breathing pattern in any of the patients, regardless of posture and the presence or absence of expiratory flow limitation. However, in both positions IC increased significantly in most flow-limited patients after bronchodilator administration, but not after heliox administration.Since heliox had no effect on dynamic hyperinflation, the use of this gas mixture, which is costly and cumbersome, does not appear to be beneficial in stable patients with COPD breathing at rest.

Salbutamol therapy in congenital myasthenic syndrome due to DOK7 mutation

IntroductionSalbutamol is a selective B2-adrenergic agonist, which has previously been described to be associated with partial improvement of myasthenia gravis and congenital myasthenic syndromes (CMS). In this study, we analyzed the effect of salbutamol in five patients with Dok-7 CMS. MethodsWe studied 5 patients (2 male and 3 female), with a mean age of 27±11.06years, who harbored c.1124_1127dupTGCC, p.G64R and/or p.S45L mutations in DOK7 gene. Salbutamol was given at a dose of 2mg three times daily (6mg/day) to all patients. The response was assessed by QMG score at baseline, 3, 6, 9 and 12months; ADL-MG score and 6minute walk test at baseline and after 12months during follow-up clinic visits. Side effect profile of salbutamol was also evaluated. ResultsWe noted an increasingly positive response as measured by the QMG score after 3months of salbutamol treatment. Improvement in specific subcomponents of the QMG score such as leg outstretched in 45° supine was most marked. In ADL-MG scores and 6minute walk test, comparison between baseline and after 12months revealed a clear beneficial response. Salbutamol was well tolerated in all patients. ConclusionsSalbutamol is an effective treatment in Dok-7 CMS. This study provides class IV evidence that salbutamol given at a dose 6mg/day improves function as measured by the QMG score, ADL-MG score and 6minute walk test.

A study into efficacy of omalizumab therapy in patients with severe persistent allergic asthma at a tertiary referral centre for asthma in Ireland

Asthma is a chronic airway disease characterized by airway inflammation, bronchial hyperresponsiveness and airflow obstruction. Patients with persistent symptoms despite maximum standard treatment as per Global Initiative of Asthma guidelines are considered to have severe persistent asthma. Omalizumab is a recombinant humanized monoclonal antibody licenced for use as an add-on therapy in these patients. To assess the clinical benefit amongst responders to omalizumab therapy at a tertiary referral centre. This was a retrospective audit assessing the effect of omalizumab therapy on asthma control, frequency of exacerbation and hospitalization rates over 6 months before and after therapy. The study included 30 responders (14 females). There was a reduction in exacerbation and hospitalization rates following initiation of omalizumab, 73 and 91%, respectively (P-value < 0.0001). The number of exacerbations decreased from 3.48 ± 2.20 to 0.93 ± 0.83 and the mean number of admissions decreased from 1.07 ± 1.1 to 0.1 ± 0.40 over the study duration (P < 0.001). There was 73% reduction in the weekly need for rescue salbutamol therapy with mean of 30.33 ± 6.49 puffs to 8.23 ± 1.51 puffs after omalizumab therapy (P < 0.0001). Seventy-nine per cent of patients were able to reduce their maintenance oral corticosteroid therapy. Overall, responders to omalizumab therapy are less likely to experience an asthma exacerbation and hospitalization. They were also more likely to reduce maintenance corticosteroid therapy and the need for rescue reliever therapy. These data suggest that omalizumab has proven effective in improving health outcomes for a cohort of carefully selected patients with severe allergic asthma in Ireland.

The FDA-mandated trial of safety of long-acting beta-agonists in asthma: finality or futility?

In 2010, in response to a prolonged debate over the safety of long-acting beta-agonists (LABAs), the United States Food and Drugs Administration (FDA) issued guidelines for the use of LABAs...

Is It Possible to Achieve Better Asthma Control by Using the Same Inhaler Device?

Achieving asthma control is central to optimizing patient quality of life and clinical outcomes. This definition of asthma control has two components: achieving current clinical asthma control and reducing future risk.1 The level of clinical asthma control is defined by the Global Initiative for Asthma (GINA) using a composite score comprising five measures. Reducing asthma exacerbations is a key factor for preventing future risk.2 The regular use of inhaled corticosteroids (ICS) is essential for controlling asthma symptoms and reducing asthma exacerbations. A previous study found that a history of exacerbations, poor asthma control, poor inhaler technique, a history of lower respiratory tract infections, poor adherence to medication, and the presence of co-morbid conditions all predicted the future risk of asthma exacerbation.3 Most control medications, including ICS, are delivered via inhalation. The correct use of inhaler devices is critical for optimizing drug delivery and obtaining clinical benefits.4 However, inhaler use still represents an important challenge for most asthmatic patients. The correct inhalation maneuver differs markedly for different inhaler types. The problems and prevalence of incorrect inhaler use have been the subject of several recent reviews.5-7 Improper technique remains common for both metered dose (MDIs) and dry power (DPIs) inhalers, and was associated with poor clinical control and increased unscheduled health-care demands in asthma clinics.8 Inhaler mishandling continues to be common among experienced outpatients referred to asthma clinics and is associated with increased unscheduled health care resource use.8 Nevertheless, inhaler technique status has not been included in most analyses examining the predictors of asthma exacerbation. Poor adherence to asthma medication is a dilemma, as it decreases the chance of achieving and maintaining proper asthma control. Education of both patients and health care professionals regarding proper inhaler technique will improve asthma control.9,10 The study by Price et al.11 in this issue is the first to compare outcomes for asthmatic patients prescribed the same inhaler device versus mixed device types for asthma control and relief therapy. This retrospective observational study identified patients with asthma (age 4-80 years) in a large primary care database who were prescribed an ICS. They compared outcomes for patients prescribed the same breath-actuated inhaler (BAI) for both the ICS controller and salbutamol reliever versus those using two devices (a BAI for the controller and a pressurized metered-dose inhaler [pMDI] for the reliever). Patients prescribed the same device (n=3,428) were significantly more likely to achieve asthma control (adjusted odds ratio, 1.15) and had significantly lower severe exacerbation rates (adjusted rate ratio, 0.79; 95%) than those prescribed two devices (n=5,452). These finding suggest that prescribing the same device for both ICS and reliever therapy improves asthma control. A previous study evaluated the skill at handling inhalers and factors associated with these skills in 145 patients with asthma under the care of asthma specialists in Korea.12 When their skill at using the inhalers was assessed visually, the performance was inadequate for 12.8% of the participants using Turbuhaler, 6.2% using Diskus, and 23.4% using pMDIs. Most showed excellent skill at using their inhalers. However, older age and the absence of previous instructions for handling the inhalers were associated with inadequate techniques, indicating that this population requires more education to improve their inhalation technique. Several studies used repeated inhaler instructions as a method to improve inhaler technique.9,13 Educational adherence support should be a collaborative effort between the patient and health care professional.14 One limitation of this study is that it includes the potential for unrecognized confounding factors, including selection bias, as it was a retrospective study.11 This study examined a database of primary physicians in the U.K. As such, there were missing data for some patients, including smoking history, which could influence outcomes. There is no assurance that patients actually took the medications as prescribed. However, this study enrolled a larger cohort of patients using ICS, included for a 1-year outcome period, and provided good evidence of improved asthma outcome with improved adherence to medications using the same BAI device for both controller ICS and reliever salbutamol therapy.

The effects of salbutamol in an experimental model with acute respiratory distress syndrome

ObjectiveTo investigate salbutamol effects on histopathologic features of acute respiratory distress syndrome (ARDS). MethodsARDS was designed in Wistar albino male rats, 250–300 g in weight, by intratracheal instillation of physiological saline solution. Anesthezied and tracheotomized rats with ARDS were pressure-controlled ventilated. At the end of the 210 minutes, two hours past and nebulized salbutamol inhalation was tried. All rats were assigned to two groups: Group 1 (n=10) control group, given no treatment, group 2 (n=10) received salbutamol. Nebulized salbutamol inhalation was given in the dosage of 0, 15 mg/kg/dose. Rats were continued to be on ventilator through the experiment. After the last inhalation, two hours past and their both lungs were excised for histopathological examination. ResultsRat-model ARDS had similar histopathological appearance occuring during the acute phase of the acute respiratory distress syndrome in humans. A statistical difference was seen between control and salbutamol group (P=0.002) for HM. The margination of leukocytes was decreased in salbutamol group. The difference was significant (P<0.042). Hemorrhage and interstitial/intraalveolar edema were much lower in 0.15 mg/dose nebulized salbutamol group than that of control group. There was a significant difference statistically between two groups (P<0.001). ConclusionsInhaled salbutamol therapy for ARDS is may be associated with the improvement of inflamation. Besides known effects of salbutamol, the reducing of infiltration of polymorphonuclear neutrophil leukocytes, interstitial/intraalveolar edema, perivascular and/or intraalveolar hemorrhage and hyaline membrane formation should be emphasized.

Inhaled Beta-2 Agonist Salbutamol for the Treatment of Transient Tachypnea of the Newborn

To evaluate the efficacy of inhaled salbutamol, a beta-2 adrenergic agonist, for the treatment of transient tachypnea of the newborn (TTN) and to determine whether inhaled salbutamol is safe in newborn infants. Inhaled salbutamol or normal saline solution was administered to 54 infants with gestational ages ranging from 34 to 39 weeks and TTN. The response to salbutamol therapy was evaluated by determining respiratory rate, clinical score of TTN, level of respiratory support, and fraction of inspired oxygen before and at 30 minutes and 1 and 4 hours after salbutamol nebulization. Among the 54 infants with TTN, 32 received salbutamol and 22 received normal saline solution. After one dose, the salbutamol group showed significant improvements in respiratory rate, clinical score of TTN, fraction of inspired oxygen, and level of respiratory support (P < .05). After treatment, the mean pH, partial pressure of arterial oxygen, and partial pressure of arterial carbon dioxide values were better in the salbutamol group when compared with the placebo group (P < .05). Duration of hospitalization in the neonatal intensive care unit was also shorter for the salbutamol group (P < .05). Inhaled salbutamol treatment was effective with respect to both clinical and laboratory findings of TTN and without adverse events.

Is There a Place for β-Mimetics in Clinical Management of Neuropathic Pain? Salbutamol Therapy in Six Cases

Is There a Place for β-Mimetics in Clinical Management of Neuropathic Pain? Salbutamol Therapy in Six Cases

Onset of relief of dyspnoea with budesonide/formoterol or salbutamol following methacholine-induced severe bronchoconstriction in adults with asthma: a double-blind, placebo-controlled study.

BackgroundThe long-acting β2-agonist (LABA) formoterol has an onset of effect comparable to that of salbutamol. Consequently, the combination of formoterol and budesonide in one inhaler, approved for maintenance use, can potentially be used for reliever therapy. This study compared the onset of relief from induced bronchospasm with a single dose of budesonide/formoterol versus standard salbutamol therapy in patients with asthma.MethodsIn this randomised, double-blind, placebo-controlled, cross-over study, 32 patients with asthma underwent a methacholine provocation test leading to a fall in forced expiratory volume in 1 second (FEV1) of ≥30% at enrolment (Visit 1) and three subsequent study visits (Visits 2–4). Immediately after each provocation at Visits 2–4, patients received one of three test treatments: one inhalation of budesonide/formoterol 160/4.5 μg (via Turbuhaler®), two inhalations of salbutamol 100 μg (via a pressurised metered-dose inhaler [pMDI]) or placebo. All patients received each of the test treatments in a randomised order, after separate methacholine provocations. The effect of treatment on FEV1 and breathlessness (using the Borg scale) was measured at 1, 3, 5, 10, 15, 20, 25 and 30 minutes after test treatment.ResultsFollowing methacholine provocation, Borg score increased from a baseline value of below 0.5 to 3.03, 3.31 and 3.50 before treatment with budesonide/formoterol, salbutamol and placebo, respectively. Budesonide/formoterol and salbutamol reversed methacholine-induced dyspnoea (breathlessness) rapidly. At 1 minute after inhalation, statistically significant decreases in Borg score were observed for budesonide/formoterol and salbutamol (p = 0.0233 and p < 0.0001, respectively, versus placebo), with similar rapid increases in FEV1 (both active treatments p < 0.0001 versus placebo). The median time to 50% recovery in Borg score after methacholine provocation was 3 minutes with budesonide/formoterol, 2 minutes with salbutamol and 10 minutes with placebo. All treatments and procedures were well tolerated.ConclusionSingle doses of budesonide/formoterol and salbutamol both provided rapid relief of dyspnoea and reversal of severe airway obstruction in patients with asthma with experimentally induced bronchoconstriction. The perception of relief, as confirmed by objective lung function assessment, provides evidence that budesonide/formoterol can be used as reliever medication in asthma.

Mucociliary clearance in COPD can be increased by both a D2/[formula omitted]2 and a standard [formula omitted]2 agonists

In addition to breathlessness and cough, excessive mucus production is one of the main symptoms of chronic obstructive pulmonary disease (COPD). Excess mucus coupled with deteriorating mucociliary clearance is associated with a decline in lung function and an increased risk of death from pulmonary infection. The effect of Viozan (Sibenadet HCl, AR-C68397AA), a novel dual D2 dopamine receptor, beta2-adrenoceptor agonist, on mucociliary clearance was investigated together with that of a beta2-adrenoceptor agonist, salbutamol. Using a double blind, parallel group study design, 15 patients with COPD, all habitual smokers, were randomised to receive nebulised sidenadet (3mg tid; n = 7) or salbutamol (5mg tid; n = 8) for 10 days. Lung mucociliary clearance rates were measured, by a standard radioaerosol technique, before and after the treatment period, as were 24-h sputum volumes. Both sibenadet and salbutamol therapies resulted in significant (P<0.02) enhancement of lung mucociliary clearance. The 24-h sputum volume was significantly reduced following sibenadet therapy (P<0.03) whereas salbutamol therapy had no effect. Our results, in addition to illustrating the effects of a standard beta2 agonist on mucociliary clearance, strongly suggest the potential dual benefit of dual-agonist compounds in lessening sputum production whilst simultaneously enhancing mucociliary clearance. For reasons unconnected with the present study, development work on this specific formulation is no Longer proceeding.

Effect of Heliox Breathing on Dynamic Hyperinflation in COPD Patients

and objective: Patients with COPD exhibit increased inspiratory work and dyspnea due to dynamic hyperinflation caused by expiratory flow limitation. Helium-oxygen mixtures (ie, heliox) have been used in treating these patients on the assumption that, by lowering airway resistance, they might be beneficial. In 22 patients with COPD, the presence of expiratory flow limitation was assessed with patients in the sitting and supine positions using the negative expiratory pressure technique, and the effects of heliox (80% He, 20% O2) on breathing pattern, expiratory flow limitation, and dynamic hyperinflation, evaluated from the change in inspiratory capacity (IC), were measured at rest and were compared with those due to inhaled salbutamol. During air breathing, 13 patients experienced flow limitation while in the sitting position and 18 experienced flow limitation while in the supine position. Neither heliox nor salbutamol therapy changed the breathing pattern in any of the patients, regardless of posture and the presence or absence of expiratory flow limitation. However, in both positions IC increased significantly in most flow-limited patients after bronchodilator administration, but not after heliox administration. Since heliox had no effect on dynamic hyperinflation, the use of this gas mixture, which is costly and cumbersome, does not appear to be beneficial in stable patients with COPD breathing at rest.

La paralysie hyperkaliémique

In severe hyperkalemia, neurologic symptoms are described more rarely than cardiac manifestations. We report a clinical case; present a systematic review of available literature on secondary hyperkalemic paralysis (SHP); and also discuss pathogenesis, clinical effects, and therapeutic options.A 75-year-old woman presented to the emergency department complaining of tetraparesis. Her serum potassium level was 11.4 mEq/L. Electrocardiogram (ECG) showed a pacemaker (PMK)-induced rhythm, with loss of atrial capture and wide QRS complexes. After emergency treatment to restore cell membrane potential threshold and lower serum potassium, neurologic and ECG signs completely disappeared. An acute myocardial infarction subsequently occurred, possibly linked to tachycardia induced by salbutamol therapy. We reviewed 99 articles (119 patients). Mean serum potassium was 8.8 mEq/L. In most cases, ECG showed the presence of tall T waves; loss of PMK atrial capture was documented in 5 patients. In 94 patients, flaccid paralysis was described and in 25, severe muscular weakness; in 65 patients, these findings were associated with other symptoms. Concurrent renal failure was often documented. The most frequent treatments were dialysis and infusion of insulin and glucose. Eighty-seven percent of patients had complete resolution of symptoms.Severe hyperkalemia is always a life-threatening medical emergency, as it can precipitate fatal dysrhythmias and paralysis. SHP should be considered in the differential diagnosis of neurologic signs and symptoms of uncertain etiology, especially in a subject with kidney failure or who is taking medications that may worsen renal function. The presence of a PMK does not necessarily impede hyperkalemic cardiac toxicity.

The administration of beta2-agonists for paediatric asthma and its adverse reaction in Australian and New Zealand emergency departments: a cross-sectional survey.

To determine the current use of beta2-agonists, in particular salbutamol, for the management of acute asthma in children in emergency departments throughout Australia and New Zealand. A cross-sectional survey using a questionnaire that sought to determine the current use of salbutamol and any adverse drug reactions in paediatric emergency departments. Out of 37 hospitals eligible as paediatric emergency departments, 33 (89.1%) responded to the survey, 54.5% having guidelines for the management of acute asthma. Of the paediatric emergency departments surveyed, 45.5% used metered-dose inhaler spacer combination in the treatment of mild to moderate asthma. All paediatric emergency departments used nebulized salbutamol for acute severe asthma. In addition, 85% of paediatric emergency departments used continuous-infusion intravenous salbutamol in unresponsive patients, 63.6% administering a single-dose intravenous salbutamol bolus before commencing the infusion. District paediatric emergency departments were more likely to treat with continuous-infusion intravenous salbutamol outside of the intensive care unit. Clinical unresponsiveness to inhaled salbutamol and clinical improvement were the reported criteria in all paediatric emergency departments for the use and cessation of intravenous salbutamol. Adverse drug reactions were common: tremor (90%), hypokalaemia (45.5%) and supraventricular tachycardia (21%), particularly if continuous-infusion intravenous salbutamol administered. Eight deaths from asthma were reported, none being related to adverse drug reactions. We report a wide variation of salbutamol use in paediatric emergency departments and a high prevalence of type A adverse drug reactions when continuous-infusion intravenous salbutamol therapy was administered. More evidence is needed on the clinical significance of the adverse effects reported in this study and optimal doses for the safe use of continuous-infusion intravenous salbutamol therapy in paediatric emergency departments.

Two administration methods for inhaled salbutamol in intubated patients

Aims: To compare serum concentrations and effects on respiratory mechanics and haemodynamics of salbutamol administered by small volume nebuliser (SVN) and metered dose inhaler (MDI) plus spacer. Methods: Blinded, randomised,...