Continuous Albuterol for Exacerbation of Asthma: End of Discussion?

Source: Khine H, et al. Acad Emerg Med 1996;3:1019-1024.

A number of recent studies have attempted to demonstrate the superiority of continuous delivery of nebulized b2-agonists as compared to the intermittent delivery systems we commonly use to treat asthma in the ED. Some investigators have found continuously delivered albuterol to be advantageous in selected populations, specifically adults and children with the most severe asthma exacerbations.1-3 Khine et al explored the application of this therapy for ED treatment of asthmatic children.

Seventy children with moderate to severe asthma exacerbations were randomized to receive nebulized albuterol by either intermittent or continuous administration. The investigators and treating physicians, but not the patients, were blinded to the treatment assignment. The intermittent group received albuterol 0.15 mg/kg every 30 minutes; the continuous group received albuterol 0.3 mg/kg/h using the HEART nebulizer device. Each group, therefore, received the same total hourly dose of albuterol. All subjects received prednisone or methylprednisolone 2 mg/kg at the start of the trial.

The proportion of children requiring hospitalization (about one-quarter) did not differ between the two groups. There were no intergroup differences in peak flow rate or ED treatment time. Subgroup analysis of those children with the most severe exacerbations also failed to find any differences between the two groups. The intermittent treatment group did have a greater mean increase in heart rate (30 vs 18 beats/min); other hemodynamic parameters were uninfluenced by treatment assignment. Based on respiratory care charges, the authors estimate that the continuous therapy was slightly less expensive than intermittent therapy. —djk

References

1. Papo MC, et al. Crit Care Med 1993;21:1479-1486.

2. Lin RY, et al. Ann Emerg Med 1993;22:1847-1853.

3. Rudnitsky GS, et al. Ann Emerg Med 1993;22:1842-1846.