A Comparison of Albuterol Administered by Metered-Dose Inhaler and Spacer With Albuterol by Nebulizer in Adults Presenting to an Urban Emergency Department With Acute Asthma

Newman, Ken; Milne, Scott; Hamilton, C; Hall, Kent N.

doi:10.1378/chest.121.4.1036

Cited by 73 publications

(44 citation statements)

References 19 publications

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“…10,11 In patients with severe bronchospasm these agents are usually delivered via pneumatic nebulizer, with a gas flow of about 6 L/min. 12 Pneumatic nebulizer is as efficient as delivery via metered-dose inhaler, 13 and more efficient and better tolerated than intravenous administration. 14 However, in patients requiring CPAP, a method for delivering bronchodilator aerosol while applying CPAP would be useful.…”

Section: Introductionmentioning

confidence: 99%

Aerosol Delivery and Humidification With the Boussignac Continuous Positive Airway Pressure Device

et al. 2011

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BACKGROUND: A simple method for effective bronchodilator aerosol delivery while administering continuing continuous positive airway pressure (CPAP) would be useful in patients with severe bronchial obstruction. OBJECTIVE: To assess the effectiveness of bronchodilator aerosol delivery during CPAP generated by the Boussignac CPAP system and its optimal humidification system. METHODS: First we assessed the relationship between flow and pressure generated in the mask with the Boussignac CPAP system. Next we measured the inspired-gas humidity during CPAP, with several humidification strategies, in 9 healthy volunteers. We then measured the bronchodilator aerosol particle size during CPAP, with and without heat-and-moisture exchanger, in a bench study. Finally, in 7 patients with acute respiratory failure and airway obstruction, we measured work of breathing and gas exchange after a ␤ 2 -agonist bronchodilator aerosol (terbutaline) delivered during CPAP or via standard nebulization. RESULTS: Optimal humidity was obtained only with the heat-and-moisture exchanger or heated humidifier. The heat-and-moisture exchanger had no influence on bronchodilator aerosol particle size. Work of breathing decreased similarly after bronchodilator via either standard nebulization or CPAP, but P aO 2 increased significantly only after CPAP aerosol delivery. CONCLUSIONS: CPAP bronchodilator delivery decreases the work of breathing as effectively as does standard nebulization, but produces a greater oxygenation improvement in patients with airway obstruction. To optimize airway humidification, a heat-and-moisture exchanger could be used with the Boussignac CPAP system, without modifying aerosol delivery.

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Section: Introductionmentioning

confidence: 99%

Aerosol Delivery and Humidification With the Boussignac Continuous Positive Airway Pressure Device

et al. 2011

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“…Adverse effects of inhaled salbutamol associated with cardiovascular system occur with high doses and such doses of salbutamol are commonly given by nebulizer during acute asthmatic attacks (10,11). Several published reports suggest that full-dose nebulized salbutamol places pediatric patients at undue risk of adverse effects.…”

Section: Discussionmentioning

confidence: 99%

“…The efficacy of salbutamol administered by metered-dose inhaler (MDI) is equivalent at lower doses to that of the nebulized salbutamol in children with acute asthma attack (10)(11)(12), however, the data regarding the effect of inhaled salbutamol administered through the spacer device on QTd is limited.…”

Section: Introductionmentioning

confidence: 99%

Effects of salbutamol given by metered-dose inhaler on dispersion of ventricular repolarization

Polat

Saz²,

Nursoy³

2011

Anadolu Kardiyol Derg

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ÖZETAmaç: Daha önceki çalışmalarda salbutamolün astımlı hastalarda QT dispersiyonunu (QTd) arttırdığı ve bununda kardiyak aritmi ile ilişkisi gös-terilmiştir. Salbutamolün kardiyak etkileri verilen dozla ilişkilidir ve akut astım atağı sırasında ölçülü doz inhalerle (ÖDİ) verilen doz miktarı nebulizatörle verilen dozların genellikle altındadır. Bu prospektif kohort çalışmada orta şiddette akut astım atağı sırasında ÖDİ ile verilen salbutamolün QTd üzerine etkisi değerlendirilmiştir. Yöntemler: Spirometrik manevraları yapabilecek ve ÖDİ ile salbutamol alabilecek 5-15 yaş arası 32 hasta çalışmaya dahil edildi. Salbutamol doz başına 50 μg/kg olacak şekilde 15-20 dakika arayla üç dozda verildi. Hastaların klinik durumu, spirometrik parametreler ve standart elektrokardiyogramdan QT ölçümleri, salbutamol verilmeden önce ve üçüncü dozdan 15 dakika sonra değerlendirildi. Sürekli değişkenlere bağlı olarak, tedavi öncesi ve sonrası ilişki eşleştirilmiş Student's t-testi ile değerlendirildi. Bulgular: Tedavi tüm hastalarda iyi tolere edildi, tedavi sonrası pulmoner indeks puanlarında ve spirometrik parametrelerde anlamlı düzelme izlendi. Tedavi öncesi ve sonrası QTd (30.4±5.6 msn; 33.7±6.2 msn, p=0.086) ve düzeltilmiş QTd (38.8±6.4 msn; 40.7±7.7 msn, p=0.18) değerlerinde farklılık saptanmadı. Sonuç: Çocuklarda orta şiddette akut astım atağında ölçülü doz inhalerle verilen salbutamol ile nebulizatörle verilen miktara göre, oldukça düşük dozlarda tatmin edici klinik düzelme sağlanmaktadır ve ventrikül repolarizasyonu etkilenmemektedir. (Anadolu Kardiyol Derg 2011; 11: 232-6) Anahtar kelimeler: Salbutamol, ölçülü doz inhaler, QT dispersiyonu, orta şiddette astım atağı ABSTRACT Objective: Salbutamol has previously been shown to increase the QT dispersion (QTd), which may be associated with high risk of cardiac arrhythmia in asthmatics. Cardiac effects of salbutamol occur in dose-related manner and salbutamol dose given by metered-dose inhaler (MDI) during acute asthma attack is commonly lower than the dose given by nebulizer. This prospective cohort study aimed to assess the effect of salbutamol given by MDI on QTd in the course of moderate acute asthma attack. Methods: Thirty-two children, between 5-15 years of age, who were able to perform spirometric maneuvers and salbutamol administration by MDI through the spacer, were enrolled. Salbutamol was administered at a dose of 50 μg/kg three times at 15-20 minute intervals. Clinical features, spirometric parameters and QT measurements from the standard electrocardiograms were studied at baseline and 15 minute after the third inhalation of salbutamol. The relation between the continuous variables was evaluated by using paired Student's t-test. Results: Overall, treatments were well-tolerated, significant improvement of pulmonary index scores and spirometric parameters were observed after treatment. No significant difference was observed between the pre and post-treatment values in QTd (30.4±5.6 ms; 33.7±6.2 ms, p=0.086) and corrected QTd (38.8±6.4 ms; 40.7±7.7 ms, p=0.18). Conclus...

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“…The most cost-effective route of delivery is pMDI and spacer, 347 provided the patient can use this device. Because of the static charge on plastic spacers, they should be pre-washed with detergent and air-dried to be ready for immediate use; if a pre-treated spacer is not available, a new spacer should be primed with at least 20 puffs of salbutamol before use.…”

Section: Inhaled Short-acting Beta 2 -Agonistsmentioning

confidence: 99%

“…The most costeffective and efficient delivery is by pMDI with a spacer 345,347 (Evidence A). Evidence is less robust in severe and nearfatal asthma.…”

Section: Inhaled Short-acting Beta 2 -Agonistsmentioning

confidence: 99%

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

Kumbhare

Strange

2018

Southern Medical Journal

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A Comparison of Albuterol Administered by Metered-Dose Inhaler and Spacer With Albuterol by Nebulizer in Adults Presenting to an Urban Emergency Department With Acute Asthma

Cited by 73 publications

References 19 publications

Aerosol Delivery and Humidification With the Boussignac Continuous Positive Airway Pressure Device

Aerosol Delivery and Humidification With the Boussignac Continuous Positive Airway Pressure Device

Effects of salbutamol given by metered-dose inhaler on dispersion of ventricular repolarization

Mortality in Asthma-Chronic Obstructive Pulmonary Disease Overlap in the United States

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