A controlled trial of nebulized salbutamol and adrenaline in acute severe asthma

Abroug, F.; Nouira, Semir; Bchir, A.; Boujdaria, Rafik; Elatrous, Souheil; Bouchoucha, Slah

doi:10.1007/bf02425149

Cited by 39 publications

(16 citation statements)

References 20 publications

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“…Although not directly compared to albuterol, no efficacy or adverse effect differences were found between nebulized epinephrine (an alpha 1 , beta 1 , and B 2 R agonist) and the SABA terbutaline in adults with severe AEA [23,24]. No routine role has been demonstrated in treating AEA in the ED with inhaled use of these agents.…”

Section: Short-acting Beta 2 Agonists (Sabas)mentioning

confidence: 66%

The Acute Management of Asthma

Albertson

Sutter

Chan

2014

Clinic Rev Allerg Immunol

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Patients presenting to the emergency department (ED) or clinic with acute exacerbation of asthma (AEA) can be very challenging varying in both severity and response to therapy. High-dose, frequent or continuous nebulized short-acting beta2 agonist (SABA) therapy that can be combined with a short-acting muscarinic antagonist (SAMA) is the backbone of treatment. When patients do not rapidly clinically respond to SABA/SAMA inhalation, the early use of oral or parenteral corticosteroids should be considered and has been shown to impact the immediate need for ICU admission or even the need for hospital admission. Adjunctive therapies such as the use of intravenous magnesium and helium/oxygen combination gas for inhalation and for driving a nebulizer to deliver a SABA and or SAMA should be considered and are best used early in the treatment plan if they are likely to impact the patients' clinical course. The use of other agents such as theophylline, leukotriene modifiers, inhaled corticosteroids, long-acting beta2 agonist, and long-acting muscarinic antagonist currently does not play a major role in the immediate treatment of AEA in the clinic or the ED but is an important therapeutic option for physicians to be aware of and to consider initiating at the time of discharge from clinic, hospital, or ED to reduce later clinical worsening and readmission to the ED and hospital. A comprehensive summary is provided of the currently available respiratory pharmaceuticals approved for asthma and other airway syndromes. Clinicians must be prepared to use the entire spectrum of medications available for the treatment of acute asthma exacerbations and the agents that should be initiated to prevent worsening or additional exacerbations. They need to be familiar with the major potential drug toxicities associated with their use.

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Section: Short-acting Beta 2 Agonists (Sabas)mentioning

confidence: 66%

The Acute Management of Asthma

Albertson

Sutter

Chan

2014

Clinic Rev Allerg Immunol

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“…One study of adult intensive care unit (ICU) patients (n = 22) with an acute, severe asthma exacerbation found inhaled epinephrine to be as efficacious as salbutamol, with no significant difference in side effects. 2 Another study, using lower doses of epinephrine and salbutamol, also in severe adult asthmatic patients (n = 18), reached similar con- clusions. 3 A third study demonstrated that while in-vitro epinephrine provided greater protection against histamine-induced contraction in airway smooth muscle, this protection was not noted in vivo.…”

mentioning

confidence: 62%

“…This finding is similar to those of one previous small crossover study (n = 10) comparing the efficacies of salbutamol and inhaled epinephrine in admitted asthmatic children 5 and studies in adult patients. 2,3 The two treatments have statistically different effects on heart and respiratory rates, but the changes are too small to be clinically significant.…”

Section: Discussionmentioning

confidence: 99%

The Efficacy of Nebulized Racemic Epinephrine in Children with Acute Asthma: A Randomized, Double‐blind Trial

Plint

Osmond

Klassen

2000

Academic Emergency Medicine

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Abstract. Objectives: Recent work in bronchiolitis has demonstrated a significant clinical improvement in children treated with epinephrine over nebulized salbutamol. The objective of this study was to determine whether nebulized epinephrine, as compared with nebulized salbutamol, causes a greater clinical improvement in children with acute asthma. Methods: Children, aged 1 to 17 years, with acute asthma presenting to the emergency department (ED) were eligible. In this double-blind study, patients were randomly allocated to receive either salbutamol or racemic epinephrine by nebulization at 0, 20, and 40 minutes. All patients received oral steroids. The primary outcome measure was a change in pulmonary index score (PIS). Results: One hundred twenty patients were randomized. The groups were comparable in terms of age, gender, asthma severity, previous treatments, and use of inhaled steroids. There was no significant difference between treatments in the change in PIS, length of stay, admission to hospital, or relapse rate. The epinephrine-treated group had significantly more minor side effects (such as excess or brownish nasal discharge). Conclusions: There is no significant clinical benefit of nebulized epinephrine over salbutamol in children 1-17 years old with mild to moderate acute asthma. Salbutamol remains the treatment of choice in children with known asthma.

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“…10,16,17 A search of MEDLINE and PubMed from 1960 to 2005 using the search terms racemic epinephrine, epinephrine and nebulizers, vapourizers and asthma, airway diseases, or bronchial hyper-reactivity revealed several randomized trials comparing nebulized epinephrine (racemic or regular) to nebulized salbutamol in the initial treatment for acute asthma. [18][19][20][21][22] These studies have all documented increases in pulmonary function and clinical status for nebulized epinephrine that are not statistically different from salbutamol. Side effects were similar between groups receiving either salbutamol or epinephrine, leading several authors to conclude that nebulized epinephrine is as effective and as safe as nebulized salbutamol for the treatment of acute severe asthma.…”

Section: Discussionmentioning

confidence: 99%

“…Side effects were similar between groups receiving either salbutamol or epinephrine, leading several authors to conclude that nebulized epinephrine is as effective and as safe as nebulized salbutamol for the treatment of acute severe asthma. [18][19][20] Finally, a meta-analysis of randomized trials comparing nebulized epinephrine and β 2 -agonists in the initial treatment of acute asthma revealed a non-significant improvement in pulmonary function for patients who received epinephrine, compared with those who received β 2 -agonists. 23 It should be noted that, based on our literature search, no clinical trial was identified that studied the effect of nebulized epinephrine in patients who did not improve with initial salbutamol treatment.…”

Section: Discussionmentioning

confidence: 99%

Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review

Wiebe

Rowe

2007

CJEM

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Acute asthma is a common emergency department (ED) problem that is typically treated with bronchodilators and anti-inflammatories. Nebulized selective, short-acting β-agonists, such as salbutamol, are the bronchodilators of choice in most Canadian EDs. Other important treatments in moderate-to-severe cases include systemic corticosteroids and in severe cases may include the addition of ipratropium bromide and magnesium sulfate. Despite aggressive management, some patients do not respond adequately to nebulized salbutamol. Treatment options in these patients are limited to interventions such as parenteral epinephrine, and non-invasive and mechanical ventilation (or both). Both parenteral epinephrine and mechanical ventilation have associated risks, so alternative treatments with a lower risk profile would be useful for the treatment of life-threatening asthma. The following case report describes a patient in whom nebulized racemic epinephrine was used successfully to treat severe acute asthma following failure of standard first-line therapies. RÉSUMÉ L'asthme aigu est un problème courant dans les services d'urgence que l'on traite habituellement au moyen de bronchodilatateurs et d'anti-inflammatoires. Des agonistes bêta à action brève, sélectifs et en aérosol, comme le salbutamol, sont les bronchodilatateurs de choix dans la plupart des services d'urgence du Canada. Les corticostéroïdes systémiques sont au nombre des autres traitements importants dans les cas de gravité moyenne à sévère. Dans les cas graves, on peut ajouter du bromure d'ipratropium et du sulfate de magnésium. En dépit d'une prise en charge agressive, certains patients ne répondent pas adéquatement au salbutamol en aérosol. Les choix de traitement dans ces cas sont limités aux interventions comme l'épinéphrine parentérale et la ventilation non effractive et mécanique (ou les deux). L'épinéphrine parentérale et la ventilation mécanique comportent toutes deux des risques et c'est pourquoi d'autres traitements présentant un profil de risque moins élevé seraient utiles pour traiter l'asthme qui met la vie en danger. Le rapport de cas qui suit décrit un patient chez qui on a utilisé avec succès de l'épinéphrine racémique en aérosol pour traiter une crise d'asthme aigu sévère à la suite de l'échec des thérapies de première intention habituelles.

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A controlled trial of nebulized salbutamol and adrenaline in acute severe asthma

Abstract: After a single dose, nebulized adrenaline (2 mg) proved as effective and safe as salbutamol (5 mg) in acute severe asthma.

Cited by 39 publications

References 20 publications

The Acute Management of Asthma

The Acute Management of Asthma

The Efficacy of Nebulized Racemic Epinephrine in Children with Acute Asthma: A Randomized, Double‐blind Trial

Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review

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