Continuous versus intermittent albuterol nebulization in the treatment of acute asthma

Lin, Robert Y.; Sauter, Diane; Newman, Thomas; Sirleaf, James A.; Walters, John L.; Tavakol, Mohammad

doi:10.1016/s0196-0644(05)80412-3

Cited by 87 publications

(36 citation statements)

References 10 publications

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“…Rapid-acting inhaled b 2 -agonists should be administered at regular intervals (Evidence A) [337][338][339]. Although most rapid-acting b 2 -agonists have a short duration of effect, the long-acting bronchodilator formoterol, which has both a rapid onset of action and a long duration of effect, has been shown to be equally effective without increasing side-effects, though it is considerably more expensive [285].…”

Section: Treatmentmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2007

Eur Respir J

2,666

2,301

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Asthma is a serious health problem throughout the world. During the past two decades, many scientific advances have improved our understanding of asthma and ability to manage and control it effectively. However, recommendations for asthma care need to be adapted to local conditions, resources and services. Since it was formed in 1993, the Global Initiative for Asthma, a network of individuals, organisations and public health officials, has played a leading role in disseminating information about the care of patients with asthma based on a process of continuous review of published scientific investigations. A comprehensive workshop report entitled ''A Global Strategy for Asthma Management and Prevention'', first published in 1995, has been widely adopted, translated and reproduced, and forms the basis for many national guidelines. The 2006 report contains important new themes. First, it asserts that ''it is reasonable to expect that in most patients with asthma, control of the disease can and should be achieved and maintained,'' and recommends a change in approach to asthma management, with asthma control, rather than asthma severity, being the focus of treatment decisions. The importance of the patient-care giver partnership and guided self-management, along with setting goals for treatment, are also emphasised.

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Section: Treatmentmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2007

Eur Respir J

2,666

2,301

View full text Add to dashboard Cite

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“…Comparisons of continuous nebulization and SVN have been limited 8,[22][23][24][25][26] but have shown continuous nebulization to be as safe and effective as SVN. There have been no randomized controlled trials of AeroEclipse versus standard aerosol delivery in pediatric patients in the ED.…”

Section: Introductionmentioning

confidence: 99%

Randomized Controlled Trial of a Breath-Actuated Nebulizer in Pediatric Asthma Patients in the Emergency Department

Sabato¹,

Ward²,

Hawk³

et al. 2011

Respir Care

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BACKGROUND: Bronchodilator treatment for asthma can be provided with various aerosolgenerating devices and methods. There have been no randomized trials of a breath-actuated nebulizer versus continuous 1-hour nebulization and/or small-volume constant-output nebulizer in pediatric asthma patients. METHODS: We conducted a randomized study of one-time albuterol treatment with the AeroEclipse breath-actuated nebulizer versus standard therapy (single treatment via small-volume nebulizer or 1-hour of continuous nebulized albuterol) in pediatric asthma patients in the emergency department. Eligible patients were those admitted to the emergency department, 0 months to 18 years of age, who presented with asthma or wheezing. We assessed all the patients with our clinical asthma scoring system and peak-flow measurement if possible. We stratified the patients by clinical asthma score and weight, and then randomized them to receive their initial albuterol treatment in the emergency department via either AeroEclipse or standard therapy. We recorded time in the emergency department, change in clinical asthma score, need for additional bronchodilator treatments, need for admission, patient response, ability to actuate the AeroEclipse, and adverse effects. RESULTS: We enrolled 149 patients between October 14, 2004 and November 11, 2005, and we randomized 84 patients to AeroEclipse and 65 to standard therapy. The cohort's average age was 5.5 years. There were no significant differences in demographics. The initial mean clinical asthma scores were 5.1 ؎ 2.4 in the AeroEclipse group, and 5.1 ؎ 2.1 in the standard-therapy group. Time in the emergency department was not different (AeroEclipse 102 min, standard therapy 125 min, P ‫؍‬ .10), but the AeroEclipse group had a significantly greater improvement in clinical asthma score (1.9 ؎ 1.2 vs 1.2 ؎ 1.4, P ‫؍‬ .001) and respiratory rate (P ‫؍‬ .002), and significantly lower admission rate (38% vs 57%, P ‫؍‬ .03). There was no difference in adverse effects. CONCLUSIONS: Although AeroEclipse did not reduce the time in the ED, it significantly improved clinical asthma score, decreased admissions, and decreased respiratory rate.

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“…Because the administered dose depends on the patient's lung volume and inspiratory flow rates, the same dose can be used in most patients regardless of age or size. Although 6 adult studies 5 and 1 pediatric study 6 showed no difference in the effects of continuous versus intermittent administration of nebulized albuterol, continuous administration was more effective in the subset of patients with severe exacerbations of asthma, 7,8 and it was more cost-effective in a pediatric trial. 6 A Cochrane meta-analysis showed no overall difference between the effects of albuterol delivered by metered dose inhaler (MDI)-spacer or nebulizer, 9 but MDI-spacer administration can be difficult in patients in severe distress.…”

Section: Primary Therapymentioning

confidence: 96%

Part 10.5: Near-Fatal Asthma

Wilkins¹

2005

Circulation

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A sthma accounts for Ͼ2 million emergency department visits and 5000 to 6000 deaths annually in the United States, many occurring in the prehospital setting. 1 Severe asthma accounts for approximately 2% to 20% of admissions to intensive care units, with up to one third of these patients requiring intubation and mechanical ventilation. 2 This section focuses on the evaluation and treatment of patients with near-fatal asthma. PathophysiologyThe pathophysiology of asthma consists of 3 key abnormalities:Complications of severe asthma, such as tension pneumothorax, lobar atelectasis, pneumonia, and pulmonary edema, can contribute to fatalities. Cardiac causes of death are less common.

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Continuous versus intermittent albuterol nebulization in the treatment of acute asthma

Cited by 87 publications

References 10 publications

Global strategy for asthma management and prevention: GINA executive summary

Global strategy for asthma management and prevention: GINA executive summary

Randomized Controlled Trial of a Breath-Actuated Nebulizer in Pediatric Asthma Patients in the Emergency Department

Part 10.5: Near-Fatal Asthma

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