Intravenous beta2-agonists for acute asthma in the emergency department

Travers, Andrew; Jones, Arthur; Kelly, Karen D.; Camargo, Carlos A.; Barker, Stephen; Rowe, Brian H.

doi:10.1002/14651858.cd002988

Cited by 79 publications

(58 citation statements)

References 39 publications

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“…Therefore, a reasonable approach to inhaled therapy in exacerbations would be the initial use of continuous therapy, followed by intermittent on-demand therapy for hospitalised patients. There is no evidence to support the routine use of intravenous b 2 -agonists in patients with severe asthma exacerbations [342].…”

Section: Initial Assessmentmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2007

Eur Respir J

2,664

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: Initial Assessmentmentioning

confidence: 99%

Global strategy for asthma management and prevention: GINA executive summary

Bateman

Ss²,

Barnes³

et al. 2007

Eur Respir J

2,664

2,301

View full text Add to dashboard Cite

show abstract

“…aminophylline [56] or i.v. or nebulised magnesium [57,58], or the mode of delivery of b 2 -agonist (intravenous, metered-dose inhaler and spacer, and nebuliser) [59,60]. The finding that, in exacerbations severe enough to warrant ED treatment, metered-dose inhaler plus spacer is as effective as a nebuliser for delivery of b 2 -agonist [60] is also relevant to self-management of exacerbations, suggesting that patients do not need to go to the expense of purchasing a nebuliser for home use.…”

Section: -Agonists In the Management Of Exacerbationsmentioning

confidence: 99%

Pharmacological strategies for self-management of asthma exacerbations: Table 1—

Reddel

Barnes²

2006

Eur Respir J

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Written action plans are effective within asthma self-management, but there are few guidelines about the specific medication adjustments which can be recommended for selftreatment of exacerbations.This review examines pharmacological strategies for self-management of asthma exacerbations in adults, including those for inhaled corticosteroid/long-acting b 2 -agonist (ICS/LABA) users.Oral corticosteroids are well-established in clinical practice and clinical trials for the treatment of severe exacerbations, including during combination therapy. Evidence supports 7-10 days treatment, with no need to taper except to reduce side-effects. Doubling the dose of ICS is not effective. Several studies have shown benefit from high-dose ICS (2,400-4,000 mg beclomethasone equivalent) for 1-2 weeks. This may be achieved by adding a high-dose ICS inhaler to maintenance ICS or ICS/LABA therapy. There is inconclusive evidence about acutely increasing the dose of maintenance budesonide/formoterol for exacerbations, and no studies of this approach with fluticasone/salmeterol. For patients taking maintenance budesonide/formoterol, use of the same medication as-needed reduces exacerbations. Short-acting b 2 -agonists are still effective in producing bronchodilation during combination therapy; however, a higher dose may be required.There is a need for further studies to clarify remaining issues about self-management of asthma exacerbations, particularly with regard to side-effects of treatment and patient acceptability.

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“…Uma revisão do Grupo de Via Aérea (Cochrane Library) 41 procurou avaliar os benefícios das drogas ß 2 -agonistas administradas por via endovenosa para tratamento de quadros de asma aguda grave, assistidos em serviços de emergência. Em uma amostragem de 584 pacientes (retirados de 15 ensaios clínicos randomizados), não foi capaz de encontrar diferenças quanto aos desfechos clínicos avaliados, nem quanto ao aparecimento de efeitos colaterais.…”

Section: Terapia Intravenosa: Papel Dos ß 2 -Agonistasunclassified

“…Entretanto, é importante ressaltar que grande parte dos pacientes selecionados provinham de estudos realizados em populações de faixa etária adulta. Somente três estudos envolviam crianças (faixa etária 0,8-14,7 anos), o que dificulta o estabelecimento de qualquer conclusão, ou a extrapolação dos achados para este subgrupo, alvo do nosso particular interesse 41 .…”

Section: Terapia Intravenosa: Papel Dos ß 2 -Agonistasunclassified

Controversies in the pharmacological management of acute asthma in children

et al. 2002

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Objective: to present a review of controversial issues related to the pharmacological management of the treatment of acute asthma in children.Sources: articles published in national and international scientific journals. Data were selected from Lilacs and Medline databases.Summary of the findings: the article was organized into topics, presenting aspects on which there is consensus regarding the pharmacological treatment of asthma in children. Issues related to the use of metered dose inhaler versus nebulizers, the role of ß2-adrenergic drugs administered intravenously as well as the role of methylxanthine and magnesium sulfate are approached critically. Conclusions:Inhaled ß2-agonist drugs combined with corticosteroids remain the treatment of choice for acute episodes of asthma in children. Either nebulizers or metered dose inhalers connected to spacers are efficient for the relief of acute symptoms. Patients who are refractory to conventional treatment and develop severe acute asthma should receive ß2-agonist drugs intravenously, provided they are properly monitored. Methylxanthine and magnesium sulfate should be considered a second choice for selected patients.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: acute asthma, beta-agonist, magnesium sulfate, aminophylline. ResumoObjetivo: apresentar uma revisão acerca de questões controversas, relativas ao manejo farmacológico utilizado nos pacientes pediátricos portadores de asma aguda. Fontes dos dados: foram utilizadas informações de artigos publicados em revistas científicas nacionais e internacionais, selecionadas das bases de dados Lilacs e Medline.Síntese dos dados: o artigo foi estruturado em tópicos, apresentando aspectos consensuais no tratamento farmacológico da asma infantil. Questões relacionadas à utilização de inaladores dosimetrados versus nebulizadores, o papel das drogas ß 2 -adrenérgicas utilizadas pela via endovenosa, bem como das metilxantinas e do sulfato de magnésio, são abordados de maneira crítica.Conclusões: os ß 2 -agonistas administrados pela via inalatória, associados aos coricosteróides, permanecem o tratamento de eleição para episódios agudos de asma na população pediátrica. Tanto os nebulizadores quanto os inaladores dosimetrados, acoplados a espaçadores, são efetivos para alívio dos sintomas agudos. Pacientes refratários ao tratamento convencional, que evoluem para quadros de asma aguda grave, devem ter considerada a utilização de drogas ß 2 -agonistas pela via endovenosa, desde que adequadamente monitorizados. Quanto às metilxantinas e ao sulfato de magnésio, devem ser considerados alternativas secundárias para pacientes selecionados.J Pediatr (Rio J) 2002; 78 (Supl.2): S151-S160: asma aguda, beta-agonistas, sulfato de magnésio, aminofilina.

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Intravenous beta2-agonists for acute asthma in the emergency department

Abstract: Intravenous beta2-agonists for acute asthma in the emergency department (Review)

Cited by 79 publications

References 39 publications

Global strategy for asthma management and prevention: GINA executive summary

Global strategy for asthma management and prevention: GINA executive summary

Pharmacological strategies for self-management of asthma exacerbations: Table 1—

Controversies in the pharmacological management of acute asthma in children

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