Reply to “Subcutaneous terbutaline as an alternative to aerosolized albuterol”

Shaker, Marcus; Oppenheimer, John; Grayson, Mitchell H.; Stukus, David R.; Hartog, Nicholas; Hsieh, Elena W.Y.; Rider, Nicholas L.; Dutmer, Cullen M.; Leek, Timothy K. Vander; Kim, Harold; Chan, Edmond S.; Mack, Doug; Ellis, Anne K.; Lang, David M.; Lieberman, Jay; Fleischer, David M.; Golden, David B.K.; Wallace, Dana; Portnoy, Jay M.; Mosnaim, Giselle; Greenhawt, Matthew

doi:10.1016/j.jaip.2020.04.016

Cited by 3 publications

(5 citation statements)

References 8 publications

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“…54 Terbutaline dapat menjadi pilihan selama masa pandemi jika tidak terdapat ruangan khusus untuk mencegah penyebaran aerosol dari alat nebulisasi. 55 Dalam kasus sulit, alih-alih sebagai pengganti, terbutaline dapat sebagai terapi tambahan jika eksaserbasi belum tercapai. 54 Terbutaline adalah obat dengan kategori B FDA, 43 golongan beta-agonis yang merangsang CONTINUING MEDICAL EDUCATION reseptor β2 bronkus lebih besar daripada reseptor β1 di jantung, sehingga dapat digunakan untuk asma.…”

Section: Manajemen Asma Dalam Kehamilanunclassified

“…54 Terbutaline adalah obat dengan kategori B FDA, 43 golongan beta-agonis yang merangsang CONTINUING MEDICAL EDUCATION reseptor β2 bronkus lebih besar daripada reseptor β1 di jantung, sehingga dapat digunakan untuk asma. 55 Terbutaline subkutan menghasilkan perbaikan klinis setara epinephrine. Sebuah studi 56 mencatat tingkat takikardi sedikit lebih tinggi pada injeksi terbutaline dibandingkan injeksi epinephrine.…”

Section: Manajemen Asma Dalam Kehamilanunclassified

“…Epinephrine SK (0,01 mg/kg/ dosis) juga bermanfaat; dosis dewasa 0,25 mg untuk terbutaline dan 0,3 -0,5 mg untuk epinephrine setiap 20 menit sebanyak total 3 dosis. [54][55][56] Sumber lain menyebutkan dosis terbutaline adalah 12 μg/kg dan diketahui lebih baik dibandingkan epinephrine untuk menghilangkan obstruksi aliran udara yang diukur berdasarkan kapasitas vital paru. 56 Selain itu, terbutaline lebih mudah tersedia di banyak rumah sakit dibandingkan epinephrine.…”

Section: Manajemen Asma Dalam Kehamilanunclassified

“…56 Selain itu, terbutaline lebih mudah tersedia di banyak rumah sakit dibandingkan epinephrine. 55 Pada kondisi asma eksaserbasi berulang yang sulit teratasi, dapat diberikan 2 gram magnesium sulfat (MgSO 4 ) dalam cairan normal saline (NS) 100 mL bolus lambat dalam 30 menit saat hendak dirujuk untuk mencegah preeklampsia sekaligus mengambil manfaatnya sebagai tokolitik. 58 Dosis sesuai literatur, yakni 40 (25-75) mg/kgBB (maksimal 2 gram).…”

Section: Manajemen Asma Dalam Kehamilanunclassified

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Manajemen Asma dalam Kehamilan: Apa yang Harus Dipahami oleh Dokter Umum

Habiburrahman

Rakasiwi

2023

Cermin Dunia Kedokteran

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Eksaserbasi asma dalam kehamilan dapat mempersulit proses persalinan dan berisiko bayi lahir dengan berat badan lahir rendah dan ibu berisiko mengalami persalinan preterm, preeklampsia, dan sectio caessaria. Penyebab eksaserbasi asma dalam kehamilan dapat akibat terapi kurang optimal selama kehamilan akibat kekhawatiran personal pasien dan dokter yang kurang didukung bukti terkait keamanan agen farmakologis asma dalam kehamilan, dan rendahnya kepatuhan pasien untuk kontrol rutin, terutama selama masa pandemi COVID-19. Hingga kini, manajemen asma antenatal menjadi tugas besar dokter umum di layanan primer, dan dokter spesialis obstetrik dan ginekologi, serta dokter spesialis paru di layanan sekunder, sedangkan panduan khusus komprehensif asma dalam kehamilan di Indonesia masih terbatas. Telaah literatur ini bertujuan untuk memberikan pemahaman esensial perubahan klinis dan mekanisme yang berkontribusi terhadap tidak terkontrolnya asma selama kehamilan, pendekatan diagnosis komprehensif asma dalam kehamilan, dan menyediakan informasi obat-obatan yang aman untuk manajemen asma dalam kehamilan. Asthma exacerbations in pregnancy can complicate the delivery process and risk low birth weight in the baby, as well as preterm labor, preeclampsia, and a cesarean section in mothers. Asthma exacerbations during pregnancy can be caused by ineffective treatment due to patient and physician concerns about the safety of asthma medications during pregnancy that are not supported by reliable data, as well as poor patient compliance for routine control, particularly during the COVID-19 pandemic. Asthma management during antenatal care falls primarily on general practitioners in primary care, and obstetricians and gynecologists, and pulmonologists in secondary-level services. While specific guidelines in Indonesia are still limited, this review aims to present a fundamental understanding of clinical changes and mechanisms that contribute to the uncontrolled status of asthma during pregnancy, a comprehensive diagnostic approach to asthma in pregnancy, and provide a safety drug profile during pregnancy

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Section: Manajemen Asma Dalam Kehamilanunclassified

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Manajemen Asma dalam Kehamilan: Apa yang Harus Dipahami oleh Dokter Umum

Habiburrahman

Rakasiwi

2023

Cermin Dunia Kedokteran

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“…The clinical signs of asthma and COVID-19 are similar, presenting mainly cough and dyspnea. Also, fever is expected during COVID-19 and asthma exacerbations (9,10). Nonetheless, respiratory viruses can trigger asthma exacerbations, increasing the severity of the infectious condition (4).…”

Section: Introductionmentioning

confidence: 99%

Profile of coronavirus disease enlightened asthma as a protective factor against death: An epidemiology study from Brazil during the pandemic

et al. 2022

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IntroductionThe possibility that asthma is not a risk factor for the worst outcomes due to coronavirus disease (COVID-19) is encouraged. The increase in Th2 response dominance can downregulate the late phase of hyperinflammation, which is typically the hallmark of more severe respiratory viral infections, alongside lower angiotensin-converting enzyme receptors in patients with asthma due to chronic inflammation. Few studies associated asthma diagnosis and COVID-19 outcomes. In this context, we aimed to associate the asthma phenotype with the clinical signs, disease progression, and outcomes in patients with COVID-19.MethodsWe performed an epidemiologic study using patients’ characteristics from OpenDataSUS to verify the severity of COVID-19 among Brazilian hospitalized patients with and without the asthma phenotype according to the need for intensive care units, intubation, and deaths. We also evaluated the demographic data (sex, age, place of residence, educational level, and race), the profile of clinical signs, and the comorbidities.ResultsAsthma was present in 43,245/1,129,838 (3.8%) patients. Among the patients with asthma, 74.7% who required invasive ventilatory support evolved to death. In contrast, 78.0% of non-asthmatic patients who required invasive ventilatory support died (OR = 0.83; 95% CI = 0.79–0.88). Also, 20.0% of the patients with asthma that required non-invasive ventilatory support evolved to death, while 23.5% of non-asthmatic patients evolved to death (OR = 0.81; 95% CI = 0.79–0.84). Finally, only 11.2% of the patients with asthma who did not require any ventilatory support evolved to death, while 15.8% of non-asthmatic patients evolved to death (OR = 0.67; 95% CI = 0.62–0.72). In our multivariate analysis, one comorbidity and one clinical characteristic stood out as protective factors against death during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Patients with asthma were less prone to die than other patients (OR = 0.79; 95% CI = 0.73–0.85), just like puerperal patients (OR = 0.74; 95% CI = 0.56–0.97) compared to other patients.ConclusionAsthma was a protective factor for death in hospitalized patients with COVID-19 in Brazil. Despite the study’s limitations on patients’ asthma phenotype information and corticosteroid usage, this study brings to light information regarding a prevalent condition that was considered a risk factor for death in COVID-19, being ultimately protective.

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Managing Severe Acute Asthma Exacerbation in Pregnancy during the COVID-19 Pandemic: A Case Report from a Resource-limited Setting

Habiburrahman¹,

Damayanti²,

Dilmy³

et al. 2023

Open Access Maced J Med Sci

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BACKGROUND: One-third of pregnant women will experience worsening asthma requiring emergency hospitalization. However, no report comprehensively discussed the management of asthma attacks in pregnant women in impoverished settings. We attempt to illuminate what general practitioners can do to stabilize and improve the outcome of severe acute asthma exacerbations in primary care with resource limitations. CASE REPORT: A nulliparous 29-year-old woman in her 21st week of pregnancy presented severe acute asthma exacerbation in moderate persistent asthma with uncontrolled asthma status along with gestational hypertension, uncompensated metabolic acidosis with a high anion gap, anemia, respiratory infection, and asymptomatic bacteriuria, all of which influenced her exacerbations. This patient was admitted to our resource-limited subdistrict hospital in Indonesia during the COVID-19 pandemic for optimal stabilization. Crystalloid infusions, oxygen supplementation, nebulized beta-agonist with anticholinergic agents, inhaled corticosteroids, intravenous methylprednisolone, broad-spectrum antibiotics, subcutaneous terbutaline, mucolytics, magnesium sulphate, oral antihypertensives, and continuous positive airway pressure were used to treat her life-threatening asthma. After she was stabilized, we referred the patient to a higher-level hospital with more advanced pulmonary management under the supervision of a multidisciplinary team to anticipate the worst scenario of pregnancy termination. CONCLUSION: Limitations in primary care, including the lack of sophisticated intensive care units and laboratory panels, may complicate challenges in managing severe acute asthma exacerbation during pregnancy. To enhance maternal-fetal outcomes, all multidisciplinary team members should be well-informed about key asthma management strategies during pregnancy using evidence-based guidelines regarding the drug, rationale, and safety profile.

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Reply to “Subcutaneous terbutaline as an alternative to aerosolized albuterol”

Cited by 3 publications

References 8 publications

Manajemen Asma dalam Kehamilan: Apa yang Harus Dipahami oleh Dokter Umum

Manajemen Asma dalam Kehamilan: Apa yang Harus Dipahami oleh Dokter Umum

Profile of coronavirus disease enlightened asthma as a protective factor against death: An epidemiology study from Brazil during the pandemic

Managing Severe Acute Asthma Exacerbation in Pregnancy during the COVID-19 Pandemic: A Case Report from a Resource-limited Setting

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