Chest
Clinical InvestigationsAsthmaComparison of 2.5 vs 7.5 mg of Inhaled Albuterol in the Treatment of Acute Asthma
Section snippets
Materials and Methods
This study was conducted in the emergency department of MetroHealth Medical Center, a large urban county-owned institution. Adult patients between the ages of 18 and 50 years presenting to the emergency department with acute asthma, as manifested by cough, dyspnea, and/or wheezing were enrolled by one of the department's research nurses. Patients were excluded from this study if they had a previous diagnosis of COPD, a history consistent with chronic bronchitis, previous lung surgery, or a
Results
One hundred and sixty patients were enrolled in the study, including 123 women and 37 men with a mean age of 36.5 ± 11.2 years (Table 1). On arrival in the emergency department, 84% of the patients had a history of using β-agonists, 27% of the patients were using theophylline products, 37% of the patients were using inhaled steroids, and 10% of the patients were using oral steroids. This did not differ between the patients in the high- or low-dose groups. Thirty percent of the patients had a
Discussion
This study has failed to demonstrate a difference between two doses of albuterol in the treatment of acute asthma. This study had an 80% power to determine an absolute difference of 17% in the percent of improvement in FEV1 pre- to post-treatment. We also failed to find a difference in admission rate between the two groups.
A previous study9 in patients with stable asthma found a log-linear dose response to increasing doses of albuterol. Nelson studied 44 asthmatic patients who received
Conclusion
We conclude that there is no advantage to the administration of doses of albuterol greater than 2.5 mg every 20 min for adult asthmatic patients. Some subpopulations may benefit from higher dose albuterol that were not detected by this study design.
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Cited by (54)
Management of Life-Threatening Asthma: Severe Asthma Series
2022, ChestCitation Excerpt :Use of metered-dose inhalers with spacers allows for targeted albuterol dosing, but offers no significant advantage over nebulization.6-8 Also a high-dose strategy (7.5 mg) offers no benefit over a low-dose (2.5 mg) of albuterol.9 IV β2-agonists should be reserved for when inhaled therapy is not feasible.10
Inhaled and intravenous treatment in acute severe and life-threatening asthma
2013, British Journal of AnaesthesiaIntravenous magnesium sulphate provides no additive benefit to standard management in acute asthma
2008, Respiratory MedicineCitation Excerpt :Similarly, in a study by Tiffany et al.23 who found no benefit with MgSO4 in severe exacerbations, a total dose of 7.5 mg of salbutamol was used. Evidence suggests that 7.5 mg nebulised salbutamol is as effective as 22.5 mg in providing optimal treatment in acute asthma.32 Therefore, high doses of β2 agonists may not provide additional bronchodilator benefit and may reduce magnesium levels although the influence of this on biological availability is unclear.
The role of intrinsic efficacy in determining response to a β<inf>2</inf>-agonist in acute severe asthma
2007, Respiratory MedicineCitation Excerpt :We used similar doses for both albuterol and isoproterenol despite the fact that these agonists have different potencies (isoproterenol>albuterol). However, in a previous study on a similar patient population with acute asthma, there was no documented advantage from administering albuterol in a higher dose than what we used (7.5 mg/h28). Thus, we believe that the difference in potency in this situation did not influence our findings.
The correlation of urinary levels of albuterol and its metabolites isomers following inhalation from a dry powder inhaler and in vitro particle size characterisation
2007, Pulmonary Pharmacology and TherapeuticsAssessment and treatment of acute asthma in children
2005, Journal of Pediatrics