Chest
Volume 115, Issue 1, January 1999, Pages 92-96
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Clinical Investigations
Asthma
Comparison of 2.5 vs 7.5 mg of Inhaled Albuterol in the Treatment of Acute Asthma

https://doi.org/10.1378/chest.115.1.92Get rights and content

Purpose

The optimal dose of albuterol to use in the treatment of acute asthma has yet to be established. The National Asthma Education and Prevention Program (NAEPP) recommends a starting dose of 2.5 to 5 mg of aerosolized albuterol every 20 min, although European authorities recommend higher doses. The purpose of this study was to compare 2.5 vs 7.5 mg of nebulized albuterol for the treatment of acute asthma.

Subjects

We studied 160 patients presenting to the emergency department with acute asthma.

Methods

On enrollment, patients underwent baseline testing, including initial spirometry. All patients received prednisone, 60 mg, orally. Patients then received in a randomized, double-blinded fashion, nebulized albuterol either 2.5 or 7.5 mg every 20 min for a total of three doses. Spirometry was repeated after each of the first two treatments and again 40 min after completion of the three treatments.

Results

The pretreatment FEV1 was 36.9 ± 16.6% of predicted normal in the low-dose group vs 41.5 ± 15.4% of predicted normal in the high-dose group (not significant [NS]). The patients in the low-dose group had a 50.3 ± 62.6% improvement in FEV1 pretreatment to post-treatment, whereas those in the high-dose group had a 44.6 ± 48.2% improvement in FEV1 (NS). There was no difference in the admission rate in the low-dose group (43%) as compared with that of the high-dose group (39%; NS).

Conclusion

We conclude that there is no advantage to the routine administration of doses of albuterol higher than 2.5 mg every 20 min. It is possible that there may be an advantage in the most severely obstructed patients, although this study did not enroll enough patients with very severe asthma to evaluate this. As has been previously demonstrated, patients who subsequently require admission have a diminished response to albuterol. This decreased responsiveness is seen with the first aerosol administration and is unaffected by increasing the dose.

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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