Comparison of outcome of salbutamol alone and salbutamol in combination with ipratropium bromide in acute asthma in children (original) (raw)
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The Professional Medical Journal, 2021
Objective: To compare the Salbutamol alone and Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR. Study Design: Randomized Controlled Trial. Setting: Pediatrics Emergency, KRL Hospital Islamabad. Period: 1st August 2016 to 31 January 2017. Material & Methods: Group A patients were given only Salbutamol (0.15mg/kg per dose with minimum 2.5 mg, maximum 5 mg/dose). Group B was given Ipratropium Bromide supplemented Salbutamol (250 mcg/dose for <20 kg while 500 mcg/dose for >20kg of Ipratropium Bromide with same dose of Salbutamol as prescribed for Group A). Baseline spirometry was performed on each patient and after measurement of baseline peak expiratory flow. The outcome was measured by Peak flow meter and reassessed at 60 minutes. Results: Comparison of salbutamol alone and ipratropium bromide supplemented salbutamol in children with exacerbation of asthma in terms of PEFR shows that 40.5 + 4.28 in Group-A and 59.5 +4.75 in Gr...
Critical Care Medicine, 2002
A cute asthma is a major problem that is commonly encountered in children in emergency departments. Over the past decade, there has been a trend to give higher and more frequent doses of inhaled bronchodilators and, more recently, combination bronchodilator therapy as initial treatment of acute asthma in children (1-4). Using frequent doses of inhaled bronchodilators such as salbutamol in severe asthma leads to clinical improvement over a period of time in many cases but often requires a large dose, which has the potential to cause toxic effects (5, 6). In cases of severe asthma, delay in clinical response caused, in part, by inflammation in the airways results in airway obstruction that can impede the delivery of inhaled drugs (7). If these drugs can access the site of action unhindered by bronchial obstruction, then earlier clinical response may be achieved (8). Attempts to achieve earlier clinical response with few adverse effects renewed interest in the use of ipratropium bromide. Recent studies using frequent-dose inhaled ipratropium bromide showed improved pulmonary function
Paediatrica Indonesiana, 2012
Background The efficacy of salbutamol-ipratropium bromide practice for this drug combination to be given to patients with Objective To compare the efficacy of salbutamol-ipratropium bromide nebulization to salbutamol alone in children with mild Methods This single-blind, randomized clinical trial was held bromide (experimental group) or 2.5 mg salbutamol alone post-nebulization. Results There were no significant differences in clinical scores, oxygen saturations, respiratory rates, or hospitalization rates between the Conclusion Reprint requests to matahari_1780@yahoo. com A sthma is global health problem in children, and is increasing in prevalence, even though the pathogenesis, pathophysiology, and management of asthma is well In Indonesia, Rahajoe et al. reported 2 Controversies in asthma management may increase morbidity and mortality of patients. The addition of ipratropium bromide for patients with 2-between the two groups.
Thorax, 2003
Background: The relative efficacies of aminophylline and salbutamol in severe acute childhood asthma are currently unclear. A single bolus of salbutamol was compared with a continuous aminophylline infusion in children with severe asthma in a randomised double blind study. Methods: Children aged 1-16 years with acute severe asthma were enrolled if they showed little improvement with three nebulisers (combined salbutamol and ipratropium) administered over an hour and systemic steroids. Subjects were randomised to receive either a short intravenous bolus of salbutamol (15 µg/kg over 20 minutes) followed by a saline infusion or an aminophylline infusion (5 mg/kg over 20 minutes) followed by 0.9 mg/kg/h. Results: Forty four subjects were enrolled, with 18 randomly allocated to receive salbutamol and 26 to receive aminophylline. The groups were well matched at baseline. An intention to treat analysis showed that there was no statistically significant difference in the asthma severity score (ASS) at 2 hours between the two groups (median (IQR) 6 (6, 8) and 6.5 (5, 8) for salbutamol and aminophylline respectively, p=0.93). A similar improvement in ASS to 2 hours was seen in the two groups (mean difference -0.08, 95% CI -0.97 to 0.80), there was a trend (p=0.07) towards a longer duration of oxygen therapy in the salbutamol group (17.8 hours (95% CI 8.5 to 37.5) v 7.0 hours (95% CI 3.4 to 14.2)), and a significantly (p=0.02) longer length of hospital stay in the salbutamol group (85.4 (95% CI 66.1 to 110.2) hours v 57.3 hours (95% CI 45.6 to 72.0)). There was no significant difference in adverse events between the two groups.
A comparison of regular salmeterol vs ‘as required’ salbutamol therapy in asthmatic children
Respiratory Medicine, 1998
TGlaxo Wellcome on behalf of an Infernafional Study Group In a multicentre, double-blind, randomized, parallel study, 426 asthmatic children aged 5-15 years old received salmeterol 50,~g b.i.d. or placebo b.i.d. via the Diskhaler@. All patients had access to inhaled salbutamol to be used on an 'as required' (p.r.n.) basis for symptomatic relief. The study design comprised a 2-week baseline, a 1Zmonth treatment period incorporating a 2-week 'off treatment' after 6 months, and a 2-week follow-up period at the end of the trial. At the end of 12 months of treatment with salmeterol, the adjusted change from baseline for morning and evening peak expiratory flow rate (PEF) was 56 and 47 1 min ~ ', respectively, and this was significantly greater than placebo (PcO.01; WO.05). Exacerbation rates did not differ between groups and results were not dependent upon concurrent inhaled steroid use. Neither treatment caused a change of z 1 doubling dose in PC,,/PD,, either during or on stopping treatment. Treatment with regular salmeterol 5Opg b.i.d. over a 12-month treatment period provides a significant, rapid and well-maintained improvement in lung function without increasing bronchial reactivity or asthma exacerbation rates compared to p.r.n. salbutamol.
Pediatric Pulmonology, 2019
Introduction: In moderate-severe asthma exacerbation, salbutamol by inhaler (MDI) is superior to salbutamol delivered by nebulizer (NEB); however, to our knowledge, no studies in children with exclusively severe exacerbations were performed. Objective: To compare the efficacy of salbutamol and ipratropium bromide by MDI versus by NEB in severe asthma exacerbations. Methods: We performed a clinical trial enrolling 103 children (2-14 years of age) with severe asthma exacerbations (defined by the Pulmonary Score ≥ 7) seen at the emergency room in Asuncion, Paraguay. One group received salbutamol and ipratropium (two puff every 10 min for 2 h and then every 30 min for 2 h more) by MDI with a valved-holding chamber and mask along with oxygen by a cannula separately (MDI-SIB); and the other received nebulization with oxygen (NEB-SIB) of salbutamol and ipratropium (1 every 20 min for 2 h and then every 30 min for 2 h more). Primary outcome was the rate of hospitalization (Pulmonary Score ≥ 7) after 4 h and secondary outcome was oxygen saturation. Results: Fifty two children received MDI-SIB and 51 NEB-SIB. After the 4th hour, children on MDI-SIB had significantly (P = 0.003) lower rate of hospital admission than on NEB-SIB (5.8% vs 27.5%, RR: 0.21 [0.06-0.69], respectively). Similarly, a significant improved clinical score after 60 min and increase in oxygen saturation after 90 min of treatment was observed in MDI-SIB versus NEB-SIB group (4.46 ± 0.7 vs 5.76 ± 0.65,
Canadian Respiratory Journal, 1997
STUDY OBJECTIVE: To compare two dosing regimens of salbutamol in acute asthma.DESIGN: Prospective randomized double-blind trial.SETTING: Urban emergency department.TYPE OF PARTICIPANTS: Patients who presented to the emergency department with moderate to severe asthma.INTERVENTIONS: All patients had pulmonary function testing and were randomized to group A (control; n=25) or group B (experimental; n=23). Group A (control) patients received salbutamol 2.5 mg delivered by wet aerosol at 0, 1 and 2 h (total dose 7.5 mg). At 20, 40, 80 and 100 mins a placebo aerosol was given. Group B patients received salbutamol 5 mg at 0 min and one-third the initial dose every 20 mins for a total of six doses by wet aerosol (total dose 15 mg).RESULTS: There were no differences in age, sex, preadmission medications or initial forced expiratory volume in 1 s (FEV1) between the groups. Forty-eight patients completed the study. Both groups of patients improved with mean absolute change in FEV1of 700 mL in...
2021
Objective: To assess efficacy of salbutamol delivered through metered dose inhaler (MDI) - spacer in paediatric patients with acute exacerbation of asthma. Study Design: Prospective observational study. Place and Duration of Study: Department of Paediatrics, Pakistan Naval Ship, Shifa Hospital, Karachi-Pakistan, from Jan to Dec 2018. Methodology: Ninety Five patients aged ≥6 to ≤12 years, with acute asthma exacerbation were enrolled. Any patient with fever, clinical asthma score (CAS) >7, on home treatment with drugs delivered through nebulization or on oral steroids was excluded. Clinical asthma score recorded on presentation, followed with salbutamol via Metered Dose Inhaler & spacer at dose of 400 µgm (4 x puffs of 100 µgm). Clinical asthma score rechecked after 20 min. Response to salbutamol was then compared in relation to the presenting Clinical asthma score. Results: Out of 95 children, 45 (47.9%) were male & 50 (52.1%) female with 67.4% having positive family history for ...
Pediatric Critical Care Medicine, 2002
To reanalyze data from two previous studies to provide stronger evidence of benefit for early use of single-dose intravenous bolus salbutamol in children with acute severe exacerbations of asthma. Methods: Randomized, double-blind, placebo-controlled trial of 84 children with acute severe asthma who presented to the emergency department of the Children's Hospital at Westmead. After clinical evaluation, patients who had severe asthma were given high-dose inhaled salbutamol and had an intravenous cannula inserted. Additional treatment consisted of intravenous methylprednisolone (1 mg/kg), oxygen (6 L/min via mask if SaO 2 was <93%). Patients were then randomized to receive an intravenous infusion of either 15 g/kg salbutamol or saline, with clinical progress assessed hourly for 2 hrs. All patients were admitted to the hospital and clinically monitored for the proceeding 2-24 hrs, with inhaled salbutamol treatment administered in accord with the hospital's protocol. Results: The intravenous salbutamol group (n ؍ 50) demonstrated earlier clinical improvement, with earlier reduction in oxygen therapy and reduced need for ongoing inhaled salbutamol therapy by the end of phase 1 compared with the control group (n ؍ 34). Patients in the intravenous salbutamol group were ready for discharge from the emergency department 3.7 hrs earlier than those in the control group and were ready for discharge from the hospital 9.7 hrs earlier than controls. No significant side effects were found in either group. Conclusion: A single-dose intravenous salbutamol bolus of 15 g/kg administered over 10 mins in the initial treatment of children with acute severe asthma in the emergency department has the potential to shorten the duration of severe attacks and reduce overall requirements for inhaled salbutamol maintenance.
Population Pharmacokinetics of Intravenous Salbutamol in Children with Refractory Status Asthmaticus
Clinical Pharmacokinetics
Background Intravenous salbutamol is used to treat children with refractory status asthmaticus, however insufficient pharmacokinetic data are available to guide initial and subsequent dosing recommendations for its intravenous use. The pharmacologic activity of salbutamol resides predominantly in the (R)-enantiomer, with little or no activity and even concerns of adverse reactions attributed to the (S)-enantiomer. Objective Our aim was to develop a population pharmacokinetic model to characterize the pharmacokinetic profile for intravenous salbutamol in children with status asthmaticus admitted to the pediatric intensive care unit (PICU), and to use this model to study the effect of different dosing schemes with and without a loading dose. Methods From 19 children (median age 4.9 years [range 9 months-15.3 years], median weight 18 kg [range 7.8-70 kg]) treated with continuous intravenous salbutamol at the PICU, plasma samples for R-and S-salbutamol concentrations (111 samples), as well as asthma scores, were collected prospectively at the same time points. Possible adverse reactions and patients' clinical data (age, sex, weight, drug doses, liver and kidney function) were recorded. With these data, a population pharmacokinetic model was developed using NONMEM 7.2. After validation, the model was used for simulations to evaluate the effect of different dosing regimens with or without a loading dose. Results A two-compartment model with separate clearance for R-and S-salbutamol (16.3 L/h and 8.8 L/h, respectively) best described the data. Weight was found to be a significant covariate for clearance and volume of distribution. No other covariates were identified. Simulations showed that a loading dose can result in higher R-salbutamol concentrations in the early phase after the start of infusion therapy, preventing accumulation of S-salbutamol. Conclusions The pharmacokinetic model of intravenous R-and S-salbutamol described the data well and showed that a loading dose should be considered in children. This model can be used to evaluate the pharmacokinetic-pharmacodynamic relationship of intravenous salbutamol in children, and, as a next step, the effectiveness and tolerability of intravenous salbutamol in children with severe asthma. Nienke J. Vet and Brenda C. M. de Winter contributed equally to this work.