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Intravenous salbutamol bolus compared with an aminophylline infusion in children with severe asthma: a randomised
1Imperial College School of Medicine at St Mary's Hospital, London, UK. g.c.roberts@ic.ac.uk
Insights
In severe childhood asthma, aminophylline infusions and salbutamol boluses showed similar short-term effectiveness. However, aminophylline infusions significantly reduced hospital stays, indicating superior overall treatment outcomes for pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
- Emergency Medicine
Background:
- The comparative efficacy of aminophylline and salbutamol in severe acute childhood asthma requires clarification.
- This study addresses the uncertainty surrounding the optimal treatment for severe pediatric asthma exacerbations.
Purpose of the Study:
- To compare the relative efficacies of a salbutamol bolus versus a continuous aminophylline infusion in children with severe acute asthma.
- To evaluate treatment outcomes including asthma severity, oxygen therapy duration, and hospital length of stay.
Main Methods:
- A randomized, double-blind study involving children aged 1-16 years with severe acute asthma.
- Participants received either an intravenous salbutamol bolus or an aminophylline infusion after initial standard treatment.
Main Results:
- No statistically significant difference in asthma severity scores at 2 hours between salbutamol and aminophylline groups.
- A trend towards longer oxygen therapy duration in the salbutamol group (p=0.07).
- Significantly shorter hospital stays were observed in the aminophylline group (p=0.02) with no difference in adverse events.
Conclusions:
- Aminophylline infusions and salbutamol boluses demonstrate comparable short-term effectiveness in severe pediatric asthma.
- Aminophylline infusions offer a significant advantage by reducing hospital length of stay, suggesting better overall management.
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 micro g/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.
Conclusions:
This study suggests that, in severe childhood asthma, there is no significant difference in the effectiveness of a bolus of salbutamol and an aminophylline infusion in the first 2 hours of treatment. Overall, the aminophylline infusion was superior as it significantly reduced the length of stay in hospital.
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