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Albuterol via metered-dose inhaler in children: Lower doses are effective, and higher doses are safe
Fabio Pereira Muchão1,2, Juliana Miguita E Souza1, Hélida Conceição Cavalcante Torres1
1Instituto da Criança, Hospital das Clínicas, School of Medicine, University of São Paulo, São Paulo, Brazil.
Insights
Higher doses of albuterol did not reduce hospital stays or admissions for children with moderate to severe asthma. The study found no significant differences in efficacy or safety outcomes between higher and standard albuterol dosages.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Pharmacology
Background:
- The optimal dosage of albuterol for acute childhood asthma remains unclear.
- This study investigated whether higher albuterol doses reduce hospital length of stay and admission rates.
Purpose of the Study:
- To evaluate the efficacy and safety of higher albuterol dosages compared to standard dosages in children with moderate to severe acute asthma.
Main Methods:
- A randomized, double-blind, multicenter study involving 119 pediatric patients (2-17 years) with moderate to severe asthma.
- Patients received either standard or escalated albuterol doses via metered-dose inhalers.
- Efficacy outcomes included Pediatric Respiratory Assessment Measure (PRAM) score, pulse oximetry, FEV1, length of stay, and admission rates. Safety outcomes included albuterol plasma levels, heart rate, and serum electrolytes.
Main Results:
- No significant differences were found between the groups in length of stay (P=0.48) or admission rates (P=0.55).
- Improvements in PRAM score, pulse oximetry, and FEV1 were similar in both groups.
- No significant differences in safety outcomes were observed between the standard and higher albuterol dosage groups.
Conclusions:
- Higher albuterol dosage regimens did not improve clinical outcomes or reduce hospitalizations in children with moderate to severe acute asthma.
- The safety profile of escalated albuterol dosing was comparable to standard dosing in this pediatric population.
Background:
The ideal dosing of albuterol via metered-dose inhalers for acute childhood asthma is not well established. We hypothesized that greater doses of albuterol would result in less time in the hospital and lower admission rates.
Methods:
This was a randomized controlled double-blind multicenter study, conducted in emergency rooms (ER). We included patients with 2-17 years old with moderate to severe acute asthma (Pediatric Respiratory Assessment Measure, PRAM, score ≥5). Dosages administered during the first hour included: 6 (up to 25 kg) or 12 puffs (>25 kg) in the control group and 9 (up to 15 kg), 12 (>15-20 kg), 15 (>20-25 kg), or 18 puffs (>25 kg) in the study group. Several efficacy (changes in PRAM score, pulse oximetry, and FEV1 , length of stay, and admission rates) and safety (albuterol plasma levels, heart rate, serum potassium, glucose and bicarbonate levels, EKG, and tremor rates) outcome measures were assessed.
Results:
We included 119 patients with similar baseline conditions, and no significant differences were observed between groups in the length of stay (P = 0.48) or admission rate (P = 0.55). No significant differences were observed in FEV1 , PRAM score, and pulse oximetry changes after 1 hr and at discharge or admission. No significant differences were observed in safety outcomes between groups.
Conclusions:
Higher albuterol dosage regimens did not result in lower admission rate or shorter length of stay in the ER, but showed similar safety profile for children with moderate to severe acute asthma. Pediatr Pulmonol. 2016;51:1122-1130. © 2016 Wiley Periodicals, Inc.
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