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Adjunctive Pharmacotherapies in Children With Asthma Exacerbations Requiring Continuous Albuterol Therapy: Findings
Steven L Shein1, Obada Farhan2, Nathan Morris2
1Divisions of Pediatric Critical Care Medicine and steven.shein@uhhospitals.org.
Insights
In children hospitalized for severe asthma, magnesium use alongside continuous albuterol was linked to longer treatment durations and hospital stays. Ipratropium did not show similar associations, suggesting a need for further research into these asthma therapies.
Area of Science:
- Pediatric Pulmonology
- Critical Care Medicine
- Pharmacology
Background:
- Acute asthma exacerbations in children often require intensive inpatient management.
- Continuous albuterol infusion is a common treatment for severe pediatric asthma.
- Adjunctive therapies like ipratropium and intravenous magnesium are frequently used but their impact on outcomes is debated.
Purpose of the Study:
- To investigate the association between ipratropium and/or intravenous magnesium use and clinical outcomes in children hospitalized with acute asthma exacerbations.
- To evaluate the impact of these adjunctive therapies on the duration of continuous albuterol treatment and overall hospitalization length.
Main Methods:
- Secondary analysis of prospectively collected data from the Ohio Pediatric Asthma Repository.
- Included children hospitalized with acute asthma exacerbations and treated with continuous albuterol.
- Compared outcomes based on the use of ipratropium and/or intravenous magnesium as adjunctive therapies.
Main Results:
- Among 242 children receiving continuous albuterol, 39% received ipratropium, 5% received magnesium, 17% received both, and 38% received neither.
- Ipratropium use was associated with a shorter duration of continuous albuterol compared to dual therapy (P = .001).
- Magnesium use was independently associated with longer durations of continuous albuterol (HR, 0.54; P < .001) and hospitalization (HR, 0.41; P < .001).
Conclusions:
- Both ipratropium and magnesium are commonly used in severe pediatric asthma hospitalizations requiring continuous albuterol.
- Magnesium use appears linked to unfavorable outcomes, potentially due to its administration in more severe cases or variations in clinical practice.
- Prospective trials are warranted to clarify the efficacy and optimal use of ipratropium and magnesium in severe pediatric asthma.
Objectives:
To identify associations between use of ipratropium and/or intravenous magnesium and outcomes of children hospitalized with acute asthma exacerbations and treated with continuous albuterol.
Methods:
Secondary analysis of data from children prospectively enrolled in the multicenter Ohio Pediatric Asthma Repository restricted to only children who were treated with continuous albuterol in their initial inpatient location. Children were treated with adjunctive therapies per the clinical team.
Results:
Among 242 children who received continuous albuterol, 94 (39%) received ipratropium only, 13 (5%) received magnesium alone, 42 (17%) received both, and 93 (38%) received neither. The median duration of continuous albuterol was 7.0 (interquartile range [IQR]: 2.8-12.0) hours. Ipratropium use was associated with a shorter duration of continuous albuterol (4.9 [IQR: 2.0-10.0] hours) compared with dual therapy (11.0 [IQR: 5.6-28.6] hours; P = .001), but magnesium use was not (7.5 [IQR: 2.5-16.0] hours; P = .542). In Cox proportional models (adjusted for hospital, demographics, treatment location, and respiratory failure), magnesium was associated with longer durations of continuous albuterol (hazard ratio, 0.54 [95% confidence interval: 0.37-0.77]; P < .001) and hospitalization (hazard ratio, 0.41 [95% confidence interval: 0.28-0.60]; P < .001), but ipratropium was not.
Conclusions:
Ipratropium and magnesium were both often used in children with severe asthma hospitalizations that required continuous albuterol therapy. Magnesium use was associated with unfavorable outcomes, possibly reflecting preferential treatment to patients with more severe cases and differing practices between centers. Given the high prevalence of asthma, wide variations in practice, and the potential to improve outcomes and costs, prospective trials of these adjunctive therapies are needed.
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