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A dose-response study of inhaled terbutaline administered via Nebuhaler or nebuliser to asthmatic children
Insights
The Nebuhaler and nebulizer deliver similar bronchodilator effects in children with asthma. The Nebuhaler requires half the dose of terbutaline to achieve equivalent lung function improvements without affecting pulse rate.
Area of Science:
- Pediatric Pulmonology
- Respiratory Pharmacology
Background:
- Asthma management in children requires effective bronchodilator delivery.
- Metered dose aerosols with spacers and nebulizers are common delivery methods.
Purpose of the Study:
- To compare the efficacy of terbutaline delivery via Nebuhaler versus nebulizer in children with asthma.
- To evaluate dose-response relationships and bronchodilator effects.
Main Methods:
- Symptom-free asthmatic children (aged 5-10 years) received cumulative doses of inhaled terbutaline.
- Delivery methods included a metered dose aerosol with a Nebuhaler and a nebulizer via face mask.
- Forced expiratory volume in 1 second (FEV1) and pulse rate were measured.
Main Results:
- Both methods showed dose-related bronchodilator responses with parallel log dose-response lines.
- Twice the dose of nebulized terbutaline was needed for effects equivalent to the Nebuhaler (P=0.05).
- Highest doses achieved at least 80% of maximal FEV1 improvement without pulse rate changes.
Conclusions:
- The Nebuhaler is as effective as nebulizers for terbutaline delivery in non-acute pediatric asthma.
- Nebuhaler offers a dose-related bronchodilator effect (0.5-4 mg) without adverse pulse rate effects.
- This suggests the Nebuhaler is a viable alternative for asthma management in children.
Abstract:
In 12, symptom-free, asthmatic children, aged 5-10 years, responses (increases in FEV1) were measured to cumulative doses of inhaled terbutaline delivered by two methods: a) 5 breaths from a 750 ml spacer (Nebuhaler) attached to a metered dose aerosol (doses were 0.5, 1, 2 and 4 mg); and b) by face mask attached to a Bennett twin-jet nebuliser containing terbutaline solution (doses were 1, 2, 4 and 8 mg in 2 ml). Responses were dose-related by both methods and the log dose-response lines were parallel. Twice the dose of nebulised terbutaline was required to give responses equivalent to those seen with the Nebuhaler (significant difference between the lines, ANOVA, P = 0.05). The highest doses given by either method resulted in achievement of at least 80% of the maximum possible improvement in respiratory function (i.e. predicted FEV1 (50th centile) minus basal FEV1) with no effects on pulse rate. Thus, the use of the Nebuhaler with terbutaline metered dose aerosol is at least as effective as administration of the same total dose by nebuliser in children who are not in acute respiratory difficulty. Also, it produces a dose-related bronchodilator effect, without pulse-rate effects, for doses of terbutaline between 0.5 to 4 mg (2 to 16 puffs of the metered dose (0.25 mg) aerosol).