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Dose response of subcutaneous terbutaline and epinephrine in children with acute asthma
Insights
Terbutaline sulfate and epinephrine improved lung function in children with airway obstruction. Terbutaline showed comparable efficacy to epinephrine with fewer side effects, making it a potentially safer option for pediatric asthma treatment.
Area of Science:
- Pediatric Pulmonology
- Pharmacology
- Clinical Trials
Background:
- Pediatric airway obstruction requires effective and safe bronchodilator therapy.
- Terbutaline sulfate and epinephrine are commonly used agents, but their comparative efficacy and safety profiles in children require further elucidation.
Purpose of the Study:
- To compare the dose-response effects of terbutaline sulfate against epinephrine in children with airway obstruction.
- To evaluate the safety and tolerability of different terbutaline sulfate doses.
Main Methods:
- A double-blind, randomized, dose-response study involving 26 children.
- Subcutaneous administration of terbutaline sulfate (3, 6, or 12 microgram/kg) or epinephrine (10 microgram/kg).
- Assessment of clinical scores, pulmonary function tests (forced vital capacity, forced expiratory volume in 1 second, mid-expiratory flow), and adverse effects.
Main Results:
- All terbutaline sulfate doses and epinephrine improved clinical scores and pulmonary function within one hour.
- The 12 microgram/kg dose of terbutaline sulfate was more effective in improving mid-expiratory airflow obstruction compared to lower doses.
- Epinephrine caused adverse effects like headache and excitement, while terbutaline sulfate had clinically imperceptible side effects, though tremor was noted at the highest dose.
Conclusions:
- Terbutaline sulfate is an effective bronchodilator in children with airway obstruction.
- Higher doses of terbutaline sulfate (12 microgram/kg) demonstrate superior efficacy.
- Terbutaline sulfate offers a favorable safety profile compared to epinephrine in pediatric patients.
Abstract:
In a double-blind dose response study in 26 children, 3, 6, or 12 microgram/kg of terbutaline sulfate was compared with 10 microgram/kg of epinephrine administered subcutaneously. In the first hour after injection, all doses of terbutaline and epinephrine resulted in improvement in mean clinical score, mean forced vital capacity, mean forced expiratory volume in the first second, and mean forced expiratory flow from 25% to 75% of vital capacity. Terbutaline epinephrine. However, while adverse effects following terbutaline were clinically imperceptible, epinephrine produced unpleasant headache and excitement in a few patients. Terbutaline did not change mean PaO2 or PaCO2 significantly in a subgroup of patients. The 12 microgram/kg dose of terbutaline was superior to 3 or 6 microgram/kg in relieving obstruction to airflow measured at the midportion of the vital capacity. This dose caused tremor in some children, but the tremor was not apparent to patients or their parents.