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Chronopharmacology of albuterol in hospitalized asthmatic children
M Cloutier1, G Labrecque, G B Rivard
1School of Pharmacy, Université Laval, Sainte-Foy, Quebec, Canada.
Insights
Children with nocturnal asthma show significant 24-hour variations in lung function and albuterol effectiveness. Their asthma medication needs may differ from those without nocturnal symptoms.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Circadian Biology
Background:
- Asthma management in children requires understanding lung function variability.
- Nocturnal asthma (NA) presents unique challenges in symptom control and treatment response.
- Standard asthma therapies may have different efficacy based on the time of day.
Purpose of the Study:
- To investigate the 24-hour pattern of lung function in hospitalized children with acute bronchospasm.
- To assess the impact of time of day on albuterol effectiveness in pediatric asthma patients.
- To compare responses in children with and without nocturnal asthma exacerbations.
Main Methods:
- Eleven children (8-16 years) with acute bronchospasm received standard care (corticosteroids, albuterol).
- Spirometry (FEV1) was measured before and after albuterol nebulization over 24 hours.
- Patients were categorized based on the presence or absence of nocturnal asthma symptoms.
Main Results:
- Children with NA exhibited significant diurnal variation in forced expiratory volume in 1 s (FEV1), peaking midday and lowest at night.
- Albuterol's bronchodilating effect was most potent at night in NA patients.
- In non-NA children, albuterol efficacy was limited, except when administered between 10 p.m. and 2 a.m.
Conclusions:
- Pediatric asthma patients display distinct 24-hour patterns in lung function and bronchodilator response.
- Nocturnal asthma is associated with significant diurnal variability in airway obstruction and treatment effectiveness.
- Timing of albuterol administration may influence therapeutic outcomes, suggesting personalized dosing strategies for pediatric asthma.
Abstract:
Eleven children (8-16 years old) hospitalized for acute bronchospasm were included in this investigation. Throughout the study, the children received the standardized course of therapy for hospitalized asthmatics with corticosteroids and albuterol nebulizations. Children receiving ipratropium were excluded from the study. Spirometric measurements, including forced expiratory volume in 1 s (FEV1), were made immediately before and 30 min after each albuterol nebulization over a 24-h period. The well-known temporal changes in FEV1 were observed in patients suffering from nocturnal asthma (NA): basal values were maximal at midday (10 a.m. to 2 p.m.) and lowest in the evening or at night (10 p.m. to 6 a.m.). This 24-h variation in lung function was not found in children without nocturnal exacerbations of their asthma. A 24-h variation was also observed in albuterol-induced bronchodilation in patients with NA: maximal effectiveness occurred at night, and lower effect was obtained with the midday administration. The albuterol-induced increases in FEV1 were not clinically significant in children without nocturnal asthma except when the beta 2-agonist was inhaled between 10 p.m. and 2 a.m. The data suggest that patients with nonnocturnal asthma might have different drug requirements than those with nocturnal symptoms.