Chest
Emergency Treatment of Acute Asthma With Albuterol Metered-Dose Inhaler Plus Holding Chamber: How Often Should Treatments Be Administered?
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Patients
Patients presenting to the ED of Montefiore Medical Center and/or North Central Bronx Hospital, Bronx, NY, with acute exacerbations of asthma, as defined by the American Thoracic Society,12 were eligible to enter the study if they met the following criteria: (1) age between 18 and 55 years; (2) FEV1 was ≤60% of normal predicted values according to the equations of Crapo et al;13 (3) total cigarette smoking history not in excess of 10 pack-years; (4) able to perform pulmonary function tests with
Patient Characteristics
One hundred forty-three patients were screened for entry into the study, and 100 patients were found to be eligible and were randomized into the protocol. Six of our 100 subjects were unable to complete the 120-min study—none from group 1 (who received albuterol every 30 min), four from group 2 (who received albuterol every 60 min), and two from group 3 (who received only one dose of albuterol in 120 min). One subject in group 2 had no response to the initial albuterol treatment and dropped out
Discussion
Although still a subject of controversy, current literature strongly supports the use of MDIs coupled with delivery devices or holding chambers to deliver aerosolized β-agonist treatments to patients presenting to EDs with acute exacerbations of asthma.6, 7, 8, 9, 10, 11 MDIs attached to many types of holding chambers have been clearly shown to provide equal improvement in pulmonary function when compared to wet nebulizers in this clinical setting.6, 7, 8, 9, 10, 11
Previous studies have
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Cited by (40)
Evaluation and management of the critically ill adult asthmatic in the emergency department setting
2021, American Journal of Emergency MedicineEuropean Resuscitation Council Guidelines 2021: First aid
2021, ResuscitationCitation Excerpt :None of these studies examined the administration of bronchodilators by first aid providers. Two RCTs demonstrated a faster return to baseline levels following the administration of a fast acting beta-2 agonist28,29 with only three studies reporting complications.28,30,31 The remaining studies reported an improvement in the specific therapeutic endpoints of Forced Expiratory Volume in 1 second (FEV1)30–35 and Peak Expiratory Flow Rate (PEFR).36,37
Part 9: First aid. 2015 International Consensus on First Aid Science with Treatment Recommendations
2015, ResuscitationCitation Excerpt :A second RCT37 with very-low-quality evidence (downgraded for bias, imprecision, and indirectness) enrolled 134 participants with an average age of 8.3 years, which demonstrated a statistically significant improvement in FEV1 after initial treatment dose (day 0) for levalbuterol/salbutamol and albuterol/salbutamol compared with placebo (33.1%, 29.6% versus 17.8%; P < 0.05). Very-low-quality evidence (downgraded for serious indirectness and imprecision) from a third RCT36 involving 100 patients demonstrated a statistically significant improvement in FEV1 when albuterol/salbutamol metered-dose aerosol was given every 30 min for 4 doses (T0, 30, 60, 90) or every 60 min for 2 doses (T0, 60) compared with when albuterol/salbutamol metered-dose aerosol was given once at T0 (MD undeterminable). Very-low-quality evidence (downgraded for serious indirectness and imprecision) was identified in another RCT38 enrolling 17 patients ranging in age from 18 to 41 years, who demonstrated a more rapid return to 85% of baseline FEV1 when treated with formoterol dry-powdered inhaler or albuterol/salbutamol dry-powdered inhaler compared with placebo (7.2 and 6.5 min versus 34.7 min, respectively).
Managing Asthma Exacerbations in the Emergency Department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Management of Asthma Exacerbations
2009, Journal of Emergency MedicineCitation Excerpt :Thereafter, frequency of treatment varies according to patient response (ie, improvement in airflow obstruction and associated symptoms). About 60% to 70% of patients will respond sufficiently to the initial 3 doses to be discharged, and most of these will demonstrate a significant response after the first dose (18,21,22). In patients with severe exacerbations (ie, <40% of predicted value for either FEV1 or PEF), continuous administration of β2-agonists might be more effective than intermittent administration (17).
Managing asthma exacerbations in the emergency department: Summary of the National Asthma Education and Prevention Program Expert Panel Report 3 guidelines for the management of asthma exacerbations
2009, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Oxygen saturation should be monitored until a clear response to bronchodilator therapy has occurred. All patients should receive inhaled β2-agonist treatment because repetitive or continuous administration of these agents is the most effective means of reversing airflow obstruction (Table III).17-20 In the ED 3 treatments administered every 20 to 30 minutes is a safe strategy for initial therapy.
Presented at CHEST 1996, the 62nd Annual International Scientific Assembly of the American College of Chest Physicians, San Francisco, October 26-30, 1996.
Supported by a grant from Glaxo Wellcome Inc.