Chest
Volume 110, Issue 1, July 1996, Pages 42-47
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Clinical Investigations: Asthma
Continuous vs Intermittent Albuterol, at High and Low Doses, in the Treatment of Severe Acute Asthma in Adults

https://doi.org/10.1378/chest.110.1.42Get rights and content

Adult patients suffering from acute asthma presenting to the Emergency Department with an FEV1 of less than 40% of predicted were randomized into four treatment groups. They were treated with nebulized albuterol at a high (7.5 mg) or standard (2.5 mg) dose given either continuously through 1 h, or intermittently every hour, for 2 h. When the FEV1 improvements for the different groups at 2 h were compared, the groups treated with continuous nebulization had the greatest improvement. The improvements (1.07 L for the high-dose group, and 1.02 L for the standard-dose group) were significantly greater than the improvement seen with standard-dose intermittent treatment (0.72 L; p<0.05). The improvement in FEV1 of the high-dose, hourly treated group was intermediate in magnitude between these (0.90 L). There was no difference in the improvement seen between the two groups treated with continuous nebulization. The potassium fall, present in all groups, was more pronounced in the groups treated with high doses of albuterol. Only one person (high dose, continuous treatment group) developed hypokalemia of less than 3.0 mmol/L. The high-dose hourly treated group had the highest incidence of side effects, and the standard-dose continuously treated group had the lowest. The standard-dose continuous-treatment regimen had the greatest improvement in FEV1 with the least number of side effects.

Section snippets

MATERIALS AND METHODS

The study was approved by the Institutional Review Board of the University of Texas Southwestern Medical Center. Patients were recruited from the ED of Parkland Memorial Hospital by the treating physician if they met the following entry criteria: (1) a diagnosis of acute asthma;6 (2) an initial FEV1 of less than 40% of predicted; (3) development of asthma at an age younger than 45 years; (4) at least 18 years of age, not pregnant or breast feeding, and not incarcerated; (5) no history of

RESULTS

The four groups were similar in terms of demographics, vital signs, and severity of disease (Table 1).

Figure 1 shows the progression of FEV1 values for the four groups with treatment. The changes in FEV1 and percent predicted FEV1 with treatment are shown in Table 2. After the first hour of nebulization therapy, the improvement in FEV1 was greatest for the two continuously treated groups. The improvement seen in these two groups was indistinguishable. The standard-dose intermittent treatment

DISCUSSION

High-dose (7.5 mg) albuterol delivered continuously over each hour is similar to the National Heart Lung and Blood Institute Expert Panel's recommended initial treatment of acute asthma of three 2.5-mg nebulization treatments over the course of 1 or 1.5 h.1 Surprisingly, the effect of this treatment was matched by the improvement in FEV1 seen with the standard-dose (2.5 mg) albuterol treatment diluted to last an hour. Both continuously treated groups improved their FEV1 values by approximately

ACKNOWLEDGMENTS

The authors would like to thank Thomas Carmody, PhD, Academic Computing Center, University of Texas Southwestern Medical Center, for assistance with, statistical analysis; Parkland Memorial Hospital, where the research was conducted; and all the patient participants, without whom any research would have been impossible.

REFERENCES (10)

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