Chest
Volume 112, Issue 1, July 1997, Pages 24-28
Journal home page for Chest

Clinical Investigations: Asthma: Articles
Treatment of Acute Severe Asthma With Inhaled Albuterol Delivered via Jet Nebulizer, Metered Dose Inhaler With Spacer, or Dry Powder

https://doi.org/10.1378/chest.112.1.24Get rights and content

Despite the increasing use of dry powder formulations in the ambulatory setting, there is a paucity of information on the efficacy of this therapeutic modality to treat acute severe asthma. In addition, studies that compared wet nebulization vs metered dose inhalers formulated with chlorofluorocarbon (CFCMDI) attached to holding chambers have yielded discrepant results. Thus, it is unclear which of the three delivery systems would elicit a superior bronchodilator response, particularly in patients with life-threatening asthma. In a prospective, randomized open design, we studied the response to inhaled albuterol (salbutamol) in 27 adult asthmatics presenting to the emergency department (ED) with an FEV1 <30% predicted. Subjects were treated with one of the following regimens (nine subjects in each group): group A, mean (SD) baseline FEV1 of 0.7 (0.2) L, received albuterol solution, 5 mg, via a nebulizer (Puritan-Bennett Raindrop; Lawrenceville, Ga) impelled with oxygen (02) at 8 L/min; group B, baseline FEV1 of 0.6 (0.15) L, received albuterol, 400 μg, via a CFCMDI attached to a 145-mL valved aerosol holding chamber (Aerochamber; Trudell Medical; London, ON); and group C, baseline FEV1 of 0.6 (0.17) L, received albuterol powder, 400 μg, by another means (Rotahaler; Glaxo; Research Triangle Park, NC). All groups received the respective treatments on arrival in the ED, every 30 min during the first 2 h, and then hourly until the sixth hour. Clinical parameters and FEVj were recorded on ED admission and 15 min after each dose of albuterol. At the time of ED admission, all patients also received continuous O2 and one dose of IV steroids (dexamethasone, 8 mg). The total dose of inhaled albuterol administered during the 6-h treatment was 45 mg of nebulized solution in group A and 3,600 μg of albuterol aerosol and dry powder in groups B and C, respectively. No significant differences were found in the population demographics, baseline FEV1, and arterial blood gas values on air. FEV1 improved significantly in all patients after the 6 h of treatment. The 6-h area under the curve FEV1 improved similarly with the three delivery methods despite differences in the total dose administered. No patient was discontinued during the trial or admitted to hospital and no evidence of cardiovascular adverse events was apparent in any of the study groups. These data support the view that the three delivery methods appear adequate to treat subjects with acute severe asthma.

Section snippets

Materials and Methods

Patients suffering from acute severe asthma and attending the ED of Hospital Ferrer, Buenos Aires, Argentina, were approached for possible enrollment in the study. Patients were considered eligible for recruitment if they suffered from asthma according to the American Thoracic Society criteria,7 were between 18 and 65 years of age inclusive, were able to cooperate for spirometric measurements, had on admission an FEV1 <1 L or <30% predicted, and were capable of giving informed consent. Patients

Results

Twenty-seven asthmatic patients were enrolled and completed the study. Relevant baseline data are shown in Table 1. There were no significant differences in demographic parameters and in the severity of their asthma attack on arrival.

FEV1 improved significantly with the three treatments over the 6-h period (Fig 1). No significant differences in the degree of improvement were detected by ANOVA among the treatment groups. After 6 h of treatment, six patients in the CFCMDI and Rotahaler groups

Discussion

The results of this study show that patients suffering from acute severe asthma improved their FEV1 in response to inhaled albuterol regardless of the three different delivery methods that were used. The major limitation to extrapolate these results to the broader population of those with acute severe asthma is the fact that this study does not demonstrate equivalence among the three therapeutic modalities. Owing to the severity of this condition and based on our own experience8, 9 and data

Cited by (55)

  • Drug Administration by Inhalation in Children

    2019, Kendig's Disorders of the Respiratory Tract in Children
  • Pulmonary drug delivery by powder aerosols

    2014, Journal of Controlled Release
    Citation Excerpt :

    In asthmatics most patients can still reach PIFR of 29 L/min from the Turbuhaler®, which results in adequate lung deposition of the terbutaline to achieve a therapeutic effect [96]. Even in acute severe asthma, most patients can achieve bronchodilation with DPIs [97]. More importantly, age can affect patient's ability to inhale adequately through a DPI especially for the elderly [86,88].

  • Beyond the guidelines: Fatal and near-fatal asthma

    2012, Paediatric Respiratory Reviews
    Citation Excerpt :

    Aerosolized beta agonists can be given by pressurized metered dose inhaler (pMDI), by intermittent jet nebulization, or by continuous jet nebulization. When the patient is capable of using a pMDI and valved holding chamber, this has been shown to as effective as a much larger nominal dose of medication given by jet nebulization and there are fewer systemic side effects, mostly likely due to decreased swallowing of drug and systemic absorption45. It is common practice to give large doses of inhaled bronchodilators by continuous nebulization to treat acute severe asthma but controlled clinical trials show that this is no more effective than intermittent lower doses of a beta agonist46.

  • A randomized placebo-controlled study of intravenous montelukast for the treatment of acute asthma

    2010, Journal of Allergy and Clinical Immunology
    Citation Excerpt :

    In other subgroup analyses, our results suggested that patients with a higher baseline FEV1 might experience a larger treatment effect of montelukast on FEV1 and a potentially lower risk of treatment failure. Several investigators define a baseline predicted FEV1 of <30% as indicative of a greater severity of acute asthma.27-29 Post hoc analyses suggested that among these patients with FEV1 ≤50%, montelukast reduced treatment failure and hospitalization to a larger extent in those patients with a baseline predicted FEV1 of ≥30%.

View all citing articles on Scopus

Presented in part at the 1992 American Thoracic Society Meeting.

View full text