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Clinical Investigations: Asthma: ArticlesTreatment of Acute Severe Asthma With Inhaled Albuterol Delivered via Jet Nebulizer, Metered Dose Inhaler With Spacer, or Dry Powder
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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
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Drug Administration by Inhalation in Children
2019, Kendig's Disorders of the Respiratory Tract in ChildrenPulmonary drug delivery by powder aerosols
2014, Journal of Controlled ReleaseCitation 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 ReviewsCitation 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 ImmunologyCitation 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%.
Presented in part at the 1992 American Thoracic Society Meeting.