Nebulized versus intravenous albuterol in hypercapnic acute asthma. A multicenter, double-blind, randomized study.
In a multicenter, randomized, double-blind study, we compared the effects of nebulized (5 mg x 2) and intravenous (0.5 mg) albuterol (salbutamol) over 1 h in 47 patients admitted to hospital with severe acute asthma defined as a peak expiratory flow (PEF) below 150 L/min and hypercapnia (Pa(CO2) > or = 40 mm Hg). Additional treatment included nasal oxygen and hydrocortisone succinate. The efficacy was assessed after 1 h. In the group treated by nebulization (NEB group, n = 22) 19 (86%) patients (95% confidence interval: 65 to 97%) had been treated successfully according to predefined criteria, versus 12 (48%) patients (95% confidence interval: 28 to 69%) in the intravenously treated group (i.v. group, n = 25), p = 0.006. The mean increase in PEF was greater in the NEB group than in the i.v. group (+107 +/- 94 L/min versus +42 +/- 66 L/min, p = 0.01) as well as the decrease in Pa(CO2) values (-10 +/- 5 mm Hg versus -2 +/- 12 mm Hg, p < 0.01). Beta agonist-induced hypokalemia was more pronounced in the i.v. group than in the NEB group. We conclude that, in hypercapnic acute asthma, the nebulized route has a greater efficacy and fewer side effects than the intravenous route.
Salmeron
S
S
Service de Pneumologie et Reanimation, Hôpital Antoine Béclère, Clamart, France.
Brochard
L
L
Mal
H
H
Tenaillon
A
A
Henry-Amar
M
M
Renon
D
D
Duroux
P
P
Simonneau
G
G
D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000420:Albuterol / Q000097:blood / Q000627:therapeutic use*; D000704:Analysis of Variance; D001249:Asthma / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D002245:Carbon Dioxide / Q000097:blood; D003131:Combined Modality Therapy; D016001:Confidence Intervals; D004311:Double-Blind Method; D016903:Drug Monitoring; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000031:analogs & derivatives / Q000627:therapeutic use; D006935:Hypercapnia / Q000097:blood / Q000209:etiology*; D007008:Hypokalemia / Q000139:chemically induced; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy; D010366:Peak Expiratory Flow Rate; D012720:Severity of Illness Index; D013997:Time Factors
D002245:Carbon Dioxide; C007133:hydrocortisone hemisuccinate; D000420:Albuterol; D006854:Hydrocortisone