title: Standard dose of inhaled albuterol significantly increases QT dispersion compared to low dose of albuterol plus ipratropium bromide therapy in moderate to severe acute asthma attacks in children.
abstract: BACKGROUND
  Beta-2 agonist therapy has previously shown to increase the QT dispersion (QTd) in asthmatic patients and increased QTd has been well documented in association with cardiac arrhythmias and sudden death. However, the data concerning the effect of low doses of beta-2 agonist therapy in combination with the anticholinergic agents to potentiate bronchodilatation on QTd in asthmatic children are limited. The objectives of this study was to investigate the changes on QTd during both the standard dose of nebulized albuterol therapy and low dose nebulized albuterol plus inhaled ipratropium therapyn to assess the potential arrhythmogenic risk of these two treatment strategies in children with acute asthmatic attacks.
  
  
  METHODS
  Forty-three children with the diagnosis of moderate to severe acute asthma were enrolled in the study. Standard dose of nebulized albuterol therapy (0.15 mg/kg) were administered to 20 patients (group 1) and low dose of nebulized albuterol (0.075 mg/kg) plus nebulized ipratropium bromide therapy (250 microg/dose) were given to the remaining 23 patients (group 2). Respiratory distress score, peak expiratory flow rate, arterial blood pressure, O2 saturation, serum potassium and urea nitrogen levels were studied and QT interval parameters were measured from the standard 12-lead electrocardiograms at baseline and after treatment.
  
  
  RESULTS
  Significant improvement was achieved in respiratory distress score and peak expiratory flow rate after three dose inhalation. No significant difference was observed between the pre and post-treatment values of serum potassium, blood urea nitrogen, O2 saturation and arterial blood pressure values. The evaluation of the corrected QTd (QTcd) showed that while there was no statistical difference in the pre and post-treatment values in group 2 (30.4+/-3.1 msn vs 32.1+/-3.9 msn), QTcd was found to be significantly increased in group 1 after treatment (29.0+/-3 msn vs 40.6+/-5.1 msn, P<0.0001).
  
  
  CONCLUSIONS
  The data of the present study suggest that the increase of the QTd is more prominent with the use of a standard dose of albuterol compared to low dose albuterol plus ipratropium therapy. Therefore, it may be concluded that a low dose of albuterol plus ipratropium bromide therapy may be preferred to avoid rhythm disturbances in asthmatic children.
authors.affiliation: Department of Pediatrics, Celal Bayar, University Medical Faculty, Manisa, Turkey. coskunsenol@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: Coskun
authors.forename: H
authors.initials: H
authors.lastname: Yuksel
authors.forename: H
authors.initials: H
authors.lastname: Tikiz
authors.forename: S
authors.initials: S
authors.lastname: Danahaliloğlu
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage* / Q000009:adverse effects; D001145:Arrhythmias, Cardiac / Q000139:chemically induced*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004562:Electrocardiography; D005260:Female; D006801:Humans; D009241:Ipratropium / Q000008:administration & dosage*; D008297:Male; D009330:Nebulizers and Vaporizers; D010100:Oxygen / Q000097:blood; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D012720:Severity of Illness Index
chemical_list: D001993:Bronchodilator Agents; D009241:Ipratropium; D000420:Albuterol; D010100:Oxygen