Efficacy of a consensus protocol therapy in adults with acute, severe asthma.
BACKGROUND
International guidelines recommend multiple doses of inhaled beta2-agonists and anticholinergics plus early administration of systemic corticosteroids for acute, severe asthma. This study examined the efficacy of this protocol in adults and analyzed those factors associated with unresponsiveness to the protocol therapy.


OBJECTIVE
Ninety-three consecutive patients 18 to 55 years old presenting for treatment of acute asthma with a peak expiratory flow rate (PEFR) < or = 50% of the predicted value were analyzed.


METHODS
All subjects received 400 microg of salbutamol every 20 minutes for three doses and 400 microg of oxitropium bromide with each of the three salbutamol doses by means of a metered-dose inhaler with a spacer device, plus intravenously 8 mg betamethasone. PEFR was measured at baseline and at 20, 40, 60, and 120 minutes.


RESULTS
Sixty-nine percent of subjects improved sufficiently to be discharged. In 31% of subjects, the protocol therapy failed. There were no significant differences in age, sex, smoking status, or beta-agonist use within 6 hours between the two groups. Logistic regression analysis demonstrated that a PEFR < 35% of the predicted value at presentation (odds ratio [OR]; 16.3, 95% confidence interval [CI] 4.5 to 59.9), viral respiratory tract infection symptoms > or = 2 days (OR, 4.8, 95% CI 1.3 to 17.1), and asthma hospitalization in the past year (OR, 4.6, 95% CI 1.1 to 19.9) were significantly associated with unresponsiveness to the protocol.


CONCLUSIONS
Unresponsiveness to protocol therapy occurs in nearly one-third of individuals presenting with acute, severe asthma. Our findings underscore the need to explore more effective strategies for improving lung function and reducing hospital admission rates.
Nakano
Yutaka
Y
Department of Internal Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Shizuoka, Japan. ynakano@sis.seirei.or.jp
Morita
Satoru
S
Kawamoto
Akira
A
Naito
Tateaki
T
Enomoto
Noriyuki
N
Suda
Takahumi
T
Chida
Kingo
K
Nakamura
Hirotoshi
H
D000208:Acute Disease; D000293:Adolescent; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy*; D001623:Betamethasone / Q000008:administration & dosage / Q000627:therapeutic use; D018680:Cholinergic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D002985:Clinical Protocols; D032921:Consensus; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D012602:Scopolamine Derivatives / Q000008:administration & dosage / Q000627:therapeutic use; D017211:Treatment Failure
D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D018680:Cholinergic Antagonists; D012602:Scopolamine Derivatives; C017590:oxitropium; D001623:Betamethasone; D000420:Albuterol