Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber

How often should treatments be administered?

Jill P. Karpel, Thomas K. Aldrich, David J. Prezant, Katia Guguchev, Alberto Gaitan-Salas, Raja Pathiparti

Research output: Contribution to journalArticle

28 Citations (Scopus)

Abstract

Study objective: To determine the optimal treatment interval for administering albuterol metered-dose inhaler (MDI) with a holding chamber to patients presenting to the emergency department (ED) with acute asthma. Design: Prospective, randomized, double-blind study. Setting: EDs of two affiliated teaching hospitals in the Bronx, NY. Patients: One hundred adult patients with acute asthma and FEV1 <60% predicted of normal. Interventions: At entry (T=0 min), eligible patients all openly received inhaled albuterol (six puffs) via MDI with a spacer. Subsequently, in a double-blind fashion, they received six puffs of albuterol or placebo with new MDIs and spacers at 30, 60, and 90 min such that group 1 (n=34) received albuterol every 30 min, group 2 (n=33) every 60 min, and group 3 (n=33) at 120 min only. FEV1 and vital signs were measured at T=0 and at 15, 30, 60, 90, and 120 min following initial treatment. Potassium levels were measured at T=0 and 120 min. Adverse events, the use of additional inhaled β-agonists or systemic corticosteroids, and hospitalization rates were recorded. Measurements and results: At T=0, the groups did not differ in age, FEV1, or prescribed asthma medications. All groups showed significant improvement in FEV1 (p<0.05; T=120 vs 0 min). The conditions of groups 1 and 2 improved significantly more than those of group 3, but did not differ compared to each other. The mean±SEM change in FEV1 (T=120 vs 0 min) was 0.993±0.108, 0.858±0.135, and 0.321±0.056 L, respectively, for the three groups. Separate analysis for patients with FEV1% <40% or >40% predicted showed similar results. However, patients who initially were low responders to albuterol treatment (<15 percentage point increase at 15 min) improved significantly with 30-min treatments compared to the other two treatment regimens. Patients who initially responded with >15 percentage point increase in FEV1 at 15 min following initial albuterol inhalation benefited equally from 30- or 60-min treatments compared to 120 min. Potassium levels did not change significantly during the study. Adverse events and hospitalization rates were equivalent. After the conclusion of the study, group 3 patients required a greater number of β-agonist treatments prior to eventual discharge from the ED. Conclusions: For acute asthma, albuterol MDI with a holding chamber can be given optimally at 60-min intervals with minimal adverse effects for the majority of patients. However, patients who initially demonstrate a low or poor bronchodilator response to albuterol should be given subsequent treatments at 30-min intervals. This will optimize care and conserve resources for patients who will benefit the most.

Original languageEnglish (US)
Pages (from-to)348-356
Number of pages9
JournalChest
Volume112
Issue number2
StatePublished - 1997

Fingerprint

Metered Dose Inhalers
Emergency Treatment
Albuterol
Asthma
Therapeutics
Hospital Emergency Service
Bronchodilator Agents
Double-Blind Method
Teaching Hospitals
Inhalation
Potassium
Hospitalization

Keywords

  • β-agonist
  • Acute asthma
  • Albuterol
  • Asthma
  • Holding chamber

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Karpel, J. P., Aldrich, T. K., Prezant, D. J., Guguchev, K., Gaitan-Salas, A., & Pathiparti, R. (1997). Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber: How often should treatments be administered? Chest, 112(2), 348-356.

Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber : How often should treatments be administered? / Karpel, Jill P.; Aldrich, Thomas K.; Prezant, David J.; Guguchev, Katia; Gaitan-Salas, Alberto; Pathiparti, Raja.

In: Chest, Vol. 112, No. 2, 1997, p. 348-356.

Research output: Contribution to journalArticle

Karpel, JP, Aldrich, TK, Prezant, DJ, Guguchev, K, Gaitan-Salas, A & Pathiparti, R 1997, 'Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber: How often should treatments be administered?', Chest, vol. 112, no. 2, pp. 348-356.
Karpel, Jill P. ; Aldrich, Thomas K. ; Prezant, David J. ; Guguchev, Katia ; Gaitan-Salas, Alberto ; Pathiparti, Raja. / Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber : How often should treatments be administered?. In: Chest. 1997 ; Vol. 112, No. 2. pp. 348-356.
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abstract = "Study objective: To determine the optimal treatment interval for administering albuterol metered-dose inhaler (MDI) with a holding chamber to patients presenting to the emergency department (ED) with acute asthma. Design: Prospective, randomized, double-blind study. Setting: EDs of two affiliated teaching hospitals in the Bronx, NY. Patients: One hundred adult patients with acute asthma and FEV1 <60{\%} predicted of normal. Interventions: At entry (T=0 min), eligible patients all openly received inhaled albuterol (six puffs) via MDI with a spacer. Subsequently, in a double-blind fashion, they received six puffs of albuterol or placebo with new MDIs and spacers at 30, 60, and 90 min such that group 1 (n=34) received albuterol every 30 min, group 2 (n=33) every 60 min, and group 3 (n=33) at 120 min only. FEV1 and vital signs were measured at T=0 and at 15, 30, 60, 90, and 120 min following initial treatment. Potassium levels were measured at T=0 and 120 min. Adverse events, the use of additional inhaled β-agonists or systemic corticosteroids, and hospitalization rates were recorded. Measurements and results: At T=0, the groups did not differ in age, FEV1, or prescribed asthma medications. All groups showed significant improvement in FEV1 (p<0.05; T=120 vs 0 min). The conditions of groups 1 and 2 improved significantly more than those of group 3, but did not differ compared to each other. The mean±SEM change in FEV1 (T=120 vs 0 min) was 0.993±0.108, 0.858±0.135, and 0.321±0.056 L, respectively, for the three groups. Separate analysis for patients with FEV1{\%} <40{\%} or >40{\%} predicted showed similar results. However, patients who initially were low responders to albuterol treatment (<15 percentage point increase at 15 min) improved significantly with 30-min treatments compared to the other two treatment regimens. Patients who initially responded with >15 percentage point increase in FEV1 at 15 min following initial albuterol inhalation benefited equally from 30- or 60-min treatments compared to 120 min. Potassium levels did not change significantly during the study. Adverse events and hospitalization rates were equivalent. After the conclusion of the study, group 3 patients required a greater number of β-agonist treatments prior to eventual discharge from the ED. Conclusions: For acute asthma, albuterol MDI with a holding chamber can be given optimally at 60-min intervals with minimal adverse effects for the majority of patients. However, patients who initially demonstrate a low or poor bronchodilator response to albuterol should be given subsequent treatments at 30-min intervals. This will optimize care and conserve resources for patients who will benefit the most.",
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N2 - Study objective: To determine the optimal treatment interval for administering albuterol metered-dose inhaler (MDI) with a holding chamber to patients presenting to the emergency department (ED) with acute asthma. Design: Prospective, randomized, double-blind study. Setting: EDs of two affiliated teaching hospitals in the Bronx, NY. Patients: One hundred adult patients with acute asthma and FEV1 <60% predicted of normal. Interventions: At entry (T=0 min), eligible patients all openly received inhaled albuterol (six puffs) via MDI with a spacer. Subsequently, in a double-blind fashion, they received six puffs of albuterol or placebo with new MDIs and spacers at 30, 60, and 90 min such that group 1 (n=34) received albuterol every 30 min, group 2 (n=33) every 60 min, and group 3 (n=33) at 120 min only. FEV1 and vital signs were measured at T=0 and at 15, 30, 60, 90, and 120 min following initial treatment. Potassium levels were measured at T=0 and 120 min. Adverse events, the use of additional inhaled β-agonists or systemic corticosteroids, and hospitalization rates were recorded. Measurements and results: At T=0, the groups did not differ in age, FEV1, or prescribed asthma medications. All groups showed significant improvement in FEV1 (p<0.05; T=120 vs 0 min). The conditions of groups 1 and 2 improved significantly more than those of group 3, but did not differ compared to each other. The mean±SEM change in FEV1 (T=120 vs 0 min) was 0.993±0.108, 0.858±0.135, and 0.321±0.056 L, respectively, for the three groups. Separate analysis for patients with FEV1% <40% or >40% predicted showed similar results. However, patients who initially were low responders to albuterol treatment (<15 percentage point increase at 15 min) improved significantly with 30-min treatments compared to the other two treatment regimens. Patients who initially responded with >15 percentage point increase in FEV1 at 15 min following initial albuterol inhalation benefited equally from 30- or 60-min treatments compared to 120 min. Potassium levels did not change significantly during the study. Adverse events and hospitalization rates were equivalent. After the conclusion of the study, group 3 patients required a greater number of β-agonist treatments prior to eventual discharge from the ED. Conclusions: For acute asthma, albuterol MDI with a holding chamber can be given optimally at 60-min intervals with minimal adverse effects for the majority of patients. However, patients who initially demonstrate a low or poor bronchodilator response to albuterol should be given subsequent treatments at 30-min intervals. This will optimize care and conserve resources for patients who will benefit the most.

AB - Study objective: To determine the optimal treatment interval for administering albuterol metered-dose inhaler (MDI) with a holding chamber to patients presenting to the emergency department (ED) with acute asthma. Design: Prospective, randomized, double-blind study. Setting: EDs of two affiliated teaching hospitals in the Bronx, NY. Patients: One hundred adult patients with acute asthma and FEV1 <60% predicted of normal. Interventions: At entry (T=0 min), eligible patients all openly received inhaled albuterol (six puffs) via MDI with a spacer. Subsequently, in a double-blind fashion, they received six puffs of albuterol or placebo with new MDIs and spacers at 30, 60, and 90 min such that group 1 (n=34) received albuterol every 30 min, group 2 (n=33) every 60 min, and group 3 (n=33) at 120 min only. FEV1 and vital signs were measured at T=0 and at 15, 30, 60, 90, and 120 min following initial treatment. Potassium levels were measured at T=0 and 120 min. Adverse events, the use of additional inhaled β-agonists or systemic corticosteroids, and hospitalization rates were recorded. Measurements and results: At T=0, the groups did not differ in age, FEV1, or prescribed asthma medications. All groups showed significant improvement in FEV1 (p<0.05; T=120 vs 0 min). The conditions of groups 1 and 2 improved significantly more than those of group 3, but did not differ compared to each other. The mean±SEM change in FEV1 (T=120 vs 0 min) was 0.993±0.108, 0.858±0.135, and 0.321±0.056 L, respectively, for the three groups. Separate analysis for patients with FEV1% <40% or >40% predicted showed similar results. However, patients who initially were low responders to albuterol treatment (<15 percentage point increase at 15 min) improved significantly with 30-min treatments compared to the other two treatment regimens. Patients who initially responded with >15 percentage point increase in FEV1 at 15 min following initial albuterol inhalation benefited equally from 30- or 60-min treatments compared to 120 min. Potassium levels did not change significantly during the study. Adverse events and hospitalization rates were equivalent. After the conclusion of the study, group 3 patients required a greater number of β-agonist treatments prior to eventual discharge from the ED. Conclusions: For acute asthma, albuterol MDI with a holding chamber can be given optimally at 60-min intervals with minimal adverse effects for the majority of patients. However, patients who initially demonstrate a low or poor bronchodilator response to albuterol should be given subsequent treatments at 30-min intervals. This will optimize care and conserve resources for patients who will benefit the most.

KW - β-agonist

KW - Acute asthma

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