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 language | English (US) |
|---|---|
| Pages (from-to) | 348-356 |
| Number of pages | 9 |
| Journal | Chest |
| Volume | 112 |
| Issue number | 2 |
| State | Published - 1997 |
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Keywords
- β-agonist
- Acute asthma
- Albuterol
- Asthma
- Holding chamber
ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
Cite this
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 journal › Article
}
TY - JOUR
T1 - Emergency treatment of acute asthma with albuterol metered-dose inhaler plus holding chamber
T2 - How often should treatments be administered?
AU - Karpel, Jill P.
AU - Aldrich, Thomas K.
AU - Prezant, David J.
AU - Guguchev, Katia
AU - Gaitan-Salas, Alberto
AU - Pathiparti, Raja
PY - 1997
Y1 - 1997
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
KW - Albuterol
KW - Asthma
KW - Holding chamber
UR - http://www.scopus.com/inward/record.url?scp=0030840762&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=0030840762&partnerID=8YFLogxK
M3 - Article
VL - 112
SP - 348
EP - 356
JO - Chest
JF - Chest
SN - 0012-3692
IS - 2
ER -