Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text Free
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via ISI Web of Science (1)
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Chandra, A.
Right arrow Articles by Dhuper, S.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Chandra, A.
Right arrow Articles by Dhuper, S.
(Chest. 2005;128:1115-1120.)
© 2005 American College of Chest Physicians

Regular vs Ad-lib Albuterol for Patients Hospitalized With Acute Asthma*

Alpana Chandra, MD; Chang Shim, MD; Hillel W. Cohen, DrPH; Virginia Chung, MD; Diane Maggiore, MD; Kartik Mani, MBBS and Sunil Dhuper, MD

* From the Division of Pulmonary Medicine (Drs. Chandra, Shim, Chung, Maggiore, and Dhuper), Jacobi Medical Center; Department of Epidemiology and Population Health (Dr. Cohen); and Department of Medicine (Dr. Mani), Albert Einstein College of Medicine, Bronx, NY.

Correspondence to: Chang Shim, MD, Jacobi Medical Center, 1400 Pelham Parkway S, Suite 5N-50, Bronx, NY 10461; e-mail: cshim107{at}aol.com

Study objectives: Inhaled, short-acting ß-agonists and systemic corticosteroids form the mainstay of therapy in acute asthma exacerbation. Asthma, however, is an inflammatory disease of the airways, and its underlying pathology is not impacted by short-acting ß-agonists. While the efficacy of ad-lib ß-agonist administration in outpatient management of asthma symptoms is well established, little data exist to support this strategy in patients with acute, severe asthma. We postulate that as long as patients hospitalized with severe asthma exacerbation receive systemic corticosteroids, regular, scheduled administration of short-acting ß-agonists is unnecessary. Similar therapeutic outcomes can be achieved with the ad-lib administration of the short-acting ß-agonists.

Design: Prospective, randomized, double-blind, placebo-controlled trial.

Setting: Pulmonary floor of a 600-bed municipal hospital.

Patients or participants: Sixty-two patients hospitalized for acute asthma.

Interventions: Patients were randomized to receive either albuterol nebulizations (regular albuterol group) or saline solution nebulizations (ad-lib group) every 4 h with management of breakthrough symptoms with albuterol metered-dose inhaler or nebulizations for both groups. All patients received systemic corticosteroids. Peak expiratory flows, asthma symptoms, and need for rescue bronchodilator were followed up on each patient until discharge.

Results: There was no significant difference in the length of hospitalization (median length, 48 h for ad-lib group vs 57.5 h for regular albuterol group, p = 0.82), rate of improvement in peak flow, or symptoms between the two groups. Ad-lib ß-agonist use compared to regular albuterol scheduled use resulted in a significant reduction in the total number of albuterol treatments administered (median, 7 treatments vs 19 treatments, p = 0.001) during hospitalization.

Conclusions: In the management of asthma exacerbation, ad-lib administration of albuterol is therapeutically as effective as regular, scheduled administration. This method of drug administration also reduces the total dose of ß-agonists received by the hospitalized patient.

Key Words: adrenergic ß-agonists • asthma • bronchodilator • drug therapy • randomized control trial






HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2005 by the American College of Chest Physicians.