Additive effects of dexamethasone in nebulized salbutamol or l-epinephrine treated infants with acute bronchiolitis

BACKGROUND: Although it is the most common lower respiratory infection of infancy, the optimal treatment for acute bronchiolitis is still controversial. The aim of this study was to compare the early and late effects of nebulized L-epinephrine (EPI) and intramuscular dexamethasone (DEX) combination therapy with nebulized salbutamol (SAL) and dexamethasone combination and bronchodilators alone in outpatients with acute bronchiolitis. METHODS: A total of 69 infants aged 2-21 months who were admitted to the Pediatrics Department of the Faculty of Medicine, Mersin University, with acute bronchiolitis were included in a randomized, placebo-controlled, prospective trial study. Patients were assigned to receive either nebulized L-epinephrine (3 mg) or salbutamol (0.15 mg/kg) and 15 min later, either dexamethasone 0.6 mg/kg or placebo (PLA), intramuscularly, in a double-blind randomized fashion. The study groups were: epinephrine + dexamethasone group (group 1, n=23), salbutamol + dexamethasone group (group 2, n=23), epinephrine + placebo group (group 3, n=11), and salbutamol + placebo group (group 4, n=12). The outcome measures were heart rate, respiratory rate and Respiratory Distress Assessment Instrument (RDAI) score determined at 30, 60, 90 and 120 min, 24 h, and 5 days after the first therapy. Patients were then followed-up during the subsequent 2 months for the prevalance of respiratory complaints regarding bronchial hyperreactivity. RESULTS: There were no significant differences between the outcome variables of the four groups within the first 120 min and at 24 hours, or between the rates of requirement of a second dose of the same bronchodilator. However, fifth day RDAI score values of both DEX groups were significantly lower than that of SAL + PLA group (P=0.000 and P=0.01, respectively). The fifth day score value of group 1 was also significantly better than that value of EPI + PLA group but not different from group 2. CONCLUSIONS: A single dose of intramuscular dexamethasone added to nebulized L-epinephrine, or salbutamol therapies resulted in better outcome measures than bronchodilators alone in the late phase (fifth day) of mild to moderate degree bronchiolitis attack. However, effects of EPI + DEX combination was not different from SAL + DEX combination.     

Nebulized hypertonic saline/salbutamol solution treatment in hospitalized children with mild to moderate bronchiolitis

Background: The objective of this study was to determine the efficacy and safety of nebulized 3% hypertonic saline solution and salbutamol in the treatment of mild to moderate bronchiolitis. Methods: In a randomized controlled trial, 93 infants with mild to moderate bronchiolitis were divided into two groups. The infants received inhalation of 2.5 mg (0.5 mL) salbutamol dissolved in either 4.0 mL normal (0.9%) saline (control group, n= 43) or 4.0 mL hypertonic (3%) saline (treatment group, n= 50). The therapy was repeated three times daily until discharge. Cough, wheezing, pulmonary physical signs, and the length of hospital stay were recorded. Results: Wheezing remission time was 3.8 ± 1.1 days in the control group and 2.7 ± 0.9 days in the treatment group (P < 0.01). Cough remission time was 6.3 ± 0.9 days in the control group and 5.3 ± 0.8 days in the treatment group (P < 0.01). The moist crackles disappeared at 5.4 ± 0.8 days in the treatment group versus 6.2 ± 0.9 days in the control group (P < 0.01). Furthermore, the average length of hospital stay decreased from 7.4 ± 1.5 days in the control group to 6.0 ± 1.2 days in the treatment group (P < 0.01). No obvious adverse effects were observed. Conclusions: Inhalation of nebulized 3% hypertonic saline solution and salbutamol is a safe and effective therapy for patients with mild to moderate bronchiolitis.     

Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis

Aim  

We evaluated the use of computerized quantification of wheezing and crackles compared to a clinical score in assessing the effect of inhaled albuterol or inhaled epinephrine in infants with RSV bronchiolitis.     

Adrenaline and nebulized salbutamol in acute asthma.

The effects of injected adrenaline and nebulized salbutamol on acute asthma were compared in 46 children. The results showed that salbutamol had a significantly better bronchodilatory effect than adrenaline. Nebulized salbutamol is recommended as a primary method of treatment of asthmatic attacks in childhood.     

Randomized trial of salbutamol in acute bronchiolitis

To test whether nebulized salbutamol (albuterol) is safe and efficacious for the treatment of young children with acute bronchiolitis, we enrolled 83 children (median age 6 months, range 1 to 21 months) in a randomized, double-blind clinical trial. Participants received two treatments at 30-minute intervals of either nebulized salbutamol (0.10 mg/kg in 2 ml 0.9% saline solution) or a similar volume of 0.9% saline solution placebo. Outcome measures were the respiratory rate, pulse oximetry, and a clinical score based on the degree of wheezing and retractions. Patients in the salbutamol arm had significantly greater improvement in clinical scores after the initial treatment (p = 0.04). There was no difference between the groups in oxygen saturation (p = 0.74); patients treated with salbutamol had a small increase in heart rate after two treatments (159 +/- 16 vs 151 +/- 16; p = 0.03). We conclude that salbutamol is safe and effective for the initial treatment of young children with acute bronchiolitis.     

沙丁胺醇、丙酸氟替卡松吸入佐治毛细支气管炎疗效观察

毛细支气管炎 (毛支 )为 2岁以下婴幼儿特有呼吸道感染性疾病。既往治疗方法多为抗病毒、氧疗、短期静脉应用糖皮质激素。本文应用沙丁胺醇溶液 (万托林 ) (葛兰素史克公司生产 ,生产批号 :C0 7195 0 )和丙酸氟替卡松 (辅舒酮 ) (葛兰素史克公司生产 ,生产批号 :D0 36 32 7)吸入佐治小儿毛支 ,疗效显著。现将报道如下。对象与方法一、对象　 2 0 0 2年 3～ 12月我科收治的毛支患儿 96例 ,均符合毛支诊断标准[1] 。随机分为治疗组、对照组各 4 8例。年龄 3～ 18个月 ;男 5 2例 ,女 4 4例。两组例数、性别、年龄、病程均无显著性差异 (P均 >…     

Treatment of asthma crises in children with nebulized salbutamol

Thirty-two children were treated with nebulized salbutamol for acute asthma. Seventy-five per cent of the treatments were efficient, either after a first nebulization at 0.15 mg/kg (47% = group I), or after a second nebulization 45 min later, at 0.05 mg/kg (27% = group II). Twenty-five per cent of the treatments (group III) were inefficient or only partly efficient. The clinical tolerance was good except in two children. Group I and II presented differences only for the auscultation score. Children from group I and II were older and had less severe asthma than those from group III. On the basis of this study, nebulized salbutamol appears to be an affective and safe treatment for acute asthma. The repeated administration of low doses, shortly after the first nebulization increases the quality of the response.     

The combination of nebulized sodium cromoglycate and salbutamol in the treatment of moderate‐to‐severe asthma in children

The aim of this multi‐centre prospective study was to evaluate the efficacy, tolerability, and safety of the combination of sodium cromoglycate (SCG) and salbutamol (administered as a nebulized solution), compared to SCG alone and salbutamol alone, in the management of severe, intractable asthma in childhood. The study was an open, randomized, cross‐over trial of 12 weeks' duration in children with moderate‐to‐severe intractable asthma. All treatments were administered twice daily by powered nebulizer. The primary outcome measure was the change in asthma severity, as measured by the mean asthma score during the last 2 weeks of a baseline period and the last 2 weeks of each treatment. Secondary outcome measure was the patient's opinion of the effectiveness of treatment. The change in asthma scores from baseline values were significantly greater with the combination treatment compared to each component administered separately. The mean difference in asthma score between the combination and salbutamol was: ?7.5; 95% CI, ?11.70 to ?3.29 (p < 0.0001). The mean difference between the combination and SCG was: ?8.53; 95% CI, ?14.03 to ?3.25 (p < 0.0001). Patients were also significantly in favor of combination treatment (p < 0.001 vs. salbutamol; p < 0.01 vs. SCG). Two patients reported adverse effects. We concluded that regular twice‐daily inhalation of a combination of SCG and salbutamol gave better control of symptoms than previous treatments in patients with severe, intractable asthma. Few adverse effects with this therapy suggest that it is extremely useful, safe, and effective.     

硫酸沙丁胺醇在治疗儿童支气管哮喘中的临床疗效分析

目的评估高选择性β2受体激动剂硫酸沙丁胺醇在儿童支气管哮喘轻中度急性发作治疗中的临床疗效与安全性。方法门诊诊断为哮喘轻中度急性发作的5～13岁患儿104例,随机分为硫酸沙丁胺醇缓释胶囊组(A组,52例)和丙卡特罗组(B组,52例)。观察2周,记录患儿哮喘日间及夜间症状评分及清晨峰流速值占正常预计值的百分比(PEFam%),在治疗前及治疗第7、14天检查肺功能,记录1 s用力呼气量占正常预计值的百分比(FEV1%),评估临床疗效评分及有效率,记录不良反应。结果 A组在治疗后第7、14天的哮喘日间症状、夜间症状、FEV1%、PEFam%与治疗前比较,均有明显改善,差异有统计学意义(P均<0.001);与B组比较,差异均无统计学意义(P>0.05)。A组临床总有效率、不良反应事件发生率与B组相比差异均无统计学意义(χ2=3.041、0.343,P均>0.05)。结论硫酸沙丁胺醇缓释胶囊在治疗哮喘轻中度急性发作中能较好改善患儿的临床症状及肺功能,缓解喘息,维持症状稳定,有较好的安全性。[临床儿科杂志,2011,29(10):967-970]     

Efficacy of adding nebulized ipratropium bromide to nebulized albuterol therapy in acute bronchiolitis.

Nebulized ipratropium bromide is though to be synergistic with albuterol in therapy for acute childhood asthma. Because the efficacy of ipratropium in bronchiolitis is uncertain and some infants with bronchiolitis do not respond to nebulized albuterol alone, the following study was undertaken. In this double-blind, placebo-controlled trial, 69 infants between 6 weeks and 24 months of age who exhibited the first episode of acute bronchiolitis were randomly assigned to receive either nebulized albuterol (0.15 mg/kg per dose) and ipratropium bromide (250 micrograms per dose) (group A, n = 36) or nebulized albuterol and normal saline (placebo) (group B, n = 33) for two doses, 1 hour apart. The two groups were comparable at baseline. Both therapies resulted in clinically significant improvement. However, the addition of ipratropium resulted in no additional benefit with respect to decrease in the respiratory rate (mean decreases 10.6/min vs decreases 8.6/min, P = .86), accessory muscle score (range 0 through 3) (decreases 0.92 vs decreases 0.82, z = -0.44), wheeze score (range 0 through 3) (decreases 0.94 vs 0.85, z = -0.20), oxygen saturation (increases 0.25% vs increases -0.33%, P = .86), or hospitalization rate (17 vs 10). The number of "nonresponders" and "clear responders" was also very similar in both groups. No toxicity was noted. The increase in heart rate was mild and similar in both groups (increases 6.7 vs increases 11.1). The power of the study to detect a difference between the two treatment groups in the respiratory rate change > or = 8/min is greater than 90%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Randomized controlled trial of nebulized adrenaline in acute bronchiolitis

Use of both l -epinephrine and racemic epinephrine (adrenaline) has improved clinical symptoms and composite respiratory scores in acute bronchiolitis. The objective of this randomized double-blind placebo-controlled study was to assess whether there was sufficient improvement in clinical state to reduce hospital admissions. Seventy-five infants aged 1 month to 1 year with a clinical diagnosis of acute bronchiolitis were treated with either 2 ml of 1:1000 nebulized adrenaline or 2 ml of nebulized normal saline administered after baseline assessment and 30 min later. Clinical respiratory parameters were recorded at 15-min intervals for a period of 2 h following the baseline assessment. Admission to hospital was the primary end-point and changes in respiratory parameters were secondary end-points. Fifty percent (19/38) of infants treated with adrenaline were discharged home compared with 38 percent (14/37) of those treated with saline. This 12 percent reduction in rate of admission is not statistically significant (95% CI of difference: −10% to 35%). There was no difference between treated and placebo groups in respiratory rate, oxygen saturation, heart rate or a composite respiratory distress score at 30, 60 or 120 min post-treatment. In this study, nebulized epinephrine did not confer a significant advantage over nebulized saline in the emergency room treatment of acute bronchiolitis.     

布地奈德、沙丁胺醇、异丙托溴铵三联吸入治疗毛细支气管炎的疗效观察

毛细支气管炎常见于2岁以内小儿，多由呼吸道合胞病毒引起，以喘憋为主要表现，有明显的毛细支气管阻塞症状，可引起呼吸困难，呼吸衰竭，甚至威胁生命。目前尚无特效抗病毒药物。平喘止咳仍为主要的治疗手段。近年来，随着毛细支气管炎发病机制的研究，抗炎治疗日益为临床医生重视。本研究采用以抗炎为主的不同药物联合治疗322例毛细支气管炎患儿，现就其临床疗效报道如下。     

Nebulized salbutamol vs salbutamol and ipratropium combination in asthma

Objective : To see the additional benefit of combined frequent nebulization with salbutamol and ipratropium bromide in acute attack of asthma with moderate severity.Methods : Fifty asthmatic children in the age range of 6–14 years were divided into two equal groups. Group I children were nebulized with three doses of Salbutamol alone (0.03 ml/kg/dose) and Group II children were given combined nebulization of Salbutamol (dose as in group I) and Ipratropium bromide (250 Μgm/dose for three doses) at 20 minutes interval. Children were observed at 15, 30, 60,120,180 and 240 minutes interval.Results : A significant improvement in % of PEFR starting at 30 minutes and lasting the entire study period of 4 hours was noted in both the groups. However on analysis of varience the results were better in group II.Conclusion : Frequent combined nebulization with Salbutamol and Ipratropium bromide is beneficial in acute asthma of moderate severity.     

Effect of salbutamol on respiratory mechanics in bronchiolitis

The effect of inhaled bronchodilators in bronchiolitis has been difficult to evaluate due to problems with techniques for assessing respiratory function in infants. Two new techniques were used to assess the response to inhaled salbutamol in 17 infants with bronchiolitis. With one technique, expiratory flow, volume, and airway occlusion pressure were measured and used to derive compliance (Crs) and conductance (Grs) of the respiratory system from a passive expiration induced by a brief end-inspiratory airway occlusion. With the other technique, the maximum flow at functional residual capacity (VmaxFRC) was measured from a partial maximum expiratory flow-volume curve generated by external chest compression. For the group, there was no change in compliance or conductance after salbutamol, but salbutamol caused a fall in maximum flow at functional residual capacity (p less than 0.01) and in the time constant of tidal expiration (p less than 0.01). The decrease in maximum flow at functional residual capacity with salbutamol is consistent with increased airway collapse on forced expiration. The decrease in tidal time constant suggests that the drug decreases expiratory braking. Presence of such braking activity may be an important strategy for maintaining lung volume. In summary, salbutamol failed to produce a beneficial effect on airways in bronchiolitis, but did produce changes in expiration which may be harmful in some infants.     

Effect of oral and inhaled salbutamol in infants with bronchiolitis

The response of bronchiolitis to bronchodilator drugs is controversial. The present study was designed to evaluate the efficacy of oral or metered dose inhaler (MDI) salbutamol using a coffee cup as a spacer device in bronchiolitis. In the trial, 31 hospitalized patients between 6 and 24 months of age, who exhibited the first episode of acute bronchiolitis without any other predisposing illness such as cystic fibrosis, congenital heart disease etc., were randomly assigned to receive oral salbutamol (n=11, 0.1 mg/kg per dose, four times a day), or MDI salbutamol (n = 12, 200 μg per dose, every 3 h) or formed the control group without any bronchodilator therapy (n = 8). All of the patients were given supplemental oxygen as needed and adequate hydration was maintained. The patients were evaluated with clinical symptom scores. There were no differences in the beneficial or side effects of salbutamol, or the number of days in hospital between the treatment groups and the control group. It was concluded that there is no beneficial effect in using bronchodilators in infants with bronchiolitis. Supplemental oxygen and maintenance of normal hydration may be adequate.     

雾化吸入药物对毛细支气管炎患儿发作期治疗的机制研究进展

毛细支气管炎是婴幼儿常见的下呼吸道感染性疾病,多由呼吸道合胞病毒引起,部分患儿可能发展成哮喘.对于毛细支气管炎目前还无特效治疗方法,治疗目的是为了解除呼吸道的梗阻、改善通气、控制喘憋、防止合并心力衰竭、呼吸衰竭.治疗药物为抗病毒、平喘及免疫疗法等.其中吸入疗法是将药物以微粒状直接吸入靶组织,直接作用于气管表面的药物受体而发挥疗效,吸收迅速,疗效好,不良反应少,因而越来越受到临床上的认可.雾化吸入药物品种繁多,常用的有β2受体激动剂、肾上腺素、糖皮质激素、硫酸镁、沐舒坦、利巴韦林、高渗盐水等.该文就近年来常用各种雾化吸入药物对毛细支气管炎患者治疗研究进展作一概述.     

Randomized clinical trial of intravenous magnesium sulfate versus salbutamol in early management of severe acute asthma in children

OBJECTIVE: To study the efficacy of intravenous magnesium sulfate and intravenous salbutamol in the treatment of severe asthma in children. METHODS: Randomized, double-blind, placebo-controlled clinical trial, including children above 2 years of age with severe acute asthma admitted to the observation ward of the Pediatric Intensive Care Unit of Hospital S?o Lucas. All patients received conventional treatment (oxygen, corticoids, beta-adrenergics) on admission, and later received one of the following solutions: a) IVMg (50 mg/kg); b) intravenous salbutamol (1 micro g/kg); c) saline solution. Clinical assessments, electrolyte concentration, and arterial blood gas analyses were recorded before intravenous infusion and one hour after that. RESULTS: Fifty patients participated in this study (of whom 53% were females, mean age = 4.5 years). There were no significant differences among the three groups. The group that received IVMg presented lower blood pressure during administration, which reached normal levels one hour afterwards, along with an increase in serum magnesium (P<0,001) and serum pH, and reduction of PaCO(2). The group that received intravenous salbutamol had lower respiratory rate (P=0.05) and higher blood pressure (P=0.01), and one hour after administration, these patients showed decreased respiratory rate (P=0.02); lower levels of serum potassium (P=0.009); higher pH, and reduced PaCO(2). This group required fewer nebulizations (P=0.009), fewer nebulizations per day (P<0.001) and less oxygen therapy than the IVMg and placebo groups. Acidosis was more persistent (P<0.01) in the placebo group. No difference as to the length of hospital stay was observed in any of the three groups. Artificial ventilation was necessary in 10% of the patients. CONCLUSIONS: The early intravenous administration of magnesium sulfate, especially salbutamol, achieved a rapid clinical response with excellent prognosis and no significant side effects.