Comparison of intravenous aminophylline and salbutamol in severe asthma. A controlled trial of intravenous salbutamol and aminophylline in acute asthma. Randomised trial of intravenous salbutamol in early management of acute severe asthma in children. Comparison of inhaled and intravenous terbutaline in acute severe asthma. Intravenous versus nebulized terbutaline in patients with acute severe asthma; a double-blind randomized study. Comparison of IV salbutamol with IV aminophylline in the treatment of severe, acute asthma in childhood. Nebulized versus intravenous albuterol in hypercapnic acute asthma. A multicenter, double-blind, randomized study. Comparison of intravenous aminophylline and salbutamol in severe asthma. Comparison of salbutamol given intravenously and by intermittent positive-pressure breathing in life-threatening asthma. [Intravenous infusion of reproterol (a beta-2-mimetic agent) in the therapy of severe asthma attacks in childhood]. Comparison of intravenous and nebulised salbutamol in initial treatment of severe asthma. Comparison of intravenous aminophylline, salbutamol and terbutaline in acute asthma. High-dose inhaled versus intravenous salbutamol combined with theophylline in severe acute asthma. Swedish Society of Chest Medicine.
nan In a randomized double-blind trial an intravenous injection of salbutamol (100mug) was compared with an intravenous injection of aminophylline (250mg) in 23 patients with acute exacerbations of asthma. Salbutamol (11 cases) and aminophylline (12) produced a mean proportionate increase in FEV of 26% and 23% respectively. Blood gas pressures showed a trend to improvement with a mean rise in oxygen tension of 2mm Hg(0-2kPa) in the aminophylline group and of 6mm Hg (0-8kPa) in the salbutamol group. Electrocardiogram patterns also showed overall improvement, and mean decreases in pulse rate of 8 beats per minute and 2 beats per minute were noted in the aminophylline and salbutamol groups respectively. Differences in results did not reach conventional levels of significance and no serious side effects were noted. It was concluded that in the doses and routes of administration compared, salbutamol was as effective as aminophylline. The mainstay of treatment for acute asthma in children is nebulised beta 2-adrenergic agents such as salbutamol, given with corticosteroids. However, penetration of the drug to the small airways is impeded by obstruction so intravenous salbutamol may be more effective. We assessed the use of intravenous salbutamol in the management of children with acute severe asthma in a double-blind randomised study.
                Children who presented to the Emergency Department of Westmead Hospital, Sydney, Australia with asthma were assessed with a clinical assessment scale, and those with severe acute asthma were given nebulised salbutamol at a dose of 2.5 mg (age < or = 2 years) or 5.0 mg (age > 2 years), made up to 4 mL with saline. Children who did not improve were eligible to enter phase one of the study. In this phase (0 h-2 h) treatment was by a standard protocol: nebulised salbutamol at the above dose: 4 L/min or 6 L/min continuous oxygen until oxygen saturation reached 93% in room air for at least 30 min; a bolus of intravenous hydrocortisone 5 mg/kg given over 3 min; and then 15 micrograms/kg intravenous salbutamol or saline, depending on randomised allocation. In phase two (2 h-24 h) the children were given nebulised salbutamol continuously then at 30 min, 1 h, 2 h, 3 h, and 4 h, according to need. All children were transferred to the ward once they were ready to start hourly nebulisation. All patients were followed up until discharge. The primary endpoints were recovery time (no longer requiring inhaled salbutamol) and persistent moderate to severe asthma 2 h after randomisation. Analyses were by intention-to-treat although no withdrawals occurred.
                The recovery time (time to cessation of nebulised salbutamol every 30 min) was 4 h in the 14 children allocated intravenous salbutamol compared with 11.5 h for the 15 children in the control group. 2 (14%) of the intravenous salbutamol group compared with 8 (53%) of the control group needed oxygen to maintain oxygen saturation at 93% room air. The intravenous salbutamol group were ready for discharge from the emergency department 9.7 h earlier than the control group. No clinically significant side-effects were found in either group.
                Addition of a 10 min infusion of salbutamol in the early treatment of children with acute severe asthma has the potential to curtail the clinical progression of asthma, reduce demand placed on hospital resources, and improve the quality of health care provided to the acutely sick child with asthma. In patients with acute severe asthma, 5 mg of terbutaline by inhalation and 500 microgram intravenously in divided doses both produced equally effective but not maximal bronchodilatation. There was no difference in the production of side-effects. These results support the view that inhaled therapy can be as effective in patients with acute severe asthma as injected treatment. In view of the risks of intravenous treatment, especially using high doses, inhaled bronchodilator therapy would seem advisable as initial treatment. Twenty-three patients with acute severe asthma were treated in a randomized double-blind way by either intravenous terbutaline two times at an hour interval 6 micrograms/kg or inhaled terbutaline two times 0.1 mg/kg. Peak expiratory flow rate in percent of expected value rose from 89 L/min to 128 L/min (P less than .01) in the intravenous group and from 97 L/min to 122 L/min (P less than .02) in the inhalation group; this was comparable for both groups. PaO2 initially was 7.55 kPa in the intravenous group and rose by 1.4 after 60 minutes (P less than .02) and by 1.33 after 120 minutes (P less than .01). The mean PaO2 did not change in the inhalation group. The pulse rate and blood pressure did not vary significantly in either of the two groups. We conclude that both the intravenous and inhalational administration of terbutaline are effective in acute severe asthma, but that the intravenous route is possibly better for increasing PaO2. A double-blind test to compare IV aminophylline with salbutamol in the treatment of acute, uncontrolled asthma showed that both drugs were equally effective during the first 24 hours. Salbutamol caused a relative tachycardia. Hydrocortisone was given after 2 hours, but did not appear to affect the rate of recovery. In a multicenter, randomized, double-blind study, we compared the effects of nebulized (5 mg x 2) and intravenous (0.5 mg) albuterol (salbutamol) over 1 h in 47 patients admitted to hospital with severe acute asthma defined as a peak expiratory flow (PEF) below 150 L/min and hypercapnia (Pa(CO2) > or = 40 mm Hg). Additional treatment included nasal oxygen and hydrocortisone succinate. The efficacy was assessed after 1 h. In the group treated by nebulization (NEB group, n = 22) 19 (86%) patients (95% confidence interval: 65 to 97%) had been treated successfully according to predefined criteria, versus 12 (48%) patients (95% confidence interval: 28 to 69%) in the intravenously treated group (i.v. group, n = 25), p = 0.006. The mean increase in PEF was greater in the NEB group than in the i.v. group (+107 +/- 94 L/min versus +42 +/- 66 L/min, p = 0.01) as well as the decrease in Pa(CO2) values (-10 +/- 5 mm Hg versus -2 +/- 12 mm Hg, p < 0.01). Beta agonist-induced hypokalemia was more pronounced in the i.v. group than in the NEB group. We conclude that, in hypercapnic acute asthma, the nebulized route has a greater efficacy and fewer side effects than the intravenous route. nan A double-blind crossover trial was carried out during 22 episodes of life-threatening asthma in 19 patients to compare salbutamol given as a 500 microgram intravenous injection and as a 0 . 5% solution administered by intermittent positive-pressure breathing (IPPB) for three minutes. Relief of pulsus paradoxus was significantly better after IPPB than the intravenous treatment. Both treatments significantly improved the peak expiratory flow rate. Salbutamol given intravenously produced a mean increase in heart rate of over 20 beats/min five minutes after treatment compared with the relief of tachycardia that occurred after administration by IPPB. Four patients had noticeable cardiovascular side effects after salbutamol given intravenously, but no such effects were noticed after administration by IPPB. Two patients withdrawn shortly after entry into the trial because of a worsening clinical condition had received intravenous salbutamol. It is concluded that salbutamol given by IPPB is better than that given by slow intravenous injection in severe acute asthma. 20 children (age range 0.8-14.7 years) with acute severe asthma were alternately randomized to receive one of two different treatment regimes. 10 children (control-group) received Salbutamol inhalation (75 micrograms/kg in 2 ml Saline every two hours). 10 children (reproterol-group) received reproterol infusion (0.2-2.0 micrograms/kg/min in Saline) and inhaled Saline only. Other therapy regimen were identical in both groups: Theophylline infusion, i.v. Prednisolone, adequate fluids intake and oxygen insufflation. Age, severity and maintenance therapy of asthma, and severity of the acute episode, were not significantly different in both groups. Treatment efficacy, assessed with a simple clinical score, the heart and respiratory rates, the peak expiratory flow (PEF) and the blood gases, was comparable in both groups. Side effects, i.e. tachycardia, blood pressure changes and tremor, were also similar and clinically not relevant in both groups. In two children, who previously needed repeated mechanical ventilation, severe respiratory failure could be successfully controlled only when the reproterol dose was raised 10 folds (2.0 micrograms/kg/min). Reproterol infusion can be recommended in children with acute severe asthma, who do not respond satisfactorily to current therapy regimen, particularly in children who previously experienced numerous intubations. nan nan In a multicentre parallel group study we studied 176 adult patients (53% men) with severe acute asthma (peak expiratory flow (PEF), 15-50% of predicted values). The effect of two doses of inhaled salbutamol (0.15 mg.kg-1 x 2; 30 min apart) (n = 87) was compared with that of one dose of salbutamol given intravenously (5 micrograms.kg-1) (n = 89). There was a significantly larger increase in peak expiratory flow after the first inhaled dose in the group that received inhalation treatment than in the i.v. treated group (69 vs 41 l.min-1, p less than 0.05), but there was no difference in systemic side-effects between the groups. After the second inhaled dose there was a further increase in PEF, but also in systemic side-effects. These treatments were also compared in a cross-over study on 18 of the patients who returned with a second attack of severe acute asthma. The cross-over evaluation produced similar results, with a significantly larger increase in PEF after the first inhaled dose than after the i.v. treatment. Fifteen of the 18 patients found the inhalations more effective than the i.v. treatment. Theophylline (3-6 mg.kg-1) was infused i.v. 60 min after the start of salbutamol treatment, and a significant increase in PEF was observed in both groups. A correlation between the increase in PEF and the increase in plasma theophylline concentration was only found in the group that had received i.v. salbutamol.(ABSTRACT TRUNCATED AT 250 WORDS)