TERBUTALINE NEBULIZATION AND EPINEPHRINE INJECTION IN TREATING ACUTE ASTHMATIC-CHILDREN

Ninety children with acute asthma, equally divided into two study grou ps, were studied to compare the efficacy and safety of nebulized terbu taline with injected epinephrine in the treatment of acute exacerbatio n. The terbutaline group received 2 ml (5,0 mg) terbutaline solution d iluted with 2 mi 0.9% saline for inhalation over 10 minutes; the epine phrine group received 0.01 ml/ kg of 1:1000 epinephrine (maximum 0,3 m l) through subcutaneous injection at deltoid area. Spirometry, pulse o ximetry, and clinical severity scoring system were evaluated at baseli ne and again 15 minutes after treatment. The baseline data of the two groups were not significantly different. The clinical severity score a nd spirometry of both groups were significantly improved after treatme nt. Compared with the terbutaline group, the epinephrine group had bet ter mean oxygen saturation (SaO(2); p<0.001), frequency of oxygen desa turation (p=0.0028) and forced expiratory flow 25-75% (FEF (25-75%), p =0.027). For those patients with initial forced expiratory volume in o ne second (FEV(1)) lower than 60% of predicted value, epinephrine trea tment was more effective in the improvement of FEV(1), FEF(25-75%). an d oxygen saturation (SaO(2)) (p=0.011, 0.012, and 0.006, respectively) . A Significantly higher rate of adverse effects occurred in patients given epinephrine (47% vs 11%, p=0.0002); these included pallor, tremo r, dizziness, headache, palpitation, soreness of legs, numbness of ext remities, cold sweating, general weakness and nausea. Considering the general trend to noninvasive therapy in children and the more frequent adverse effects after epinephrine injection, such nebulized beta-2 ag onists as terbutaline appear preferable for initial therapy of acute a sthma if oxygen is supplemented to prevent possible hypoxemia. However , parenteral epinephrine still is worth trying, particularly in any se vere, life-threatening attack.