CONTINUOUS VERSUS FREQUENT INTERMITTENT NEBULIZATION OF ALBUTEROL IN ACUTE ASTHMA - A RANDOMIZED, PROSPECTIVE-STUDY

Background: In acute severe asthma the optimal dose, frequency, durati on and method of administration of beta-2 agonists is unknown. No stud y to date has evaluated the efficacy of high dose beta-2 agonists beyo nd the initial two hours. Objective: (1) To determine whether high-dos e continuous nebulization of albuterol (7.5 mg/h) is as safe and as ef ficacious as high-dose intermittent nebulization of albuterol (2.5 mg every 20 minutes) for four hours. (2) To evaluate whether there is a c ontinual improvement using high dose therapy beyond two hours. Methods : We devised a simple means of continuous nebulization calibrated to d eliver 7.5 mg albuterol per hour. Twenty-two nonsmoking, patients with acute, severe asthma who presented to the emergency department with l ess than 60% predicted normal PEFR were randomized to either the conti nuous or intermittent group. All patients received intravenously 125 m g methyl prednisolone on initiation of the study. No theophylline was administered. Spirometry and vital signs were measured at baseline and every 30 minutes thereafter, Electrocardiograms were obtained on all patients and all patients had continuous cardiac monitoring, Results: Both groups doubled their baseline spirometric values over the four-ho ur period (P < .0001), The FEV(1) did not differ significantly between regimens at any time interval, Improvement from 120 minutes to 240 mi nutes was statistically significant (P < .0001). There was no signific ant difference in vital signs at the end of the study compared with ba seline in either group, nor between the two groups at any time interva l. Conclusion: High-dose continuous nebulization of albuterol is as sa fe and as efficacious as intermittent nebulization of albuterol in the early treatment of asthma in an emergency department. To our knowledg e, this is the first study showing continued significant improvement b eyond the initial two hours of therapy using high dose nebulized beta- 2 agonists.