OBSERVATIONS ON THE EFFECTS OF AEROSOLIZED ALBUTEROL IN ACUTE ASTHMA

To determine the dose of albuterol required to terminate acute episode s of asthma, 92 acutely ill subjects received three doses of 2.5 mg ea ch by nebulization every 20 min. Peak expiratory flow hates (PEFR) and signs and symptoms were serially monitored. A dose-response increase in pulmonary function was found, but only 66% of the subjects improved sufficiently to be sent home. Of these, 56% required less than or equ al to 5.0 mg of drug to reach the discharge threshold, whereas the rem ainder needed 7.5 mg. In 34% of participants, albuterol was ineffectua l. These individuals were characterized by more severe obstruction at presentation, and after three doses of medication their PEFR still did not exceed 40% of the the expected value. Further treatment in the em ergency department (ED) or hospital was not immediately helpful, and t hese patients ultimately required 3.8 +/- 0.4 d of inpatient care to b ecome asymptomatic. There were no discernible differences between resp onders and nonresponders in the type or quantity of medications used. However, the nonresponders had more severe disease as measured by recu rrent hospitalizations and ED visits. This study demonstrates that, in emergency situations, albuterol does not relieve acute airway obstruc tion in all asthmatic individuals with equal efficacy. Two-thirds of p atients are sensitive, and in these patients 5 to 7.5 mg of albuterol provides optimal treatment. in The remainder, albuterol, even in high doses, has little effect for days.