NEBULIZED VERSUS INTRAVENOUS ALBUTEROL IN HYPERCAPNIC ACUTE ASTHMA - A MULTICENTER, DOUBLE-BLIND, RANDOMIZED STUDY

In a multicenter, randomized, double-blind study, we compared the effe cts of nebulized (5 mg x 2) and intravenous (0.5 mg) albuterol (salbut amol) over 1 h in 47 patients admitted to hospital with severe acute a sthma defined as a peak expiratory flow (PEF) below 150 L/min and hype rcapnia (Pace, greater than or equal to 40 mm Hg). Additional treatmen t 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 bee n treated successfully according to predefined criteria, versus 12 (48 %) patients (95% confidence interval: 28 to 69%) in the intravenously treated group (IV group, n = 25), p = 0.006. The mean increase in PEF was greater in the NEB group than in the IV group (+107 +/- 94 L/min v ersus +42 +/- 66 L/min, p = 0.01) as well as the decrease in Pace, val ues (-10 +/- 5 mm Hg versus -2 +/- 12 mm Hg, p < 0.01). Beta agonist-i nduced hypokalemia was more pronounced in the IV group than in the NEB group. We conclude that, in hypercapnic acute asthma, the nebulized r oute has a greater efficacy and fewer side effects than the intravenou s route.