Comparison of 2.5 vs 7.5 mg of inhaled albuterol in the treatment of acuteasthma

Purpose: The optimal dose of albuterol to use in the treatment of acute ast hma has yet to be established. The National Asthma Education and Prevention Program (NAEPP) recommends a starting dose of 2.5 to 5 mg of aerosolized a lbuterol every 20 min, although European authorities recommend higher doses . The pm-pose of this study was to compare 2.5 vs 7.5 mg of nebulized albut erol for the treatment of acute asthma, Subjects: We studied 160 patients presenting to the emergency department wi th acute asthma, Methods: On enrollment, patients underwent baseline testing, including init ial spirometry. AU patients received prednisone, 60 mg, orally. Patients th en received in a randomized, double-blinded fashion, nebulized albuterol ei ther 2.5 or 7.5 mg every 20 min for a total of three doses. Spirometry was repeated after each of the fn-st two treatments and again 40 min after comp letion of the three treatments, Results: The pretreatment FEV, was 36.9 +/- 16.6% of predicted normal in th e low-close group vs 41.5 +/- 15.4% of predicted normal in the high-dose gr oup (not significant [NS]), The patients in the low-dose group had a 50.3 /- 62.6% improvement in FEV1 pretreatment to post-treatment, whereas these in the high-dose group had a 44.6 +/- 48.2% improvement in FEV1 (NS). There was no difference in the admission rate in the low-dose group (43%) as com pared with that of the high-dose group (39%; NS), Conclusion: We conclude that there is no advantage to the routine administr ation of doses of albuterol higher than 2.5 mg every 20 min. It is possible that there mn,. be an advantage in the most severely obstructed patients, although this study did not enroll enough patients with very severe asthma to evaluate this, rls has been previously demonstrated, patients who subseq uently require admission hale a diminished response to albuterol, This decr eased responsiveness is seen with the first aerosol administration and is u naffected by increasing the dose.