As-required versus regular nebulized salbutamol for the treatment of acutesevere asthma

Current British guidelines for the administration of beta(2)-agonists in ac ute severe asthma recommend regular nebulized therapy in hospitalized patie nts, followed by as-required (p.r.n) use via hand-held devices after discha rge. Since beta(2)-agonists do not possess anti-inflammatory activity in vi vo, and are thus unlikely to influence the rate of recovery from an asthma exacerbation, it was hypothesized that patients given the short-acting beta (2)-agonist salbutamol on an as-required basis after admission to hospital would recover as quickly as those on regular treatment, but with potential reductions in the total dose delivered, Forty-six patients with acute severe asthma were randomly assigned to eithe r regular prescriptions of nebulized salbutamol or to usage on a p.r.n, bas is, from 24 h after hospital admission. The primary outcome measures were l ength of hospital stay, time to recovery, and frequency of salbutamol nebul ization from 24 h after admission to discharge. Secondary outcome measures were treatment side-effects (tremor, palpitations), and patient satisfactio n. Length of hospital stay was reduced in those patients allocated to p.r.n. s albutamol (geometric mean (GM) 3.7 days) versus regular salbutamol (GM 4.7 days). Time taken for peak expiratory how to reach 75% of recent best was t he same in both groups, There was a highly significant reduction in the num ber of times nebulized therapy was delivered to the p.r.n, group (GM 7.0, r ange 1-30) compared with the regular treatment group (GM 14.0, range 4-57; p=0.003; 95% confidence interval for ratio of GMs 1.29-3.09). In addition, patients reported less tremor (p=0.062) and fewer palpitations (p=0.049) in the p.r,n, group. Of the patients in the p.r.n. group who had received reg ular nebulized therapy on previous admissions (n=12), all preferred the p.r .n. regimen, Prescribing beta(2)-agonists on a p.r.n, basis from 24 h after hospital adm ission is associated with reduced amount of drug delivered, incidence of si de-effects, and possibly length of hospital stay. This has implications for the efficient use of healthcare resources.