Albuterol via metered-dose inhaler in children: Lower doses are effective, and higher doses are safe

• Published in: Pediatric pulmonology 2016-11, Vol.51 (11), p.1122-1130
• Main Authors: Muchão, Fabio Pereira, Souza, Juliana Miguita e, Torres, Hélida Conceição Cavalcante, De Lalibera, Isabella Batista, de Souza, Andréa Vieira, Rodrigues, Joaquim Carlos, Schvartsman, Claudio, da Silva Filho, Luiz Vicente Ribeiro Ferreira
• Format: Article
• Language: English
• Subjects: Administration, Inhalation; Adolescent; albuterol; Albuterol - administration & dosage; Albuterol - adverse effects; Albuterol - therapeutic use; Asthma; asthma & early wheeze; Asthma - drug therapy; Asthma - physiopathology; Bronchodilator Agents - administration & dosage; Bronchodilator Agents - adverse effects; Bronchodilator Agents - therapeutic use; Child; Child, Preschool; children; clinical trials; Dose-Response Relationship, Drug; Double-Blind Method; Emergency Service, Hospital; Female; Heart Rate; Humans; Male; Metered Dose Inhalers; Oximetry; Patient admissions; Status Asthmaticus - drug therapy; Status Asthmaticus - physiopathology; treatment; Treatment Outcome
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.23469

Summary Background The ideal dosing of albuterol via metered‐dose inhalers for acute childhood asthma is not well established. We hypothesized that greater doses of albuterol would result in less time in the hospital and lower admission rates. Methods This was a randomized controlled double‐blind multicenter study, conducted in emergency rooms (ER). We included patients with 2–17 years old with moderate to severe acute asthma (Pediatric Respiratory Assessment Measure, PRAM, score ≥5). Dosages administered during the first hour included: 6 (up to 25 kg) or 12 puffs (>25 kg) in the control group and 9 (up to 15 kg), 12 (>15–20 kg), 15 (>20–25 kg), or 18 puffs (>25 kg) in the study group. Several efficacy (changes in PRAM score, pulse oximetry, and FEV1, length of stay, and admission rates) and safety (albuterol plasma levels, heart rate, serum potassium, glucose and bicarbonate levels, EKG, and tremor rates) outcome measures were assessed. Results We included 119 patients with similar baseline conditions, and no significant differences were observed between groups in the length of stay (P = 0.48) or admission rate (P = 0.55). No significant differences were observed in FEV1, PRAM score, and pulse oximetry changes after 1 hr and at discharge or admission. No significant differences were observed in safety outcomes between groups. Conclusions Higher albuterol dosage regimens did not result in lower admission rate or shorter length of stay in the ER, but showed similar safety profile for children with moderate to severe acute asthma. Pediatr Pulmonol. 2016;51:1122–1130. © 2016 Wiley Periodicals, Inc.