High-dose versus low-dose nebulized albuterol in acute asthmatic attack: a randomized double-blind clinical trial

Introduction

Asthma is a common condition, and seems to be increasing in prevalence in most countries around the world. Current guidelines for the treatment of patients with acute asthma have recommended the use of inhaled beta-agonists to reverse airflow obstruction. The optimal dose of albuterol for treatment of acute asthma has yet to be established. Most American references recommend a starting dose of 2.5 mg aerosolized albuterol every 20 min, while European authobities recommend higher doses.

Objectives

The purpose of this study was to compare 2.5 mg with 7.5 mg nebulized albuterol for the treatment of acute asthma, using spirometric data and arterial blood gas sampling.

Study design

A double-blind randomized clinical trial.

Subjects

We studied 106 patients older than 15 years who presented to the emergency department with moderate to severe acute asthmatic attacks.

Methods

On enrolment, patients underwent baseline testing, including initial spirometory/peak flowmetry and arterial blood gas sampling. A standardized treatment algorithm was used for all patients so they received oxygen and corticosteroid and underwent cardiopulmonary monitoring. Patients then received in a randomized, double-blinded fashion, nebulized albuterol at a dose of either 2.5 or 7.5 mg over 20 min. Spirometry or peak flowetry and ABG sampling were repeated after treatment. Measurements were taken of FEV₁, PEFR, FVC, PH, PCO₂, PO₂.

Results

While there was no statistically significant difference in pretreatment and post-treatment values between the two groups, there was a both clinically and statistically significant improvement in post-treatment values in each group.

Conclusion

Overall, we may reach the conclusion that there is no advantage in the routine administration of albuterol at doses higher than 2.5 mg for adult patients with acute asthmatic attacks. It is possible that there may be an advantage in the most severely obstructed patients, although this study did not enrol enough patients with very severe asthma to evaluate this.