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PubMed2000

Undiluted albuterol aerosols in the pediatric emergency department.

OBJECTIVE: To evaluate the efficacy and efficiency of a short treatment method of administering albuterol aerosols. METHODS: Fifty children 6 to 18 years of age with severe acute asthma (peak flow rates <60% of predicted) were enrolled in a single-blind, controlled trial in an urban pediatric emergency department. Patients were randomized to receive either the study short treatment (3.5 mL of undiluted albuterol nebulized for 20 inhalations) or the control treatment (albuterol diluted [.5 mL] and nebulized in normal saline [3 mL]) every 20 minutes for a total of 3 treatments. Peak flow and spirometric measurements were performed before and after each treatment. RESULTS: There were 25 patients in the study group and 25 in the control group. There were no demographic differences between groups; both had comparable pulmonary function at presentation. The mean forced expiratory volume in 1 second percent predicted improvement between 0 and 60 minutes was 18.8% in the study group and 14.5% in the control group. The total time of treatment delivery for the study group was 6.4 minutes versus 32.7 minutes for the control group. CONCLUSION: Undiluted albuterol short treatments seem to be as effective as standard diluted albuterol in severe asthmatics, while offering the ease and efficiency of shorter treatment administration time.

Acute Disease↗

PubMed1996

Dexamethasone in bronchiolitis: a randomised controlled trial.

BACKGROUND: Although corticosteroids are commonly prescribed in the treatment of bronchiolitis, there is no evidence on the efficacy of these drugs in this disorder. We designed a randomised, double-blind, prospective study to assess the efficacy of dexamethasone in infants with bronchiolitis who require hospital management. METHODS: Infants younger than 12 months who had been admitted to hospital for an initial episode of wheezing, were randomly allocated intramuscular dexamethasone (1 mg/kg daily) or placebo, every 24 h for three doses. We excluded infants who were younger than 4 weeks, who required admission to the intensive care unit, or who had a history of congenital heart disease, mechanical ventilation, or supplemental oxygen use. We assessed infants on admission and every 12 h thereafter--vital signs were taken, severity of accessory muscle use and wheezing were measured by a clinical severity score, and pulse oximetry in room air was done. Our primary endpoints were the time to resolution of symptoms--defined as the number of assessments needed to reach oxygen saturation of more than 95% while receiving no supplemental oxygen, an accessory muscle score of 0, a wheeze score of 0 or 1, and resumption of normal feeding--and duration of oxygen therapy. Follow-up assessments were made 10-14 days after discharge by telephone. We used a proportional-hazards model for our survival analysis. FINDINGS: 197 infants presented with bronchiolitis that required inpatient management. 75 were not enrolled (31 no consent, 28 no approach made, 16 transferred elsewhere). Of the 122 enrolled, four were excluded (clinical deterioration, diagnosis of cystic fibrosis, previous intubation, did not receive all study treatment). There were no differences between the dexamethasone (n = 65) and placebo-treated infants in demographic factors, exposure to tobacco smoke, duration of illness, presence of respiratory syncytial virus (RSV) antigen, respiratory rate, or severity score. More dexamethasone-treated patients had an initial oxygen saturation of 95% or less (51 [79%] dexamethasone vs 31 [59%] placebo, p = 0.02). There were no differences in duration of oxygen therapy (p = 0.74) or time to resolution of symptoms (p = 0.22). Stratification for presence of RSV antigen or family history of atopy did not affect the results. INTERPRETATION: Our findings do not support the use of dexamethasone in the treatment of bronchiolitis in infants.

Anti-Inflammatory Agents, Non-Steroidal↗