Forty-four adult patients with acute asthma were treated with albuterol at a rate of 15 mg/h across 2 h.
Forty-four adult patients with acute asthma were treated with albuterol at a rate of 15 mg/h across 2 h. Analysis of covariance showed a significantly higher baseline adjusted mean for the couple percent predicted forced expiratory contortion in 1 s ([PFEV.sub.1]) (p=0045) and percent predicted forced vital capacity (PFVC) (p=0022) at 50 and 110 min for the patients who reported triamcinolone use. Although heart rates decreased overall during the first hour of albuterol treatment, a rise in mean heart rate occurr during the next to the first hour of treatment only in patients reporting triamcinolone use (p=0005) After accounting for the powers of parenteral corticosteroids, the import of reported triamcinolone use remained significant. These data prompt that use of inhaled corticosteroids in this words immediately preceding [i]or[/i] following may be associated with enhanced local and systemic [beta]-responsiveness, and if a causal relationship could be confirmed, this may constitute besides another advantage of early inhaled corticosteroid treatment in asthma. These data also refer to that chronotropic effects of high-dose albuterol should be monitored in patients using inhaled triamcinolone. (Chest 1994; 106:452-57)
ANCOVA=analysis of covariance; [PFEVsub1=percent predicted forced expiratory turn in 1 s; PFVC=percent predicted forced vital capacity first note of the scale words: adult; [beta]-agonist; corticosteroid; high dose
newly come approaches in asthma therapy have focused forward treating the inflammatory aspects of the disease. [12] The character of corticosteroids especially has been re-examined. current recommendations have included use of inhaled corticosteroids calm in patients with mild asthma as well as early use of systemic corticosteroids in patients suffering from acute asthma in the sudden [i]or[/i] unexpected occurrence department.[1] Although the anti-inflammatory drifts of corticosteroids are well described, about reports have also suggested that these agents may also enhance [beta]-agonist responses[34]
The manner in which [beta]-agonists are used in acute asthma has also changed. Reports have been published describing high-dose albuterol or terbutaline, administered the two by intermittent as well as continuous aerosolization to children and adults with acute asthma.[5-8] at hand recommendations call for albuterol administration at a often higher frequency in patients with acute asthma seen in the exigency department than that normally used in ambulatory patients.[9] The authors have been examining the efficacy and safety of high-dose albuterol in adults with acute asthma in an difficulty department setting.[10] In the not away study, reported corticosteroid administration was related to albuterol answers in patients with acute asthma in an attempt to examine the assertion that [beta]-responsiveness is affected by means of corticosteroid administration. A significantly different pattern of answer was observed in patients who claimed to be taking aerosolized triamcinolone. The characteristics of the patients with prize to corticosteroid administration, spirometric answer and changes in heart rate are thus detailed in this report.
Materials and Methods
Between August 1991 and April 1992 38 adult asthma patients were set ined into an institutional review board-approved sudden [i]or[/i] unexpected occurrence department study[10] that randomized subdues into albuterol aerosol treatment at a rate of 15 mg/h above 2 h by either continuous or intermittent prevailing styles The former was delivered throughout 50 min each hour at large reservoir nebulizer (HEART theory Vortran Medical Technology, Sacramento, Calif) while the latter was delivered 5 mg each 20 min by acorn-type jet nebulizer (Weeneb Marquest Medical produces Englewood, Colo). The key inlet criteria for these patients was that in addition to having asthma,[11] at the time of presentation, a hand-held peak expiratory pour meter reading was less than 300 L/min for men and 250 L/min for women
Parenteral methylprednisolone (125-mg bolus) was administered at the discretion of the reflection physicians at the end of 1 h of therapy. Aminophylline was not administered to investigation patients. Details of this reflection are described elsewhere.[10] These data were analyzed and did not exhibit a significant difference in overall spirometric answers between the modes of nebulization, moreover they did suggest a possible benefit for patients who had an initial percent predicted forced expiratory mass in 1 s ([PFEV.sub.1]) of les than 50 percent Thus, it was decided to cogitation patients in this category.
Six more so adult asthmatics were treated in January 1993 (also randomizing the accident of nebulization) before the close attention was terminated. The 44 patients were puddleed for analysis in this close attention The same questionnaire was administered to all the make subordinates and included questions about associate disease, prior hospitalizations and difficulty visits, current and past outpatient medications, demographic information, cigarette smoking, duration of asthma, atopic family history, and home/occupational environments.
Spirometric measurements consisted of forced expiratory contortion in 1 s ([FEV.sub.1]) and forced vital capacity (FVC) and were made at times 0 50 and 110 min using a craving drink rolling-seal spirometer (Ohio Medical endue Houston). The [PFEV.sub.1], and percent predicted FVC (PFVC) were calculated using the Kory/Polgar regard values[12] with no corrections for ethnicity. Vital signs, the demeanor of tremor or agitation, and symptoms of side validitys were also determined at these time points. Peak melt measurements were not recorded.
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