Asthma: acute exacerbation: iv salbutamol speeded recovery in children.

Clinical bottom line (level 1b)

  1. Children with severe asthma who had iv salbutamol were more likely to improve than those who did not (NNT = 2 at 2 hours) , and were less likely to be on continuous oxygen (NNT = 3 at 2 hours) .
  2. Children given iv salbutamol came off nebulisers faster.
Browne et al: Lancet 1997; 349: 301-305
Expires November 2002

The study

Double-blinded ?concealed randomised trial with intention-to-treat
Setting: emergency department, university paediatric hospital, Australia

29 patients (aged range 1 to 12 years; mean ~7, 66% male) children with severe asthma

Excluded if
  • mild-to-moderate asthma
  • at imminent risk of respiratory arrest
  • congenital heart disease, family history or previous episode of supraventricular tachycardia
  • underlying respiratory disease other than asthma
  • diabetes mellitus or glucose intolerance
  • aged < 12 months, or > 12 years
  • weight < 10 kg or > 50 kg
  • already had maximum iv study drug for that day
  • no consent given


    • Note:
  • All patients had nebulised salbutamol: 2.5 mg if two years old or less, 5 mg if > two. Children who failed to improve were entered into the trial.


    • Control Group: (n = 15, 15 analysed): saline iv
    Experimental Group: (n = 14, 14 analysed): iv salbutamol 15 mcg/ kg over 10 minutes
    All patients received nebulised salbutamol, 4-6 l/min oxygen until saturation > 93% for at least 30 min; iv hydrocortisone 5 mg/kg over 3 min.
    100% followed for 24 hours

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    moderate-to-severe asthma 2 hours 14
    (93.3%)    		 5
    (35.7%)    		 62%
    (22% to 81%)    		 57.6%
    (29.5% to 85.7%)    		 2
    (1 to 3)
    on continuous oxygen 2 hours 8
    (53.3%)    		 2
    (14.3%)    		 73%
    (-5% to 93%)    		 39.1%
    (7.85% to 70.3%)    		 3
    (1 to 13)

    Outcome Control Group
    (SD)    		 Experimental Group
    (SD)    		 Mean Difference
    (95% CI)
    time to cessation of nebuliser every 30 minutes (hours) 11.1
    ()     		4.0
    ()     		p=0.03
    ( to )
    time to cessation of nebuliser every 60 minutes (hours) 21.2
    ()     		11.5
    ()     		p=0.02
    ( to )

  • Side-effects were reported not to be statistically or clinically different between the two groups (no data given).

    • Comments

    1. Since the use of these additional, evidence-based therapies is associated with earlier reversal of bronchoconstriction and inflammation, physicians should be encouraged to start them as early as possible in acute severe attacks.
    2. Clinical grading of asthma was based on National Australian Asthma Campaign guidelines clinical assessment scale.

    Citation

    1. Browne GJ, Penna AS, Phung X, et al: Randomised trial of intravenous salbutamol in early management of acute severe asthma in children. Lancet 1997; 349: 301-305
    Search Terms: acute asthma in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer: Mona Nabulsi

    Clinical Question.
    Patient children with severe acute asthma
    Intervention or Exposure iv salbutamol
    Outcome improvement