The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts


Andrew G. Miller, Sarah Mausert, Malissa Dunn, Kathryn Eakins, Janice J. Thalman, John Davies, Neil R. MacIntyre; Duke Medical Center, Durham, NC

Background: The use of continuous albuterol has been shown to a be safe and effective treatment for severe asthma exacerbations. Current asthma guidelines recommend patients with mild to moderate asthma exacerbation be treated with three 2.5-5 mg albuterol treatments with 0.5 mg atrovent within 1 hour of their arrival and to assess for response. For severe exacerbations, continuous albuterol therapy may be indicated. A literature review showed that the patients with the most severe airflow obstruction may benefit from the use of continuous albuterol. There is currently no data showing toxicity with continuous albuterol administration. The purpose of this review was to examine our current emergency department continuous albuterol practice. Methods: Pediatric patients placed on continuous albuterol (20 mg/hr) in the Duke ED from 2/21/2009 to 4/31/2011 were reviewed. Data tracked consisted of; the number of bronchodilator treatments received in the ED prior to initiation of continuous albuterol, concomitant corticosteroid administration, patient diagnosis, and disposition from the ED. Patients who received bronchodilator treatments but not continuous albuterol were not included in this study. Results: 135 pediatric patients who required bronchodilation therapy in the emergency department were included. 121 (89.6%) patients were admitted and 131 (97%) of patients received corticosteroids. Overall 128 (94.8%) were diagnosed as having reactive airway disease or asthma, 2 (1.5%) with cystic fibrosis, 2 (1.5%) with allergic reactions, and 3 (2.2%) with other diagnoses. 58 patients received 0 bronchodilator treatments prior to initiation of continuous albuterol, 52 patients received 1 or 2 bronchodilator treatments, and 25 patients received 3 or more treatments prior to initiation of continuous albuterol. Conclusion: In this group of patients immediate placement on continuous albuterol did not lower the overall admission rate. Patients receiving 3 bronchodilator treatments prior to initiation of continuous albuterol had lower rates of PICU admissions and higher rates of regular/CEU admission. Our results appear to support the existing guidelines.
Sponsored Research - None
of Treatments Prior to Continuous Albuterol
PICU = Pediatric Intensive Care Unit
RAD = Reactive Airway Disease
CEU = Clinical Evaluation Unit 24 hour observation unit located within the emergency department