This study was undertaken to determine if intermittent inhalation of salbutamol delivered by jet nebulizer provided better clinical response than intravenous salbutamol in the initial therapy of acute severe asthma. In a randomized single blind clinical trial, patients with acute severe asthma were given salbutamol either intravenously 5 µg/kgBW or by inhalation of 0.15 mg/kgBW for 10 minutes. A greater improvement in peak expiratory flow rate (PEFR) was observed in the inhalation group compared to the intravenous group. The PEFR in the inhalation group was initially 19.69 ± 6.84% of the predictive value, 51.04 ± 15.56% one hour, and 56.64 ± 15.93% two hours after treatment, with p < 0.01, whereas in the group receiving intravenous salbutamol, the values were 18.18 ± 6.21%, 41.05 ± 12.63, 50.83 ± 24.36% respectively, with p < 0.05. A statistically significant difference was found between both groups in the first hour after treatment was initiated (p < 0.01). There was also a significant difference in the results assessed by modified British Thoracic Society and Cochrane scoring methods. No correlation was found between the severity of initial airway obstruction with the duration of dyspnea prior to admission, instead, moderate corellation was found between the severity of obstruction and the improvement of PEFR 45 minutes after initial treatment. Palpitation, tremor, and chest pain were more pronounced in intravenous group the first hour after treatment, particularly during the first 15 - 30 minutes. Symptoms of vomiting and headache were so severe in one patient given intraveous salbutamol that treatment had to be discontinued. In another patient, the rate of infusion had to be reduced because of the ectopic heartbeat it caused.
- Acute severe asthma
- Initial therapy