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Clinical Investigations: ASTHMA |

Comparison of Single 7.5-mg Dose Treatment vs Sequential Multidose 2.5-mg Treatments With Nebulized Albuterol in the Treatment of Acute Asthma*

Rita K. Cydulka, MD, MS; E. Regis McFadden, MD; Joshua H. Sarver, BA; Charles L. Emerman, MD
Author and Funding Information

*From the Departments of Emergency Medicine (Drs. Cydulka and Emerman), Medicine (Dr. McFadden), and Epidemiology and Biostatistics (Mr. Sarver), MetroHealth Medical Center, Case Western Reserve University, School of Medicine, Cleveland, OH.

Correspondence to: Rita K. Cydulka, MD, MS, Department of Emergency Medicine, MetroHealth Medical Center, Room BG3-68, 2500 MetroHealth Dr, Cleveland, OH 44109; e-mail: rcydulka@metrohealth.org or rcydulka@aol.com



Chest. 2002;122(6):1982-1987. doi:10.1378/chest.122.6.1982
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Study objectives: The purpose of the current trial was to compare the relief of airway obstruction from treatment with a single dose of albuterol,7.5 mg (single-dose group), with that from three sequential doses of albuterol, 2.5 mg, spaced 20 min apart (multidose group).

Design: Randomized clinical trial designed to test equivalence.

Setting: Urban county hospital emergency department.

Patients or participants: Adult patients between the ages of 18 and 60 years presenting to the emergency department with acute asthma, as defined by the American Thoracic Society criteria, with FEV 1 on presentation to the emergency department of ≤ 75% of predicted were included in the study.

Interventions: After the initial evaluation, patients were administered either albuterol, 2.5 mg via nebulizer every 20 min for a total of three doses, or albuterol 7.5 mg via nebulizer in a single dose.

Measurements and results: Ninety-four patients participated, 46 in the single-dose group and 48 in the multidose group. Patients in both groups had severe obstruction on presentation to the emergency department (single-dose group pretreatment FEV1, 45% of predicted [SD, 16% of predicted]; multidose group pretreatment FEV1, 47% of predicted [SD, 17% of predicted]; p = 0.62). The primary outcome measure was the change in FEV1 percent predicted over time. The secondary outcome measures were disposition after treatment (ie, hospitalization or discharge to home) and the incidence of side effects. We noted a 44.5% improvement (SD, 56.2%) in pretreatment to posttreatment FEV1 values in the single-dose group and a 38.1% improvement (SD, 37.3%) in the multidose group (p = 0.52). A similar proportion of patients in both groups required hospitalization (single-dose group, 48%; multidose group, 41%; p = 0.51). There was a trend for the patients in the singledose group to experience more side effects than patients in the multidose group (patients in the single-dose group patients, 40% [SD, 19%]; multidose group patients, 22% [SD, 10%]; p = 0.06).

Conclusion: A single dose of 7.5 mg nebulized albuterol and sequential doses of 2.5 mg nebulized albuterol are clinically equivalent in the treatment of patients with moderate-to-severe acute asthma and result in similar dispositions from the emergency department.

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