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Continuous albuterol well tolerated in inpatient setting
Recent data show low rates of adverse outcomes after receipt of continuous albuterol in a non-ICU, inpatient setting, an indication that the treatment can be delivered effectively with appropriate support structures and care processes.
Chén C. Kenyon, MD, MSHP, of The Children’s Hospital of Philadelphia, and colleagues assessed electronic medical record data for children discharged from an inpatient floor with a primary or secondary diagnosis of asthma, an order for the asthma pathway during hospitalization, and a standing order for inhaled albuterol administered at least every 2 hours. Study participants were aged 2 to 18 years and were discharged from July 2011 to June 2013.
Of the 3,003 children initially admitted to the inpatient unit with an asthma pathway order, 1,298 received continuous aerosolized albuterol and 1,705 received intermittent albuterol.
Children receiving continuous albuterol were older than children receiving intermittent albuterol. There was a greater proportion of children receiving continuous therapy who were black compared with those receiving intermittent therapy.
More children receiving continuous albuterol had at least one ED visit in the previous year than those receiving intermittent albuterol (53% vs. 40%). Thirty-one percent of children receiving continuous albuterol were hospitalized at least once in the last year vs. 22% of children receiving intermittent therapy.
Children on continuous albuterol had a higher age-standardized heart rate and respiratory zscores at ED presentation and at admission compared with those on intermittent therapy.
Median duration of therapy was 14.4 hours for children receiving continuous albuterol. They also averaged 3.6 hours longer on the moderate portion of the pathway compared with children receiving intermittent albuterol. Children on continuous therapy had a longer average length of stay compared with children on intermittent therapy — 57 vs. 40.2 hours.
Twenty-six percent of children on continuous therapy received treatment for more than 24 hours. Of these, 33 children were transferred to the ICU.
Fifty-three children were transferred to the ICU, 49 received enhanced respiratory support and 32 experienced both, indicating 70 patients (5%) clinically deteriorated.
None of the children receiving continuous albuterol were intubated.
Analysis indicated that age older than 5 years, gastroesophageal reflux disease diagnosis, food allergy diagnosis and higher age-standardized heart rate at admission were associated with prolonged therapy. Odds of prolonged therapy decreased as number of previous ED visits increased. Prolonged therapy and failure to respond were associated with higher number of previous hospitalizations, receipt of magnesium or terbutaline in the ED and concomitant pneumonia diagnosis. Children with a higher age-standardized respiratory rate at admission were more likely to clinically deteriorate.
The percentage of children with serum potassium levels less than 3 mEq/L did not significantly differ between children on continuous or intermittent therapy (12.2% vs. 11%). Similarly, the number of children diagnosed with arrhythmia did not significantly differ between children receiving intermittent or continuous albuterol (0.8% vs. 0.5%).
“Our data suggest that continuous aerosolized albuterol may be safely provided on the inpatient floor with appropriate staff support. These data may serve as a starting point for future assessments of continuous albuterol across institutions, with varying staffing models and approaches to the inpatient care of severe asthma,” the researchers concluded.
Disclosure: The researchers report no relevant financial disclosures.
