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Abstract PCCLB-57: SALBUTAMOL PLUS IPRATROPIUM BY INHALER IS SUPERIOR TO BY NEBULIZER IN CHILDREN WITH SEVERE ACUTE ASTHMA EXACERBATION RANDOMIZED CLINICAL TRIAL

Iramain, R.1; Bogado, N.2; Castro Rodriguez, J.3; Jara, A.4; Cardozo, L.4; Morinigo, R.5; De Jesus, R.4

Pediatric Critical Care Medicine: June 2018 - Volume 19 - Issue 6S - p 261
doi: 10.1097/01.pcc.0000538142.30152.a4
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1NATIONAL UNIVERSITY OF ASUNCION, CENTRAL, ASUNCION, Paraguay

2National University of Asunción, Central, Asuncion, Paraguay

3School of Medicine- Pontificia Universidad Católica de Chile, Department of Pediatric Cardiology and Respiratory, Santiago, Chile

4National University of Asunción, Emergency Department, Asunción, Paraguay

5National University of Asunción, Emergency Department, Asuncion, Paraguay

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Aims & Objectives:

In moderate-severe asthma exacerbation, salbutamol by inhaler (MDI) is superior to by nebulizer (NEB); however, no studies in children with exclusively severe exacerbations were performed. The aim was to compare the efficacy of salbutamol plus ipratropium bromide by MDI vs. by NEB in severe asthma exacerbations.

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Methods

Methods: We performed a clinical trial enrolling 103 children (2 to 14 years of age) with severe asthma exacerbations (defined by the Pulmonary Score ≥7/9) attending at the emergency department in Asuncion, Paraguay. One group received salbutamol plus ipratropium (2 puff every 10 min for 2 hrs. and then every 30 min for 2 hrs. more) by MDI plus valved-holding chamber (MDI-SIB); and the other received nebulization (NEB-SIB) of salbutamol plus ipratropium (1 every 20 min for 2 hrs. and then every 30 min for 2 hrs. more). The principal outcome was rate of hospitalization (Pulmonary Score ≥7) after 4 hrs. Secondary outcomes were clinical score and oxygen saturation.

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Results

Results: Fifty two children received MDI-SIB and fifty one NEB-SIB. After the fourth hour children on MDI-SIB had significantly lower rate of hospital admission than on NEB-SIB (17% vs. 27%, RR: 0.21 [0.06–0.69], p=0.003, respectively). Similarly, a significant improved of clinical score after 60 min and increase in oxygen saturation after 90 min of treatment was observed in MDI-SIB vs. NEB-SIB group (4.46 ± 0.7 vs. 5.76 ± 0.65, p<0.00001; and 90.5 ± 1.7 vs. 88.43 1 ± 1, p<0.00001, respectively).

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Conclusions

Conclusion: Even in severe asthma exacerbations administration of salbutamol plus ipratropium by MDI plus valved-holding chamber was more effective than by nebulizer.

©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies