We studied 46 consecutive eligible patients who presented to the Emergency Department of the Sir Mortimer B. Davis-Jewish General Hospital, Montreal, because of an exacerbation of asthma. Entry requirements dictated that subjects be at least 18 years of age and have a previous diagnosis of asthma as defined by the American Thoracic Society (ATS) criteria. Patients with complicating medical illnesses such as pneumonia, ischemic heart disease (acute or chronic), frequent ventricular premature beats, or diabetes mellitus were excluded from the study. Pregnant women and nursing mothers were also ineligible for this protocol. This study was approved by the ethics committee of the Sir Mortimer B. Davis- Jewish General Hospital. Signed informed consent was obtained from each patient.
Forty-six patients were randomized to one of two treatment protocols. Each treatment period was of 2 hours* duration.
Bolus Nebulization (BN): Subjects received albuterol (Ventolin, Glaxo, Ganada) by intermittent nebulization at time 0 and 1 hour later. The dose of albuterol used was 5.0 mg (1.0 ml diluted in 2.0 ml of normal saline solution). This solution was delivered via a facemask by an Airlife-Misty Nebulizer (American Pharmaseal Co, Valencia, Calif) driven by 100 percent oxygen at a flow of 5 to 8 L/min. The particle size of the nebulized solution was 3.56 ± 0.089 um. The medication was delivered throughout the respiratory cycle and How was not interrupted during expiration. Nebulization time was 10 to 15 minutes and was terminated when no solution was visible in the reservoir. After 2 hours each subject had received two treatments for a total of 10 mg of albuterol and the study was terminated.
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Contimums Xcbulizatioti (C\): Subjects received albuterol by continuous nebulization that was uninterrupted for 2 hours except for brief intervals when spirometry was performed. Albuterol nebulizer solution 100 тд (20 ml) was mixed with 480 ml of saline solution and was nebulized continuously via a facemask using a Jet nebulizer No. 5207 (Seamless, Oeala, Fla) driven by oxygen at 5 to 8 L/min. The nebulizer employed had previously been calibrated and had a constant output of 50.6±2.7 (mean±SD) ml for two hours when the initial volume in the nebulizer was 500 ml. Therefore, each patient should have received 10.1 ±0.54 mg of albuterol over 2 hours. Seventy percent of particles emitted from this nebulizer are less than 5
All patients were examined and treated under the supervision of the Emergency Department physicians. The nebulized medication described above was the initial aerosol or p-agonist therapy administered. Intravenous aminophylline and/or corticosteroids were given at the discretion of these physicians. All other medications were prohibited.