It is generally accepted that inhaled p-agonists are efficacious in the treatment of acute asthma in patients presenting to the emergency department. More controversial, however, is the choice of dose, frequency of treatment, and method of delivery associated with optimal bronchodilation. Currently, standard therapy in most hospitals involves the administration of a Э-agonist at frequent intervals, often every 30 to 120 minutes in acutely ill patients. However, this approach is labor intensive and requires repeated visits by the respiratory therapist. In addition, relatively high doses of medication are used in an intermittent fashion potentially resulting in peaks and troughs of bronchodilator delivery over time. One appealing alternative has been the administration of (3-agonist by continuous nebulization. The pharmacologic rationale for this approach is analogous to that used when systemic agents such as heparin or ami- nophylline are given via continuous infusion rather than the bolus technique. Uncontrolled studies in asthmatic children have demonstrated that f32-agonists may be safely and effectively administered by continuous nebulization. However, this approach has not been reported in the acute management of adult asthmatics. In this study we evaluated the safety and efficacy of continuously nebulized albuterol (salbutamol) in the initial emergency treatment of asthma. The results indicate that this method was safe and well tolerated by the patients. It was as effective as intermittently nebulized albuterol in the first two hours of treatment in patients with acute asthma.
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