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Wong MWH, Chien LC, Bhammar DM. Acute Effects of Albuterol on Ventilatory Capacity in Children with Asthma. Pediatr Rep 2024; 16:46-56. [PMID: 38251314 PMCID: PMC10801572 DOI: 10.3390/pediatric16010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Children with asthma may have a reduced ventilatory capacity, which could lead to symptoms and early termination of a cardiopulmonary exercise test (CPET). The purpose of this study was to examine the effects of short-acting beta agonist (albuterol) administration on estimated ventilatory capacity in children with asthma. METHODS Fifteen children (eleven boys, 10.6 ± 0.9 years) completed spirometry at baseline, after 180 µg of albuterol, and after the CPET in this cross-sectional study. Ventilatory capacity was calculated from forced vital capacity (FVC) and isovolume forced expiratory time from 25 to 75% of FVC (isoFET25-75) as follows: FVC/2 × [60/(2 × isoFET25-75)]. Differences in outcome variables between baseline, after albuterol administration, and after the CPET were detected with repeated measures mixed models with Bonferroni post hoc corrections. RESULTS Estimated ventilatory capacity was higher after albuterol (68.7 ± 21.2 L/min) and after the CPET (75.8 ± 25.6 L/min) when compared with baseline (60.9 ± 22.0 L/min; P = 0.003). Because forced vital capacity did not change, the increased ventilatory capacity was primarily due to a decrease in isoFET25-75 (i.e., an increase in mid-flows or isoFEF25-75). CONCLUSION Albuterol administration could be considered prior to CPET for children with asthma with relatively well-preserved FEV1 values to increase ventilatory capacity pre-exercise and potentially avoid symptom-limited early termination of testing.
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Affiliation(s)
- Michael W. H. Wong
- Department of Kinesiology and Nutrition Sciences, School of Integrated Health Sciences, University of Nevada Las Vegas, Las Vegas, NV 89154, USA;
| | - Lung-Chang Chien
- Department of Epidemiology and Biostatistics, School of Public Health, University of Nevada Las Vegas, Las Vegas, NV 89154, USA;
| | - Dharini M. Bhammar
- Center for Tobacco Research, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Agbim C, Fornari M, Willner E, Isbey S, Berkowitz D, Palacious K, Badolato G, McIver M. Improving Care at Emergency Department Discharge for Pediatric Patients with Anaphylaxis Using a Quality Improvement Framework. Pediatr Qual Saf 2022; 7:e589. [PMID: 38584958 PMCID: PMC10997310 DOI: 10.1097/pq9.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/27/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Anaphylaxis is a potentially fatal systemic reaction that requires prompt recognition and targeted treatment. Despite international consensus and national guidelines, there is often incomplete care for pediatric patients discharged from the emergency department (ED) with a diagnosis of anaphylaxis. Our institution experienced wide variability in discharge planning for patients with anaphylaxis. The goal of our study was to improve care at ED discharge for pediatric patients with anaphylaxis using a quality improvement framework. The specific aims were to increase the frequency of patients diagnosed with anaphylaxis who receive an anaphylaxis action plan at ED discharge from 0% to 60% and to increase referrals to an allergy clinic from a baseline of 61%-80% between October 2020 and April 2021. Methods Targeted interventions included revisions to the electronic health record system, forging interdisciplinary partnerships and emphasizing provider education. Outcome measures were the proportion of patients receiving an anaphylaxis action plan and an allergy clinic follow-up. The balancing measure was the ED length of stay. Results The study showed an increase in anaphylaxis action plans from 0% to 34%. Allergy clinic referral rates improved from 61% to 82% within the same period. The average length of stay of 347 minutes remained unchanged. Conclusions Revising the discharge instructions to include an anaphylaxis action plan and reinforcing provider behaviors with educational interventions led to an overall improvement in discharge care for patients with anaphylaxis. Future work will focus on electronic health record changes to continue progress in additional clinical settings.
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Affiliation(s)
- Chisom Agbim
- From the Emergency Department, Children’s Hospital Colorado, Aurora, CO
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Marci Fornari
- Emergency Department, Children’s National Hospital, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Emily Willner
- Emergency Department, Children’s National Hospital, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Sarah Isbey
- Emergency Department, Children’s National Hospital, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Deena Berkowitz
- Emergency Department, Children’s National Hospital, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | - Katura Palacious
- Emergency Department, Children’s National Hospital, Washington, DC
| | - Gia Badolato
- Emergency Department, Children’s National Hospital, Washington, DC
| | - Mandisa McIver
- Emergency Department, Children’s National Hospital, Washington, DC
- Department of Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC
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Burger C, Vendiola DF, Arnold DH. Nebulized albuterol delivery is associated with decreased skeletal muscle strength in comparison with metered-dose inhaler delivery among children with acute asthma exacerbations. J Am Coll Emerg Physicians Open 2021; 2:e12422. [PMID: 33855311 PMCID: PMC8032924 DOI: 10.1002/emp2.12422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/25/2021] [Accepted: 03/10/2021] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Albuterol is a β2-agonist and causes an intracellular shift of potassium from the interstitium. Whole-body hypokalemia is known to cause skeletal muscle weakness, but whether this occurs as a result of hypokalemia from the intracellular shift during albuterol treatment is unknown. We sought to determine if albuterol total dose or route of administration (nebulization and/or metered-dose inhaler) is associated with skeletal muscle weakness. METHODS This was a prospective observational study using convenience sampling. Skeletal muscle strength was measured before and after 1 hour of albuterol treatment using a hand-grip dynamometer in participants aged 5-17 years with acute asthma exacerbation in the emergency department. We examined associations of albuterol dose and route of administration with changes in grip strength. RESULTS Among 50 participants, 10 received continuous albuterol by nebulizer and 40 received albuterol by metered-dose inhaler. The median (interquartile range) in change of grip was -7.8% (interquartile range, -23.3, +5.1) for those treated with a nebulizer and +2.4% (interquartile range, -5%, +12.7%) for those treated with a metered-dose inhaler (P = 0.036 for the difference). In a multiple linear regression model adjusted for the pretreatment Acute Asthma Intensity Research Score and age, participants treated with a nebulizer had a 12.9% decrease in skeletal muscle strength compared with those treated with a metered-dose inhaler. CONCLUSION Higher doses of albuterol administered via nebulization result in decreased skeletal muscle strength in patients with acute asthma; whereas, albuterol administration via metered-dose inhalers showed no effect on skeletal muscle strength.
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Affiliation(s)
- Catherine Burger
- Department of PediatricsDivision of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Department of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Danica F. Vendiola
- Vanderbilt Undergraduate Clinical Research Internship ProgramNashvilleTennesseeUSA
| | - Donald H. Arnold
- Department of PediatricsDivision of Emergency MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
- Center for Asthma ResearchVanderbilt University School of MedicineNashvilleTennesseeUSA
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Nomura O, Ihara T, Morikawa Y, Sakakibara H, Hagiwara Y, Inoue N, Akasawa A. Metered-dose inhaler ipratropium bromide for children with acute asthma exacerbation: A prospective, non-randomized, observational study. Pediatr Int 2020; 62:319-323. [PMID: 31930755 DOI: 10.1111/ped.14146] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/13/2019] [Accepted: 12/23/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ipratropium bromide (IB), when administered with β2-agonists, is effective in reducing hospital admissions of children presenting to the emergency department (ED) with severe asthma. While IB is commonly delivered in its nebulized form, using a metered-dose inhaler (MDI), can, reportedly, shorten patients' length of stay in the ED. However, the effectiveness and safety of IB administration using an MDI with a spacer have not been established. This study aimed to investigate the effectiveness and safety of MDI-delivered IB in pediatric patients with acute asthma exacerbation. METHODS This prospective, non-randomized, observational study included patients aged ≥4 years with a history of severe asthma exacerbation. Patients received IB via MDI with a spacer three times at 20-min intervals. IB use was determined by the physicians' treatment policy. Propensity score matching was used to adjust the confounding factors related to IB administration. RESULTS Of the 158 patients, 88 were treated with IB and 70 were treated without IB. A propensity score-matching analysis extracted 54 patients from each group. We found no statistical difference in the admission rate of the two groups (IB group: 25.9% vs non-IB group: 31.5%; P = 0.67). The post-treatment modified pulmonary index scores (mean ± SD) were also similar (IB: 6.6 ± 2.0 vs non-IB: 6.3 ± 2.5; P = 0.53). Only one patient (1.0%) treated with IB experienced vomiting, which resolved spontaneously. CONCLUSION The metered-dose inhaler IB was ineffective in reducing the admission rate possibly because it was less effective than a nebulizer for IB inhalation.
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Affiliation(s)
- Osamu Nomura
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical , Tokyo, Japan.,Department of Emergency and Disaster Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Takateru Ihara
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical , Tokyo, Japan
| | - Yoshihiko Morikawa
- Clinical Research Support Center, Tokyo Metropolitan Children's Medical Center, Tokyo
| | - Hiroshi Sakakibara
- Departments of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Japan, Tokyo
| | - Yusuke Hagiwara
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical , Tokyo, Japan
| | - Nobuaki Inoue
- Division of Pediatric Emergency Medicine, Tokyo Metropolitan Children's Medical , Tokyo, Japan
| | - Akira Akasawa
- Department of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
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Heidi M, Emily K, Benjamin H, Michael C, Robert K, Mitch B, Chris G, Mando W, Andrew B. Patient reported outcomes for preschool children with recurrent wheeze. NPJ Prim Care Respir Med 2019; 29:7. [PMID: 30914646 PMCID: PMC6435695 DOI: 10.1038/s41533-019-0120-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 02/26/2019] [Indexed: 01/21/2023] Open
Abstract
Children with preschool wheeze regularly attend UK emergency departments. There is no international consensus on any specific personalised management approach. This paper describes the first attempt to co-design patient-centred outcomes with families. Preschool wheezers' parents participated in semi-structured interviews and focus-group discussions to air their concerns and identify potential additional support. Fifty-seven families participated in these interviews. From these, themes were defined through qualitative content analysis. Parental experience was mapped to the patient pathway and seven important personalised outcomes were described. These can be used to inform a tool which following further validation could potentially support management of children with preschool wheeze and provide an additional patient focused clinical outcome measure in audit and research.
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Affiliation(s)
- Makrinioti Heidi
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK.
| | - Keating Emily
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Holden Benjamin
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Coren Michael
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Klaber Robert
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Blair Mitch
- Department of Paediatrics, Northwick Park Hospital, North West London Hospitals NHS Trust, London, UK.,Division of Medicine, Imperial College, London, UK
| | - Griffiths Chris
- Asthma UK Centre for Applied Research, Centre for Primary Care and Public Health, Blizard Institute, Barts and the London, School of Medicine and Dentistry, London, E1 2AT, UK
| | - Watson Mando
- Department of Paediatrics, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Bush Andrew
- Division of Medicine, Imperial College, London, UK.,National Heart and Lung Institute, Imperial College, London, UK
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