Continuous versus intermittent nebulization of salbutamol in acute Severe asthma in children under 12 years of age

Abstract

Objective: To compare the efficacy of continuous versus intermittent nebulization of salbutamol (SB) in the treatment of acute severe asthma (ASA) in children visiting the emergency department.

Methodology: This randomized controlled trial was performed at the emergency department of pediatric medicine, The Children’s Hospital and The Institute of Child Health, Multan, Pakistan, during April 2024 to September 2024. Children aged 2-12 years, diagnosed with severe exacerbation of acute asthma, with clinical asthma score (CAS) > 8. Group-A was administered continuous SB nebulization at 0.3 mg/kg/hour for four hours, with 5-15 mg/hour. In Group-B, SB was administered intermittently at a dose of 0.15 mg/kg per dose. CAS, length of hospital stay, and treatment duration, were compared.

Results: In a total of 120 children, 68 (56.7%) were male. The mean age was 8.06±1.6 years. Between Group-A (Continuous), and Group-B (Intermittent), there were no significant differences at 20 minutes (p=0.673), 40 minutes (p=0.419), one-hour (p=0.365), two-hours (p=0.536), and four-hours (p=0.536) in terms of CAS. The time to treatment initiation (p=0.837), time to treatment stop (p=0.77), duration of treatment (p=0.084), and hospital stay duration (p=0.959) were statistically similar in both treatment groups. Both groups reported relatively higher safety profile (95.0% [n=57] patients without any side effects in Group-A vs. 96.7% [n=58] in Group-B, p=0.648).

Conclusion: Continuous, or intermittent nebulization of SB were both effective methods for treating severe exacerbation of acute asthma in children. CAS, treatment duration, or length of hospital stay between the two methods did not exhibit any significant differences.