Comparison of two dosage regimens of albuterol in acute asthma

Background: The standard therapy for acute episodes of asthma in the United States consists of three 2.5-mg doses of aerosolized albuterol given every 20 minutes. Whether this approach represents optimum therapy has never been tested. Methods: This study employed a prospective, sequential design in which the effects of two doses of 5.0 mg of aerosolized albuterol administered during 40 minutes (high dose) were contrasted with the standard dose (three 2.5-mg doses). Improvements in pulmonary function, clinical resolution of the asthma attacks, and admission rates were used as primary endpoints. Both regimens were part of an overall care plan that involved objective, pretested decision algorithms. Results: In an emergency department, 160 patients who presented with acute exacerbations of asthma received either standard (n = 80) or high-dose (n = 80) albuterol treatment. There were no significant baseline differences in gender, racial composition, clinical signs and symptoms, medication use, or peak expiratory flow (PEF) between the groups. Both treatment schedules were effective, but the high-dose regimen increased lung function more rapidly and to a greater extent than standard-dose therapy. It also resulted in lower charges to third party payers. More subjects attained the discharge criteria quicker and left the emergency department with peak expiratory flows closer to normal. Fewer patients in the high-dose group were admitted, but this trend did not quite reach statistical significance. Conclusions: Two 5.0-mg treatments of aerosolized albuterol at a 40-minute interval provide effective therapy for acute exacerbations of asthma. This combination of dose and frequency promotes maximum bronchodilatation, increases efficiency, and reduces the risks of undertreatment.