THE EFFECT OF NEBULIZED SALBUTAMOL ON SERUM POTASSIUM AND BLOOD SUGAR LEVEL OF ASTHMATIC PATIENTS

Background: To evaluate the effect of nebulized salbutamol used in the management of patients with asthma who have normal serum potassium and blood glucose levels. Methods: Hospital based prospective study conducted on 30 children mild exacerbation of asthma who needed two doses of 2.5 mg nebulized salbutamol, 10 minutes apart for the relief of their symptoms will be include. Results: The potassium mean was significantly decreased after 1 hour of nebulizer administration. The random blood sugar mean was significantly increased after 1 hour of nebulizer administration (p<0.001). Conclusions: The nebulizer applying salbutamol has a profound effect in lowering the Potassium level and increasing blood glucose level after 60 minutes of administration. Keywords: effect, nebulized, salbutamol, blood sugar, serum potassium

Nebulization Practice and use of Antibiotic in the Treatment of Childhood Asthma at the Rural Area

Background : Management of childhood asthma is not optimum in our country especially at the community level. Objectives : The study was conducted to see the nebulization practice in the management of moderate and sever acute asthma in children at the community level. Methodology : This cross-sectional observational study was conducted in different private clinics and pharmacy of Daudkandi Upazila of Cumilla during the period of November 2017 to March 2018. Total 30 doctors’ diagnosed cases of acute exacerbation of moderate and severe asthma between 2-15 years of age were included in this study. Each patient’s treatment advice was followed up to see whether the use of nebulized Salbutamol and Antibiotic in the management of acute asthma was appropriate or not. All data were recorded in to a pretested proforma. Data were analyzed manually, and values were expressed as frequency and percentage. Results : Among the cases 25 (83.33%) cases had moderate and 5 (16.67%) cases had severe exacerbation of asthma. For nebulization, salbutamol was used to all cases and ipratropium bromide was added to 11 (36.7%) cases. Nebulization frequency was as per national guideline but the ratio of salbutamol respiratory solution to normal saline was not appropriate in most of the cases. Antibiotic was given to all cases and among them parenteral Ceftriaxone was given to 22 (73.3%) cases. Conclusion : Frequency of nebulization was appropriate but ratio of Salbutamol respiratory solution to normal saline was inappropriate. Antibiotic was given to all cases. Northern International Medical College Journal Vol.11 (2) Jan 2020: 471-474

COMPARISON OF TREMOR RELATED ADVERSE DRUG REACTION BETWEEN INTRAVENOUS AMINOPHYLLINE AND NEBULIZED SALBUTAMOL FOR ASTHMA EXACERBATION TREATMENT

The Department of Health estimates that asthma including 10 major causes of morbidity and mortality in the hospital. Asthma is a chronic respiratory disease that is becoming a serious health problem in many countries around the world. Drugs used in the treatment of asthma exacerbations is salbutamol and aminophylline. Drugs such as salbutamol and aminophylline can cause ADR (Adverse Drug Reaction) in the form of tremor with a sign involuntary shaking part of the hand. This research was conducted at the RSAL Dr. Oepomo to sample Aminofilin and in hospitals Seowandi to sample Salbutamol. The method used was quasi experimental. This study was conducted to compare the incidence of tremor in both asthma drug that is often used for the treatment of asthma such as Salbutamol and Aminofilin. The results of this study indicate there are differences in the incidence rate of ADR-related tremor between salbutamol and Aminofilin. Knowing the difference in incidence rate of tremor between aminophylline and salbutamol can assist in the selection of treatment which safer to avoid the effects of tremors that can occur from the use of of drugs asthma exacerbations.

Salbutamol nebulization for management of transient tachypnea of newborn (TTN).

Objective: To compare the mean change in respiratory rate with salbutamol nebulization versus placebo for treatment of transient tacyopnea of newborn. Study Design: Randomized Control Trial. Setting: Department of Neonatology, Federal Government Polyclinic (PGMI), Islamabad. Period: 8th August 2017 to 7th February 2018. Material & Methods: 100 neonates fulfilling selection criteria were enrolled in the study. Informed consent was obtained from parents. Demographic information was also noted. All baseline respiratory rate were noted. Neonates were divided into two groups by lottery method. Neonates in Treatment group were nebulized with Salbutamol. Placebo group was nebulized with Normal Saline. Then neonates were followed-up in N.I.C.U after 4 hours of second nebulization. After 4 hours, respiratory rates were assessed and change in respiratory rate was noted. Both groups were compared for mean reduction in respiratory rate by using independent sample t-test. Results: In nebulized salbutamol, group, mean respiratory rate was changed from 79.62±8.18bpm to 52.06±4.96bpm. This was a significant decrease (p<0.05). In placebo group, mean respiratory rate was changed from 81.88±8.86bpm to 62.50±6.75bpm. This was significant decrease (p<0.05). The difference between both groups at baseline was insignificant while after 4 hours was significant. The mean changed in respiratory rate with nebulized salbutamol was 27.56±6.83bpm while with placebo was 19.35±9.83bpm. There was significant difference in mean reduction in respiratory rate (p<0.05). Conclusion: It has been proved that nebulized salbutamol can be helpful in reducing respiratory rate significantly in neonates with TTN as compared to placebo.

Nebulized heparin and salbutamol versus salbutamol alone in acute exacerbations of chronic obstructive pulmonary disease requiring mechanical ventilation: a double-blind randomized controlled trial

BackgroundNebulized heparin has been effectively used in the management of many pulmonary diseases. However, its effect on mechanically ventilated patients with acute exacerbation chronic obstructive pulmonary disease (AECOPD) has never been studied. This study aimed to assess the efficacy of nebulized heparin and salbutamol to increase ventilator-free days (VFD) in mechanically ventilated AECOPD patients and the effect of nebulized heparin on respiratory and coagulation functions.MethodsIn this double-blind controlled study, 60 mechanically ventilated adult patients with AECOPD were randomly allocated into two groups; heparin and salbutamol (HS) group and salbutamol only (S) group. In the HS group, patients received nebulized heparin (25,000 IU) and salbutamol (5 mg) every 6 hours. Patients in the S group received nebulized salbutamol only (5 mg). The treatment was continued while patients remained ventilated for a maximum of 14 days. The primary outcome was VFDs at day 14. PaCO2, PaO2/FiO2 ratio, number of nebulizations withheld, C-reactive protein (CRP) titer and activated partial thromboplastin time (APTT) were secondary outcomes.ResultsPatients in the HS group had significantly more VFDs (4.7 [3.3]) compared with those in the S group (2.4 [2.6]), P = 0.007. PaCO2 levels, PaO2/FiO2, the decrease in the CRP level and the increase in the APTT from the baseline were comparable in both groups.ConclusionsThe co-administration of nebulized heparin and salbutamol, compared with salbutamol alone, significantly increased (VFDs) among mechanically ventilated AECOPD patients without increasing bleeding risks.

Case Report of Severe Lactic Acidosis and Persistent Diastolic Hypotension After Standard Dose Intermittent Salbutamol Nebulization in a Child: Rare Adverse Effects for Common Treatment.

BackgroundSalbutamol is a selective β2 receptor agonist widely used to treat asthma and other conditions and it often represents the treatment of choice for reversing airflow obstruction both in emergency and domiciliary settings. However, it can be associated to a broad spectrum of side effects and even paradox effects, if administered intravenously, at high doses continuous nebulized treatment and even at standard doses intermittent nebulized treatment, the latter being the most hazardous due to its infrequency. Lactic acidosis and persistent diastolic hypotension secondary to intermittent salbutamol nebulization are rare in children, moreover at standard therapeutic doses during asthma exacerbations.Case presentation We present a case of a 12 year-old boy, 34 Kg, who experienced a serious drug reaction during a moderate asthma attack, after intermittent inhaled (0.2 mg in 3 hours interval – overall 1.4 mg in 24 hours before arrival) and nebulized treatment (3.25 mg in 20 minutes interval in 60 minutes, overall 11.25 mg in our ED). He began experiencing symptoms of toxicity (tremor) in the emergency department few minutes after administration of the second dose of nebulized salbutamol, without reporting that to health care providers. Few minutes after the end of the third nebulized dose, clinical conditions worsened showing hyperglycemia (highest value 222 mg/dl), hypokalemia (lowest value 2.6 mEq/L), electrocardiogram alterations, decreased blood pressure (lowest value 87/33 mm/Hg), increased lactate serum level (highest value 8.1 mmol/L). The patient fully recovered after discontinuation of salbutamol and was discharged after 24 hours of staying in the intensive brief observation unit of our pediatric emergency department.ConclusionsWe reinforce the message that not only intravenous administration or continuous nebulization of salbutamol can lead to severe complication in children, but also intermittent therapy given at standard doses. Then, health care providers should pay attention not only in emergency settings in order to achieve prompt recognition and proper management of this adverse reaction.

Efficacy of Nebulized Magnesium Sulphate in the Treatment of Acute Bronchial Asthma Compared to Nebulized Salbutamol: A Randomized Control Trial

Background: Nebulized salbutamol is commonly used in treatment of asthma in children. The use of nebulized MgSO4 is one of the different treatment options available during acute exacerbation. Objective: To compare the efficacy of nebulized MgSO4 with nebulized salbutamol in the treatment of acute asthma in children. Materials and method: This randomized controlled study was conducted in Dhaka Medical College Hospital between January to December 2016. Children of 7-12 years with acute exacerbation of asthma were randomized into study group-A (MgSO4 group, n=30) and control group-B (Salbutamol group, n=30). Children of both groups were treated with serial nebulization thrice at 20 minute intervals by either 2.4 ml (4% MgSO4, 96 mg) or salbutamol (0.15 mg/kg minimum 2.5 mg) with 2.5 ml of isotonic normal saline. Results: The mean final PEFR were not different between the two groups (275.0±41.42 L/min in MgS04 group and 263±36.17 L/min in salbutamol group). The increase in PEF was statistically significant and comparable in both groups (by 35.1% in the MgS04 group and by 42.1% in the salbutamol group). Fischl score improvement was comparable and significant in both groups (4.31 to 0.43 in MgS04 group and 4.29 to 0.76 in salbutamol group). Statistically significant increase in oxygen saturation and reduction of heart rate was found in MgS04 group without any side effects. Nebulized MgSO4 was found having significant bronchodilator effect which is comparable to salbutamol. Conclusion: Nebulized MgS04 was found equally effective as nebulized salbutamol in the treatment of severe acute asthma in children. Bangladesh J Child Health 2020; VOL 44 (1) :24-29

Utility of Rapid Exome Sequencing in the Diagnosis of a Rare Congenital Myasthenic Syndromes in a Preterm Infant

Congenital myasthenic syndromes (CMS) are rare and challenging diagnoses in preterm neonates. We presented in this case report a preterm infant with recurrent extubation failures. An exhaustive workup to rule out common etiologies of chronic ventilator dependence was negative including a neostigmine trial, acetylcholine receptor antibodies, and chromosomal microarray. Electromyography (EMG) showed features of a neuromuscular junction defect. After ruling out metabolic, inflammatory, and immune mediated causes, a rapid exome sequencing demonstrated CHRNB1 gene mutation diagnostic of autosomal dominant slow channel CMS. The patient was started on fluoxetine and nebulized salbutamol with a gradual improvement in her respiratory function over time with minimal ventilator support.