Asthma Medications: where’s the evidence?

10 March, 2011 by: colinparker

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We like to think we practice evidence-informed medicine… but what evidence do we have that these medications work in acute asthma? Inhaled treatments make sense, and we can see them working right before our eyes, but when things get serious, response to more aggressive interventions don’t seem to be quite as convincing.

We have hand-picked a few papers to show the way, in terms of backing up the use of Magnesium, Ipratropium, Aminophylline, and IV Salbutamol (albuterol).  Join us as we skip joyfully through some evidence from the last few years.

Evidence base for drug treatments in Acute Asthma

CP: welcome, disclaimer

CP: variability of practice (Bianchi 2010, variable ED cultures)

SF: Ipratropium (Munro 2006 and Rodrigo 2005, EMMA study)

KB: Aminophylline (Mitra 2005 = Cochrane, which included Yung 1998 = RCH Melbourne)

SF: Magnesium (Markovitz 2002 bestBET, Rowe 2008)

CP: Salbutamol IV (evidence vs inhaled/nebs, adverse effects, dosing rationale):

Lawford 1978
Salmeron 1994
Browne 1997
Browne 2002

All/CP: Personal experiences, summary, goodbye


Bianchi M, Clavenna A, Bonati M. Inter-country variations in anti-asthmatic
drug prescriptions for children. Systematic review of studies published during
the 2000-2009 period. Eur J Clin Pharmacol. 2010 Sep;66(9):929-36. Epub 2010 Jun 9. Review. PubMed PMID: 20533030.

Munro A, Maconochie I. Best evidence topic reports. Beta-agonists with or
without anti-cholinergics in the treatment of acute childhood asthma? Emerg Med J. 2006 Jun;23(6):470. Review. PubMed PMID: 16714513; PubMed Central PMCID: PMC2564349.

Rodrigo GJ, Castro-Rodriguez JA. Anticholinergics in the treatment of children
and adults with acute asthma: a systematic review with meta-analysis. Thorax.
2005 Sep;60(9):740-6. Epub 2005 Jul 29. Review. Erratum in: Thorax. 2006 May;61(5):458. Thorax. 2010 Dec;65(12):1118. Thorax. 2006 Mar;61(3):274. Thorax. 2008 Nov;63(11):1029. PubMed PMID: 16055613; PubMed Central PMCID: PMC1747524.

Mitra A, Bassler D, Goodman K, Lasserson TJ, Ducharme FM. Intravenous aminophylline for acute severe asthma in children over two years receiving
inhaled bronchodilators. Cochrane Database Syst Rev. 2005 Apr 18;(2):CD001276. Review. PubMed PMID: 15846615.

Yung M, South M. Randomised controlled trial of aminophylline for severe acute
asthma. Arch Dis Child. 1998 Nov;79(5):405-10. PubMed PMID: 10193252; PubMed Central PMCID: PMC1717748.

Markovitz B. Does magnesium sulphate have a role in the management of paediatric status asthmaticus? Arch Dis Child. 2002 May;86(5):381-2. Review.
PubMed PMID: 11970943; PubMed Central PMCID: PMC1751095.

Rowe BH, Camargo CA Jr. The role of magnesium sulfate in the acute and chronic management of asthma. Curr Opin Pulm Med. 2008 Jan;14(1):70-6. Review. PubMed PMID: 18043278.

Lawford P, Jones BJ, Milledge JS. Comparison of intravenous and nebulised salbutamol in initial treatment of severe asthma. Br Med J. 1978 Jan 14;1(6105):84. PubMed PMID: 339993; PubMed Central PMCID: PMC1602586.

Salmeron S, Brochard L, Mal H, Tenaillon A, Henry-Amar M, Renon D, Duroux P, Simonneau G. Nebulized versus intravenous albuterol in hypercapnic acute asthma. A multicenter, double-blind, randomized study. Am J Respir Crit Care Med. 1994 Jun;149(6):1466-70. PubMed PMID: 8004299.

Browne GJ, Penna AS, Phung X, Soo M. Randomised trial of intravenous salbutamol in early management of acute severe asthma in children. Lancet. 1997 Feb 1;349(9048):301-5. PubMed PMID: 9024371.

Browne GJ, Trieu L, Van Asperen P. Randomized, double-blind,placebo-controlled trial of intravenous salbutamol and nebulized ipratropium bromide in early management of severe acute asthma in children presenting to an emergency department. Crit Care Med. 2002 Feb;30(2):448-53. PubMed PMID: 11889328.

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