Intravenous salbutamol for childhood asthma: evidence-based medicine?

Abstract

Intravenous salbutamol is commonly used to treat children with severe asthma unresponsive to inhaled β2-agonist therapy. However, in this setting, there is little clinical trial data demonstrating its effectiveness. Additionally, there are significant concerns that intravenous salbutamol-dosing recommendations for children with acute asthma are excessive, and unnecessarily raise the potential for adverse reactions, such as lactic acidosis and tachycardia which, by increasing respiratory workload, exacerbate respiratory failure. Here, we review salbutamol clinical pharmacology and toxicology, evidence relating to its use in acute asthma and highlight gaps in the evidence base.

Variation in treatment of acute childhood wheeze in emergency departments of the United Kingdom and Ireland: an international survey of clinician practice

“…We defined these terms through reference to available CPGs, though some would reserve the term ‘loading’ for a dose which is followed by continuous infusion and ‘bolus’ for a dose not followed by an infusion. There is threefold and 10-fold variation in bolus doses and continuous infusion rates, respectively, and infrequent usage of loading doses, reflecting the paucity of evidence on the pharmacokinetics of intravenous salbutamol 18. BTS/SIGN guidelines suggest a bolus of 15 μg/kg over 10 min, followed by an infusion of 1–5 μg/kg/min if required with no loading dose described.…”

Impurity Profile and Validation of Pharmaceutical (Api) Bulk Drug

“…Serious side effects may include worsening bronchospasm, irregular heartbeat and low blood potassium levels. [4] It can be used during pregnancy and breastfeeding, but safety is not entirely clear. It is a short-acting β 2 adrenergic receptor agonist which works by causing airway smooth muscles to relax.…”

Solving the problem of dose optimization of children’s medicines

“…This trial involved 29 children, only 14 of whom received the active drug. This regimen means that children aged 2 and above who weigh 20 kg or over will receive the same bolus dose as an adult [14]. Pharmacokinetic simulations predict that this dosing regimen puts children at significant risk of experiencing systemic salbutamol concentrations in the toxic range, and thus increases the risk of adverse effects [14].…”