Prospective, Randomized Trial of Epinephrine, Metaproterenol, and Both in the Prehospital Treatment of Asthma in the Adult Patient

Quadrel, Mark; Lavery, Robert F.; Jaker, Michael; Atkin, Suzanne H.; Tortella, Bartholomew J.; Cody, Ronald P.

doi:10.1016/s0196-0644(95)70116-8

Cited by 25 publications

(6 citation statements)

References 10 publications

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“…No deaths or intubations were recorded in the final outcomes of any study. Quadrel et al 25 reported exclusion of two participants from the analysis as they were withdrawn due to need for intubation. One patient received epinephrine, the other metaproterenol.…”

Section: Resultsmentioning

confidence: 99%

Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

Baggott

Hardy

Sparks

et al. 2021

Thorax

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BackgroundInternational asthma guidelines recommend against epinephrine (adrenaline) administration in acute asthma unless associated with anaphylaxis or angio-oedema. However, administration of intramuscular epinephrine in addition to nebulised selective β2-agonist is recommended for acute severe or life-threatening asthma in many prehospital guidelines. We conducted a systematic review to determine the efficacy of epinephrine in comparison to selective β2-agonist in acute asthma.MethodsWe included peer-reviewed publications of randomised controlled trials (RCTs) that enrolled children or adults in any healthcare setting and compared epinephrine by any route to selective β2-agonist by any route for an acute asthma exacerbation. The primary outcome was treatment failure, including hospitalisation, need for intubation or death.ResultsThirty-eight of 1140 studies were included. Overall quality of evidence was low. Seventeen studies contributed data on 1299 participants to the meta-analysis. There was significant statistical heterogeneity, I2=56%. The pooled Peto’s OR for treatment failure with epinephrine versus selective β2-agonist was 0.99 (0.75 to 1.32), p=0.95. There was strong evidence that recruitment age group was associated with different estimates of the odds of treatment failure; with studies recruiting adults-only having lower odds of treatment failure with epinephrine. It was not possible to determine whether epinephrine in addition to selective β2-agonist improved outcomes.ConclusionThe low-quality evidence available suggests that epinephrine and selective β2-agonists have similar efficacy in acute asthma. There is a need for high-quality double-blind RCTs to determine whether addition of intramuscular epinephrine to inhaled or nebulised selective β2-agonist improves outcome.PROSPERO registration numberCRD42017079472.

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Section: Resultsmentioning

confidence: 99%

Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

Baggott

Hardy

Sparks

et al. 2021

Thorax

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“…24 For patients with bronchial obstruction, improvement of the peak expiratory flow by the prehospital administration of beta agonists was demonstrated. 25 Our experience however is, that the differentiation between bronchial obstruction and cardiac failure-both leading to severe breathing disorders-is more difficult to decide for paramedics than for physicians but undoubtedly necessary for starting the right drug treatment.…”

Section: Quality Of Performancementioning

confidence: 99%

Comparing emergency medical service systems—A project of the European Emergency Data (EED) Project

et al. 2011

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“…Results consistently demonstrated a lack of benefit of parenteral medications over inhaled SABAs in pulmonary function testing [62][63][64][65][66]. One study, by Ruddy et al from 1986, demonstrated a statistically significant improvement in the Wood-Downes clinical asthma score [67] at 2 h and at discharge in the group treated with SABA (metaproterenol) [65].…”

Section: Parenteral Beta-adrenergicsmentioning

confidence: 99%

Controversies in the Care of the Acute Asthmatic in the Prehospital and Emergency Department Environments

Tennyson

2015

Curr Emerg Hosp Med Rep

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Asthma is an episodic disease of the airways characterized by inflammation and constriction of the bronchi. It has a significant societal impact with over 25 million persons affected in the United States alone and annually accounts for approximately 3300 deaths in the US. Standard therapy for acute severe asthma is effective for most patients, but controversies exist surrounding the care of the impending or actual respiratory failure patient. Non-invasive positive pressure ventilation has been effective in multiple case reports, but lacks large trial evidence to support its use. Intravenous ketamine similarly has supporting case reports, but an absence of rigorous evidence. Finally, parenteral beta-adrenergic medications have a long history of use, but have not been consistently shown to be superior to inhaled short-acting beta agonists. Further, they have been associated with higher rates of adverse effects.

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Prospective, Randomized Trial of Epinephrine, Metaproterenol, and Both in the Prehospital Treatment of Asthma in the Adult Patient

Cited by 25 publications

References 10 publications

Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis

Comparing emergency medical service systems—A project of the European Emergency Data (EED) Project

Controversies in the Care of the Acute Asthmatic in the Prehospital and Emergency Department Environments

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