DELHI, India (Reuters Health) – Subcutaneous epinephrine is as effective as nebulized salbutamol (albuterol) in the treatment of acute asthma in children, Indian researchers report.
Drs. Anita Sharma and Arvind Madan, from Pt. B. D. Sharma Postgraduate Institute of Medical Sciences, Rohtak, conducted a study of 50 children between 6 and 14 years with acute asthma.
Half of the children received a maximum of 0.01 mL/kg of epinephrine subcutaneously, in a solution containing 1 mg/mL of epinephrine. The other half received 0.03 mL/kg/dose salbutamol in a 0.5% respiratory solution (to a maximum of 1 mL/dose) administered via nebulizer. The medications were both given in three doses at 20 minute intervals.
Children in both the groups received oxygen and other supportive measures. The investigators measured clinical parameters, including respiratory rate, heart rate and blood pressure. Peak expiratory flow rate (PEFR) was also monitored using Wright's mini peak flow meter.
The improvement, noted clinically and by an increase in the PEFR, was similar in both the groups, the investigators report in the December 2001 issue of Indian Journal of Pediatrics. The PEFR increased by over 25% in both the groups 4 hours after initiation of treatment, and the difference between the groups was not statistically significant.
While the heart rate and systolic blood pressure was higher in the epinephrine group 30 minutes after starting treatment, subsequently there no significant difference between the two groups.
Tremors and palpitations, which subsided spontaneously, were noted in both groups. There was no significant difference in side effects between the groups. Four children each in both the groups were classified as non-responders at the end of 4 hours and were started on aminophylline and parenteral steroids, the researchers note.
The researchers acknowledged that though previous studies have also found subcutaneous epinephrine as effective and safe as nebulized salbutamol, salbutamol is still preferred because of its selective action on the bronchial musculature and ease of administration.
However, epinephrine is still used in situations where nebulization may not be successful, as in unconscious patients and in cases of very severe asthma where the bronchoconstriction and poor air entry may limit the absorption of nebulized bronchodilators, Drs. Sharma and Madan note. "Side effects [of epinephrine] can be minimised by restricting the dose to 0.03 mL/dose in older children and 0.05 mL/dose in small children" and in avoiding the use of epinephrine in patients with cardiac abnormalities, they recommend.
"Subcutaneous epinephrine can be safely used provided the maximal dose is adhered to," especially in situations where nebulizers may not be affordable or power supply is irregular, the researchers conclude.