nebulized atropine sulfate in the treatment of acute asthma: owens mw, george rb chest...

Abstracts

Abstracts in this issue were

prepared by residents in the

Denver General/St Anthony's/

St Joseph Hospitals Emergency

Medicine Residency Program

Richard Dart, MD

Co-Editor

Section of Emergency Medicine

University of Arizona College

of Medicine

Tucson, Arizona

Vincent J Markovchick, MD,

FACEP

Co-Editor

Emergency Medical Services

Denver General Hospital

Denver, Colorado

William A Robinson, MD, FACEP

Co-Editor

Department of Emergency

Medicine

University of Missouri-Kansas City

School of Medicine

Kansas City, Missouri

asthma

Comparison of albuterol and metaproterenol syrup in the treatment of childhood asthma Wolfe JD, Shapiro GG, Rather PH Pediatrics 88:312-319 Aug 1991

While inhaled rtagonist therapy is generally preferred over oral thera- py, there are instances in which the former is not practical in the pedi- atric population, and oral I~-agonist therapy becomes necessary. A prospective, randomized study enrolled 65 children between ages 6 and 9 in a four-week study in which each was placed on either albuterol syrup (2 mg) or metaproterenol syrup (10 rag) three times a day. Patients were evaluated on days 1 and 28 and monitored their symptoms and peak flow at home. On day 1, the improvement in FEV 1 after albuterol was significantly greater than after metaproterenol (28% vs 20%). Patients using albuterol at home also had a higher mean FEV 1 on day 28. The effect of albuterol lasted longer on both days 1 and 28. Mean peak flows at home did not differ significantly between the two thera- pies. Both drugs caused mild increases in baseline heart rate and systolic blood pressure, but metapro- terenol's effects were slightly greater and lasted longer. Both had similar low incidences of adverse

side effects, mostly gastrointestinal and central nervous sytem. The authors concluded that for the above reasons albuterol had therapeutic advantages over metaproterenol.

Mark Radlauer, MD

atropine, asthma

Nebulized atropine sulfate in the treatment of acute asthma Owens MW, George RB Chest 99:1084-1087 May 1991

This study was designed to deter- mine whether atropine sulfate increases bronchodilation when added to an inhaled r&-adrenergic agonist during the initial treatment (first two hours) of an acute asthma attack. Forty adult asthmatics pre- senting to the emergency depart- ment with acute exacerbations of asthma were randemized in a dou- ble-blinded fashion to receive metaproterenol (0.3 mL of a 5% solution), either alone or with atropine sulfate (2.5 mg), by nebu- lization. Spiremetry, vital signs, and the presence of side effects at 0, 30, 60, and 120 minutes after treatment were determined. There were no significant differences between the metaproterenol alone and the meta- proterenol plus atropine groups with regard to age, duration of asthma, baseline spirometry, side effects, changes in baseline FEV 1 and FVC during the observation period, or

disposition. The authors concluded that nebulized atropine sulfate yields no additional bronchodilation when added to nebulized metaproterenol during the initial treatment of an acute exacerbation of asthma.

Mark Cope~and, MD

myocardial ischemia, B-blockers

Attenuation of myocardial ischemia during coronary occlusion by uhrashort-aeting beta adrenergie blockade Labovitz AJ, Barth C, Castdlo R, et al Am Heart J 121.1347-1351 May 1991

The use of f& blockade in the setting of acute myocardial ischemia has been shown to be cardioprotective in terms of morbidity and mortality. This prospective study evaluated the effect of esmolol, a short-acting &-blocker, on ischemia during acute coronary arterial occlusion. Electro- cardiography and echocardiography were performed continuously on 16 patients undergoing coronary angio- plasty. Balloon occlusion and mea- surements were done before and then during esmolol infusion. ST segment elevations occurred in 14 of 16 patients prior to esmolol infu- sion. Esmolol infusion significantly reduced both the height and duration of the ST changes.Echo-

JANUARY 1992 21:1 ANNALS OF EMERGENCY MEDICINE 1 0 3 / 1 3 7 I