Objective: Bronchiolitis is a common respiratory infection in infants that is sometimes treated with albuterol. Response to albuterol is determined by clinical assessment, but this subjective determination is potentially unreliable. In this study, we compared providers' clinical assessment of response to albuterol with the measurement of response by pulmonary mechanics in intubated, sedated, and ventilated infants.
Design: Before and 20 minutes following racemic albuterol therapy, a nurse, respiratory therapist, and physician performed simultaneous examinations and assessed response to albuterol in a population of intubated infants with bronchiolitis. Measurements of ventilator-derived pulmonary mechanics were obtained at these same times.
Setting: This study was conducted in a PICU of a children's hospital.
Patients: Seventy-five paired clinical assessments were made in 25 infants who were intubated and mechanically ventilated for severe bronchiolitis.
Interventions: Pulmonary function measurements and clinical assessments before and after administration of albuterol.
Measurements And Main Results: Response to albuterol was defined using a threshold of improvement in respiratory system resistance from baseline. Nine children (36%) had greater than 20% change and were deemed responders. Providers' discrimination of response was poor. The positive predictive values of nurses, respiratory therapists, and physicians were 38%, 25%, and 25%, respectively, and the negative predictive values were 67%, 54%, and 59%, respectively. Overall accuracy was 44% for nurses, 40% for respiratory therapists, and 48% for physicians. When comparing separate assessments of wheezing, aeration, and expiratory time, there was poor agreement between groups of providers in all variables (κ < 0.4 for each).
Conclusions: A provider's clinical assessment was not a reliable method for determining response to albuterol in children with bronchiolitis. Without assessment of pulmonary mechanics, caution should be used in classifying children with bronchiolitis as responders to albuterol.
Download full-text PDF |
Source |
|---|---|
| http://dx.doi.org/10.1097/PCC.0000000000000999 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
On-the-spot spirometry & combined salbutamol & glycopyrronium reversibility testing in obstructive airway disease: A real-world appraisal.
Indian J Med Res
November 2024
Department of Biotechnology, and Dr BC Guha Centre for Genetic Engineering and Biotechnology, University of Calcutta, Kolkata, West Bengal, India.
Background & objectives Spirometric glycopyrronium responsiveness, a new advent, needs to be examined at in terms of degree and frequency in different obstructive-airway diseases diagnosed in real world practise. Methods Serial and willing symptomatic affected individuals of suspected airway disease underwent a pragmatic post-consultation spirometry-protocol on the same day with salbutamol followed by glycopyrronium bromide. The diagnosis of asthma (FEV1-reversibility ≥ 200 ml + 12%), chronic obstructive pulmonary disease (COPD) (FEV1/FVC<0.
View Article and Find Full Text PDFAssessing Lung Ventilation and Bronchodilator Response in Asthma and Chronic Obstructive Pulmonary Disease with F MRI.
Radiology
December 2024
From the Translational and Clinical Research Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (B.J.P., M.A.N., C.W.H., A.J.S., P.E.T.); Newcastle Magnetic Resonance Centre, Health Innovation Neighbourhood, Newcastle University, Newcastle upon Tyne NE4 5PL, United Kingdom (B.J.P., M.A.N., C.W.H., P.E.T.); Pulmonary, Lung and Respiratory Imaging Sheffield, Section of Medical Imaging and Technologies, Division of Clinical Medicine, School of Medicine and Population Health, University of Sheffield, Sheffield, United Kingdom (A.M.M., J.M.W.); Department of Respiratory Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom (I.F.); Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom (R.A.L.); Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, United Kingdom (H.F.F., J.N.S.M.); and Insigneo Institute, University of Sheffield, Sheffield, United Kingdom (J.M.W.).
Background Pulmonary function tests are central to diagnosis and monitoring of respiratory diseases but do not provide information on regional lung function heterogeneity. Fluorine 19 (F) MRI of inhaled perfluoropropane permits quantitative and spatially localized assessment of pulmonary ventilation properties without tracer gas hyperpolarization. Purpose To assess regional lung ventilation properties using F MRI of inhaled perfluoropropane in participants with asthma, participants with chronic obstructive pulmonary disease (COPD), and healthy participants, including quantitative evaluation of bronchodilator response in participants with respiratory disease.
View Article and Find Full Text PDFPharmacometabolomics via real-time breath analysis captures metabotypes of asthmatic children associated with salbutamol responsiveness.
iScience
December 2024
Department of Biomedical Engineering, University of Basel, 4123 Allschwil, Switzerland.
Asthma is a widespread respiratory disease affecting millions of children. Salbutamol is a well-established bronchodilator available to treat asthma. However, response to bronchodilators is very heterogeneous, particularly in children.
View Article and Find Full Text PDFUse of metered dose inhalers for bronchodilator responsiveness testing: laboratory practices in Australia and opportunities for carbon footprint reduction.
BMJ Open Respir Res
December 2024
Respiratory Medicine, Alfred Health, Melbourne, Victoria, Australia.
Background: Metered dose inhalers (MDIs) are important devices for delivering inhaled medications; however, they have an outsized carbon footprint due to their propellant gas. Many short-acting beta-agonist inhalers contain HFA-134a which has a global warming potential >1000 fold higher than carbon dioxide. We aimed to determine the practices around MDI use and disposal within Australia's major lung function testing laboratories and identify the actions that most influence the carbon footprint of bronchodilator responsiveness (BDR) testing.
View Article and Find Full Text PDFThis short communication serves as an update to previously published pilot study results on bronchodilator response (BDR) in children with asthma. We expanded our cohort from 54 to 165 pediatric patients seeking emergency department care for an asthma exacerbation. We obtained measured BDR before and after albuterol administration using the Pediatric Asthma Severity Score and collected genomic DNA.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!