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Two versus four puffs of albuterol: does dose change bronchodilator response?

Authors McLaughlin AV, Bhandari A, Schramm CM

Received 13 September 2017

Accepted for publication 5 September 2018

Published 31 January 2019 Volume 2019:12 Pages 59—65

DOI https://doi.org/10.2147/JAA.S151531

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Colin Mak

Peer reviewer comments 3

Editor who approved publication: Dr Luis Garcia-Marcos


Anne V McLaughlin,1,2 Anita Bhandari,3 Craig M Schramm1,2

1Department of Pediatric Pulmonary Medicine, Connecticut Children’s Medical Center, Hartford, CT, USA; 2Department of Pediatrics, University of Connecticut School of Medicine, Farmington, CT, USA; 3Division of Pulmonary Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

Background: Reversible obstruction on spirometry may be used to diagnose asthma. As per 2005 American Thoracic Society (ATS) guidelines, our pulmonary center began using 360 µg (four puffs) of albuterol rather than 180 µg (two puffs) to determine reversibility on spirometry starting in 2009.
Hypothesis: We hypothesized that fewer patients would respond to two puffs of albuterol than four puffs during spirometric testing.
Methods: We retrospectively reviewed records from new asthmatics seen in Pediatric Pulmonary Clinic from March 2002 to April 2014 who performed reproducible spirometry. Patients were divided into two groups based on whether they had received two or four puffs of albuterol for bronchodilator assessment. A positive bronchodilator response was defined as an increase of ≥12% in forced expiratory volume in one second (FEV1) or ≥25% in forced expiratory flow (FEF25–75%). Data were expressed as percentages and mean ± standard error of the mean values. Chi-squared test and Student’s t-test were utilized.
Results: Data were collected for 240 patients; 115 patients received two puffs of albuterol and 125 patients received four puffs. There were no significant differences in baseline characteristics between the two groups. There were no differences following two puffs or four puffs in changes in FEV1 (10.0±1.1% vs 10.5±1.1% predicted) or FEF25–75% (30.2±2.9% vs 33.5±2.9% predicted). Moreover, there was no difference in ATS-defined bronchodilator response between the two groups.
Conclusion: Based on the mean change in FEV1 and overall bronchodilator responsiveness, two puffs of albuterol were not inferior to four puffs in the determination of bronchodilator responsiveness in our pediatric asthmatic patients.

Keywords: asthma, reversible obstructive lung disease, pulmonary function testing


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