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Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review

Published online by Cambridge University Press:  21 May 2015

Kristopher Wiebe  and
Brian H. Rowe
Kristopher Wiebe*
Affiliation:
Department of Emergency Medicine, Chilliwack General Hospital, Chilliwack, BC
Brian H. Rowe
Affiliation:
Department of Emergency Medicine, University of Alberta, Edmonton, Alta.
*
46022 Bridleridge Cr., Chilliwack BC V2R 5W2; kriswieb@telus.net

Abstract

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Acute asthma is a common emergency department (ED) problem that is typically treated with bronchodilators and anti-inflammatories. Nebulized selective, short-acting β-agonists, such as salbutamol, are the bronchodilators of choice in most Canadian EDs. Other important treatments in moderate-to-severe cases include systemic corticosteroids and in severe cases may include the addition of ipratropium bromide and magnesium sulfate. Despite aggressive management, some patients do not respond adequately to nebulized salbutamol. Treatment options in these patients are limited to interventions such as parenteral epinephrine, and non-invasive and mechanical ventilation (or both). Both parenteral epinephrine and mechanical ventilation have associated risks, so alternative treatments with a lower risk profile would be useful for the treatment of life-threatening asthma. The following case report describes a patient in whom nebulized racemic epinephrine was used successfully to treat severe acute asthma following failure of standard first-line therapies.

Keywords

asthmaemergency departmentbronchodilators

Information

Type
Case Report • Observation de cas
Information
Canadian Journal of Emergency Medicine , Volume 9 , Issue 4 , July 2007 , pp. 304 - 308
Copyright
Copyright © Canadian Association of Emergency Physicians 2007

References

1.Lemiere, C, Bai, T, Baiter, M, et al. Adult Asthma Consensus Guidelines Update 2003. Can Respir J 2004;11(Suppl A):9A–18A.Google Scholar
2.National Asthma Education P. Expert Panel Report II. Guidelines for the Diagnosis and Management of Asthma. Bethesda, (MD): National Institutes of Health; 1997.Google Scholar
3.Camargo, CA Jr., Spooner, CH, Rowe, BH. Continuous versus intermittent beta-agonists in the treatment of acute asthma. The Cochrane Database of Systematic Reviews 2003;4:CD001115.Google Scholar
4.Cates, CJ, Bara, A, Crilly, JA, et al. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma. The Cochrane Database of Systematic Reviews 2003;2:CD000052.Google Scholar
5.Stoodley, RG, Aaron, SD, Dales, RE. The role of ipratropium bromide in the emergency management of acute asthma exacerbation: A meta-analysis of randomized clinical trials. Ann Emerg Med 1999;34:8–18.CrossRefGoogle ScholarPubMed
6.Rowe, BH, Spooner, C, Ducharme, FM, et al. Early emergency department treatment of acute asthma with systemic corticos-teroids. The Cochrane Database of Systematic Reviews 2001;1:CD002178.Google Scholar
7.Edmonds, ML, Camargo, CA Jr, Pollack, CV Jr, et al. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002;40:145–54.Google Scholar
8.Rowe, BH, Bretzlaff, JA, Bourdon, C, et al. Magnesium sulfate for treating exacerbations of acute asthma in the emergency department. The Cochrane Database of Systematic Reviews 2000;1:CD001490.Google Scholar
9.Carter, ER. Heliox for acute severe asthma. Chest 2000;117:1212–3.Google Scholar
10.Putland, M, Kerr, D, Kelly, AM. Adverse events associated with the administration of intravenous epinephrine in emergency department patients presenting with severe asthma. Ann Emerg Med 2006;47:559–63.Google Scholar
11.Ram, FSF, Wellington, SR, Rowe, BH, et al. Non-invasive positive pressure ventilation for treatment of respiratory failure due to severe acute exacerbations of asthma. The Cochrane Database of Systematic Reviews 2005;1(2):CD004360Google Scholar
12.Weber, EJ, Silverman, RA, Callaham, ML, et al. A prospective multicenter study of factors associated with hospital admission among adults with acute asthma. Am J Med 2002;113:371–8.Google Scholar
13.Ledwith, C, Shea, L, Mauro, R. Safety and efficacy of nebulized racemic epinephrine in conjunction with dexamethasone and mist in the outpatient treatment of croup. Ann Emerg Med 1995;25:331–5.Google Scholar
14.Menon, K, Sutcliffe, T, Klassen, TP. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acuet bronchiolitis. J Pediatr 1995;126:1004–7.Google Scholar
15.Prendergast, M, Jones, JS, Hartman, D. Racemic epinephrine in the treatment of laryngotracheitis: can we identify children for outpatient therapy? Am J Emerg Med 1994;12:613–6.Google Scholar
16.Rowe, BH, Camargo, CA. Emergency department treatment of severe acute asthma. Ann Emerg Med 2006;47:564–6.Google Scholar
17.Shaver, K, Adams, C, Weiss, S. Acute myocardial infarction after administration of low dose epinephrine for anaphylaxis. Can J Emerg Med 2006;8:289–94.CrossRefGoogle ScholarPubMed
18.Abroug, F, Nouira, S, Boujdaria, R, et al. A controlled trial of nebulized salbutamol and adrenaline in acute severe asthma. Intensive Care Med 1995;21:18–23.CrossRefGoogle ScholarPubMed
19.Adoun, M, Frat, JP, Dore, P, et al. Comparison of nebulized epinephrine and terbutaline in patients with acute severe asthma: a controlled trial. J Crit Care 2004;19:99–102.CrossRefGoogle ScholarPubMed
20.Zeggwagh, A, Abouqal, R, Madani, N, et al. Comparative efficiency of nebulized adrenaline and salbutamol in severe acute asthma: A randomized controlled prospective study. Ann Fr Anest Reanim 2002;21:703–9.Google Scholar
21.Plint, AC, Osmond, MH, Klassen, TP. The efficacy of nebulized racemic epinephrine in children with acute asthma: a randomized, double-blind trial. Acad Emerg Med 2000;7:1097–103.Google Scholar
22.Coupe, MO, Guly, U, Brown, E, et al. Nebulised adrenaline in acute severe asthma: a comparison with salbutamol. Eur J Respir Dis 1987;71:227–32.Google Scholar
23.Rodrigo, GJ, Nannini, LJ. Comparison between nebulized adrenaline and beta-2 agonists for the treatment of acute asthma: a meta-analysis of randomized trials. Am J Emerg Med 2006;24:217–22.Google Scholar
24.Elatrous, S, Elidrissi, H, Trabelsi, H, et al. Dose-effect of adrenaline nebulization in asthma: comparative study with salbutamol. Rev Pneumol Clin 1997;53:187–91.Google Scholar
25.Waisman, Y, Klein, BL, Boenning, DA, et al. Prospective randomized double-blind study comparing L-epinephrine and racemic epinephrine aerosols in the treatment of laryngotracheitis (croup). Pediatrics 1992;89:302–6.CrossRefGoogle ScholarPubMed
26.Nutman, J, Brooks, LJ, Deakins, KM, et al. Racemic versus L-epinephrine aerosol in the treatment of postextubation laryngeal edema: results from a prospective, randomized, double-blind study. Crit Care Med 1994;22:1591–4.CrossRefGoogle ScholarPubMed
27.Cho, SH, Oh, SY, Bahn, JW, et al. Association between bronchodilating response to short-acting beta-agonist and non-synonymous single-nucleotide polymorphisms of beta-adrenoceptor gene. Clin Exp Allergy 2005;35:1162–7.Google Scholar