Pulmonary diseases in pregnancy
Hung N. Winn, Frank A. Chervenak, Roberto Romero in Clinical Maternal-Fetal Medicine Online, 2021
Airway inflammation is treated with inhaled corticosteroids and bronchial hyper-responsiveness is treated with short- or long-acting bronchodilators. In addition, leukotriene receptor antagonists, theophylline, and cromolyn appear to be safe during pregnancy and may be considered in select patients (21). Most data on the safety of asthma medications in pregnancy are observational, with the most extensively studied being albuterol and inhaled budesonide (21–23). Albuterol appears to be safe based on a review of six published studies including 1599 women and a prospective study including 1828 women, in whom no significant relationship was found between the use of inhaled beta-2 agonists and adverse pregnancy outcomes (21,24). The National Asthma Education and Prevention Program Working Group reviewed 10 studies, including 6113 patients who were treated with inhaled corticosteroids during pregnancy and found no increases in congenital malformations or adverse perinatal outcomes in these patients (24).
β2-Agonists: Terbutaline, Albuterol, and Fenoterol GüNther Hochhaus and Helmut MöLlmann
Hartmut Derendorf, Günther Hochhaus in Handbook of Pharmacokinetic/Pharmacodynamic Correlation, 2019
A similar model was recently described for the pulmonary effects after oral and sublingual forms of albuterol.130 Because of the slow absorption processes after these forms of administration, the definition of an effect compartment was not necessary (Scheme 3b). EC50 values for albuterol were, on average, 5 ng/ml (Table 7); thus, the activity of albuterol and terbutaline at the site of action are rather similar. Maesen and Smeets suggested that a mean plasma albuterol concentration of 10 ng/ml represents a satisfactory therapeutic level.131 Similarly, a therapeutic plasma level of 30 ng/ml was found sufficient for the inhibition of uterine contractions.47 The PK/PD model (assuming an average EC50 value of 5 ng for albuterol), indicated that the above clinically established levels would ensure roughly 70 and 90% of the maximal effects,130 respectively.
Asthma
James M. Rippe in Lifestyle Medicine, 2019
Because short-acting beta-2 agonist therapy like albuterol should only be used for the symptomatic relief of asthma, the use of this medication can also serve as a marker of asthma stability. The more albuterol necessary to control symptoms, the greater the airway inflammation that is present, and the stronger is the need for optimization of inhaled anti-inflammatory therapy. Using a short-acting beta-2 agonist inhaler at the rate of one or more canisters per month has been associated with an increase in asthma morbidity and mortality.87 Seventy to 80% of chronic asthma patients in this country should be able to be controlled to a level of mild episodic asthma. Mild episodic asthmatics have two or fewer mild asthmatic attacks a week. Therefore, if more than four puffs of a short-acting beta agonist are used weekly, then enhanced asthma control is necessary. A well-controlled asthmatic should only need one or two canisters of a short-acting beta-2 agonist per year, not counting the therapy that would be used to prevent exercise-induced bronchospasm.
Inpatient albuterol spacing as an indicator of discharge readiness
Published in Journal of Asthma, 2023
Burton H. Shen,, Brianna Aoyama,, Brian Lee
The institution at which this study was performed is an 87-bed, free-standing, tertiary-care pediatric hospital. The institution standard of care for patients admitted with asthma is that bronchodilators are weaned by respiratory therapists (RTs) using our institutions standard CPG. Specifically, RTs use the Pediatric Respiratory Score (PRS) to determine whether a patient should be on continuous albuterol, every 2-h albuterol, or every 4-h albuterol (Table 1).5 For PRSs of ≥10, continuous nebulized albuterol is started. For PRSs between 7 and 9, albuterol treatments are given every 2 h. For PRSs less than 6, albuterol is given every 4 h. While admitted, albuterol is administered by nebulization, MDI, or a combination at the discretion of the respiratory therapist. Patients who tolerate two sequential albuterol treatments each spaced apart by ≥4 h are deemed stable for discharge. We hypothesized that few, if any, patients would require escalation of care (as defined by more frequent bronchodilator administration) once able to tolerate albuterol ≥3.5 h from prior administration. A cutoff of 3.5 h was used in this study to allow for variance in administration times. Secondary outcomes included re-presentation and re-admission to the hospital. Chart review was done by two authors (B.H.S. and B.A.) between April 2018 and April 2019.
State-of-the-art beta-adrenoreceptor agonists for the treatment of asthma
Published in Expert Opinion on Pharmacotherapy, 2022
W. Tatiana Garzon-Siatoya, Ismael Carrillo-Martin, Sergio E Chiarella, Alexei Gonzalez-Estrada
Albuterol (Salbutamol) is created by modifying the primary catechol nucleus common to the naturally occurring adrenergic neurotransmitters adrenaline and noradrenaline. Albuterol is longer lasting than isoprenaline and isoetharine because it is not broken down by COMT [30]. The albuterol molecule (Figure 3) can directly reach the β2-receptor from the extracellular compartment because of its hydrophilic properties. Because of this, albuterol can effectively bronchodilate in as little as 2–3 minutes and reach maximum bronchodilation within 15 minutes after inhalation. It binds to the AR weakly, which allows it to diffuse into the systemic circulation only after a short (3–6 hours) duration of action [36]. Given these characteristics, albuterol is considered the preferred go-to relief medication for asthma management [9].
Multimedia Evaluation of EMT-Paramedic Assessment and Management of Pediatric Respiratory Distress
Published in Prehospital Emergency Care, 2021
Stephanie Schroter, Danny Thomas, Mark Nimmer, Alexis Visotcky, Raphael Fraser, M. Riccardo Colella, Lorin R. Browne
The importance of selecting the correct treatment for a respiratory condition is best demonstrated by looking at the physiology of each condition and how treatment addresses these physiologic changes. For example, asthma causes lower airway obstruction and is treated by β2-agonists (albuterol) that cause relaxation of the lower airways (4, 19–23). Conversely, croup causes upper airway obstruction due to edema of the upper airway caused by respiratory viral infections. Nebulized epinephrine acts through its α1 effect to cause vasoconstriction, addressing the edema, which leads to upper airway obstruction. Albuterol, being a β2 agonist has no significant effect on the α1 receptors making it ineffective for croup. In fact, albuterol’s β-effect could potentially cause and worsen vasodilation, leading to worsening upper airway edema (4, 19–23). Albuterol may also cause significant adverse effects such as tachycardia and tremors when inappropriately given to children with bronchiolitis. As with all inappropriate medication administration, misuse of these treatments for pediatric respiratory distress is associated with increased health care costs (24).
Related Knowledge Centers
- Asthma
- Bronchodilator
- Hyperkalemia
- Nebulizer
- Smooth Muscle
- Chronic Obstructive Pulmonary Disease
- Beta2-Adrenergic Agonist
- Exercise-Induced Bronchoconstriction
- Metered-Dose Inhaler
- Intravenous Therapy