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Volume 39, Number 1, February 2006

Comparison of the effects of nebulized terbutaline with or without intravenous betamethasone on exhaled nitric oxide in children with acute asthma attack


Ming-Yung Lee, Yi-Giien Tsai, Kuender D. Yang, Chih-Hsing Hung
Department of Pediatrics, Tri-service General Hospital, National Defense Medical Center, Taipei; Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung University, Kaohsiung; Department of Pediatrics, Faculty of Pediatrics, College of Medicine, Kaohsiung Medical University, Kaohsiung; and 4Department of Pediatrics, Kaohsiung Medical, University Chung-Ho Memorial Hospital, Kaohsiung Medical University, Taiwan

Received: December 29, 2004    Revised: May 26, 2005    Accepted: July 13, 2005   

 

Corresponding author:

Dr. Chih-Hsing Hung, Department of Pediatrics, Kaohsiung Medical University Chung-Ho Memorial Hospital, Kaohsiung Medical University, #100, Tz-You 1st Road, Kaohsiung 807, Taiwan. E-mail: pedhung@hotmail.com This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

 



 

Background and purpose: 

Exhaled nitric oxide (eNO), a non-invasive marker that reflects the degree of airway inflammation, may be useful for assessing the response to anti-inflammatory treatment of asthma. The purpose of this randomized prospective study was to compare the effect of a nebulized terbutaline plus a single intravenous dose of betamethasone at baseline followed by a second of terbutaline at 6 h with the effect of the same protocol of nebulized terbutaline alone on airway inflammation of acute asthmatic children as demonstrated by eNO levels.

 



 

Methods:

Children visiting the emergency department due to acute asthma attack were recruited. All enrolled patients had fluorescent assay-proven hypersensitivity to Dermatophagoides pteronyssinus. Patients were randomized to receive either nebulized terbutaline plus intravenous betamethasone (experimental group, n = 11) or nebulized terbutaline alone (control group, n = 11) at baseline followed by a second dose of nebulized terbutaline alone 6 h later.

 



 

Results:

Exhaled NO concentrations were significantly reduced in the experimental group at 7 h (40.25 ± 12.43 vs 28.88 ± 18.02 ppb; p=0.005) and 12 h (40.25 ± 12.43 vs 30.11 ± 18.16 ppb; p=0.007) after treatment. The eNO level in the experimental group was also reduced at 7 h (28.88 ± 18.02 vs 38.12 ± 16.50 ppb; p=0.034) and 12 h (30.11 ± 18.16 vs 39.36 ± 17.63 ppb; p=0.035) compared to the control group. The change of eNO concentration was correlated to the change of peak expiratory flow rate (PEFR) [r = -0.678; p=0.022] and pulmonary index scores (r = 0.606; p=0.048) at 7 h after treatment in the betamethasone group.

 



 

Conclusion:

Nebulized terbutaline given at baseline and 6 h later was significantly more effective in improving PEFR and asthmatic symptoms (pulmonary index scores) for at least 12 h when the initial dose was administered in combination with intravenous betamethasone.

 



 

Key words:

 Asthma, betamethasone, breath tests, nitric oxide, terbutaline


 



 

J Microbiol Immunol Infect 2006;39:33-38.