No Association Between Weight-Based Continuous Albuterol and Length of Hospital Stay

Weight-based dosages of continuous albuterol made no difference in adjusted duration of albuterol therapy or adjusted length of hospital stay for pediatric patients with asthma exacerbation, according to study results published in the Journal of Asthma.

Although National Heart Lung and Blood Institute asthma guidelines on continuous albuterol for asthma exacerbation in children and adolescents suggest 0.5 mg/kg/h as the recommended dosage, a lack of evidence exists regarding how weight-based dosage rates affect hospital outcomes. In this retrospective cohort study designed to address this lack, researchers used ICD codes to identify patients aged 4 to 17 years who required continuous albuterol for asthma exacerbation from January 2015 to December 2016 at an urban tertiary-care center. Albuterol concentration (5-20 mg/h) and treatment duration were used to determine total albuterol administration.

Average weight-based doses were divided into 5 equal quintiles, and initial statistical analysis included a full model with the following covariates: age, race, sex, primary family history of asthma, smoking exposure, use of inhaled corticosteroid, magnesium administration, prior hospitalization for asthma, severity score, and quintile. Only the covariates shown to be significant in the full model were included in the final model; these were age, magnesium administration, severity score, and quintile. The incidence rate ratio (RR), 95% CI, and unadjusted and adjusted length of continuous albuterol and length of stay for each quintile were reported.

Of a total of 533 patient hospitalizations for asthma exacerbation, 289 individuals received continuous albuterol, with average weight-based dosage quintiles ranging from 0.07 to 0.29 mg/kg/h at the lowest, and 0.76 to 3.2 mg/kg/h at the highest. Aside from race, age, and magnesium administration, baseline characteristics were similar among the 5 groups, and no difference was observed in initial asthma severity score.

After adjustments were made for race, age, and magnesium administration, no significant differences in length of stay were seen among quintiles. Adjusted length of stay was similar to unadjusted values, ranging from 48.7 hours to 63.5 hours. After adjustments were made for age, initial severity score, and magnesium administration, no difference among the quintiles was seen for duration of continuous albuterol, which was similar to unadjusted values and ranged from 23.8 hours to 31.4 hours.

Despite limitations that included being a single-center study with only 80% power to detect a 10-hour difference in length of stay due to the sample size, the investigators concluded, “No association between different weight-based concentration of continuous albuterol and hospital length of stay or duration of continuous albuterol therapy was found. If lower amounts of continuous albuterol are as efficacious as higher doses, this could improve cost of status asthmaticus management and limit the number of adverse events associated with high exposure to continuous albuterol. Future randomized prospective trials comparing different weight-based continuous albuterol dosage are needed to validate these findings.”

Reference

Parlar-Chun R, Arnold K. Association of various weight-based doses of continuous albuterol on hospital length of stay [published online February 6, 2020]. J Asthma. doi:10.1080/02770903.2020.1723622