Résumé
Bronchial asthma is an atopic disease characterized by chronic airway inflammation and hyper-responsiveness. Severe acute asthma is a medical emergency and sometimes difficult to treat. This prospective study was done at Dhaka Medical College Hospital from January 1997 to January 1998. Total 30 patients of bronchial asthma were included in this study. Diagnosis was established on the basis of symptoms, evidence of airflow obstruction and its reversibility by bronchodilator therapy. The age range was 18 to 80 years with a mean 36.64±4.91. Of them, 63% were male and 37% were female. It revealed that all patients had classical triad of dyspnoea, wheeze and cough. Almost all patients (80%) had some precipitating agents for their attack. Regarding treatment of severe acute asthma - Nebulized salbutamol is superior to conventional intravenous aminophylline, as p value of nebulized salbutamol group is <0.001 which is significant. So, severe acute asthma should be managed with nebulized salbutamol instead of intravenous aminophylline.
Résumé
PURPOSE: Nebulized selective beta2-adrenoreceptor agonists have been widely used in acute asthma and selectively in acute bronchiolitis. However, nebulized salbutamol have been reported to cause arterial oxygen desaturation in some of the acute bronchiolitis and severe asthma patients. This may be the results of a paradoxical bronchoconstriction linked to acidic and hyper-osmolar nebulized salbutamol solution and etc. We assessed the changes in arterial oxygen saturation by percutaneous pulse oxymeter during and after nebulization of salbutamol solution and compared the effect of 100% oxygen with the compressed air as a driving gas. METHODS: This study was performed in 80 mild to moderate wheezy children(bronchiolitis 51, asthma 29) who were admitted to Pediatrics department of of EWHA from January 1992 to October 1993. The study children are randomly assigned to be nebulized by compressed air or 6l/min of 100% oxygen as a driving gas. The arterial oxygen saturation, wheeze score, retraction score, and heart rate were recorded before nebulization, post-nebulization, 5, 10, 15 and 30minutes. RESULTS: 1) Arterial oxygen saturation decreased significantly at post-nebulization five minutes only in bronchiolitis, treated with salbutamol nebulization without oxygen(p0.05). 2) Wheeze score decreased significantly at post-nebulization 5-30minutes in asthma but not in bronchiolitis whether nebulized salbutamol with or without oxygen(p0.05). CONCLUSIONS: Significant fall in arterial oxygen saturation was noted only in bronchiolitis treated with salbutamol nebulization without oxygen. In bronchiolitis, oxygen (6l/min) is better than compressed air as a driving gas during salbutamol nebulization to prevent hypoxemia.