Medical students' perceptions of the impact of artificial intelligence in radiology.

OBJECTIVES: To analyse medical students' perceptions of the impact of artificial intelligence in radiology. MATERIAL AND METHODS: A structured questionnaire comprising 28 items organised into six sections was distributed to students of medicine in Spain in December 2019. RESULTS: A total of 341 students responded. Of these, 27 (7.9%) included radiology among their three main choices for specialization, and 51.9% considered that they clearly understood what artificial intelligence is. The overall rate of correct answers to the objective true-or-false questions about artificial intelligence was 70.7%. Whereas 75.9% expressed their disagreement with the hypothesis that artificial intelligence would replace radiologists, only 41.9% disagreed with the hypothesis that the demand for radiologists would decrease in the future. Only 36.7% expressed concerns about the role of artificial intelligence related to choosing radiology as a specialty. A greater proportion of students in the early years of medical school agreed with statements that radiologists accept artificial-intelligence-related technological changes and work with the industry to apply them as well as with statements about the need to include basic training about artificial intelligence in the medical school curriculum. CONCLUSIONS: The students surveyed are aware of the impact of artificial intelligence in daily life, but not of the current debate about its potential applications in radiology. In general, they think that artificial intelligence will revolutionise radiology without having an alarming effect on the employability of radiologists. The students surveyed think that it is necessary to provide basic training about artificial intelligence in undergraduate medical school programs.

Percepciones de estudiantes de Medicina sobre el impacto de la inteligencia artificial en radiología / Medical students’ perceptions of the impact of artificial intelligence in radiology

Objetivos: Analizar la percepción de alumnos de Medicina sobre el impacto de la inteligencia artificial (IA) en radiología. Material y Métodos: Se distribuyó una encuesta estructurada en 28 ítems, organizados en seis secciones, entre estudiantes de Medicina españoles durante diciembre de 2019. Resultados: Respondieron 341 estudiantes, de los que 27 (7,9%) incluyeron la radiología entre sus tres opciones principales para elegir especialidad; el 51,9% consideró que entendía bien qué es la inteligencia artificial. La tasa de acierto global en preguntas objetivas verdadero/falso sobre inteligencia artificial fue del 70,7%, y un 75,9% expresó su desacuerdo con la hipótesis de un reemplazo futuro del radiólogo, mientras que el desacuerdo con una hipotética reducción de la demanda de radiólogos fue menor (41,9%). Solamente el 36,7% mostró preocupación por la inteligencia artificial a la hora de elegir radiología como especialidad. Los estudiantes de cursos inferiores se mostraron más de acuerdo con que los radiólogos acepten los cambios tecnológicos de la inteligencia artificial y trabajen con la industria para su aplicación y con la necesidad de incluir formación básica sobre inteligencia artificial en el currículo de medicina. Conclusiones: Los estudiantes encuestados son conscientes del impacto de la inteligencia artificial en la vida diaria, pero desconocen el debate actual sobre sus potenciales aplicaciones en radiología. En general, piensan que la inteligencia artificial revolucionará la radiología, pero sin un impacto alarmante en la empleabilidad de los radiólogos. Los alumnos encuestados opinan que es necesario proporcionar formación básica sobre inteligencia artificial en pregrado.(AU)

Objectives: To analyze medical students’ perceptions of the impact of artificial intelligence in radiology. Material and methods: A structured questionnaire comprising 28 items organized into six sections was distributed to students of medicine in Spain in December 2019. Results: A total of 341 students responded. Of these, 27 (7.9%) included radiology among their three main choices for specialization, and 51.9% considered that they clearly understood what artificial intelligence is. The overall rate of correct answers to the objective true-or-false questions about artificial intelligence was 70.7%. Whereas 75.9% expressed their disagreement with the hypothesis that artificial intelligence would replace radiologists, only 41.9% disagreed with the hypothesis that the demand for radiologists would decrease in the future. Only 36.7% expressed concerns about the role of artificial intelligence related to choosing radiology as a specialty. A greater proportion of students in the early years of medical school agreed with statements that radiologists accept artificial-intelligence-related technological changes and work with the industry to apply them as well as with statements about the need to include basic training about artificial intelligence in the medical school curriculum. Conclusions: The students surveyed are aware of the impact of artificial intelligence in daily life, but not of the current debate about its potential applications in radiology. In general, they think that artificial intelligence will revolutionize radiology without having an alarming effect on the employability of radiologists. The students surveyed think that it is necessary to provide basic training about artificial intelligence in undergraduate medical school programs.(AU)

Medical students' perceptions of the impact of artificial intelligence in radiology. / Percepciones de estudiantes de Medicina sobre el impacto de la inteligencia artificial en radiología.

OBJECTIVES: To analyze medical students' perceptions of the impact of artificial intelligence in radiology. MATERIAL AND METHODS: A structured questionnaire comprising 28 items organized into six sections was distributed to students of medicine in Spain in December 2019. RESULTS: A total of 341 students responded. Of these, 27 (7.9%) included radiology among their three main choices for specialization, and 51.9% considered that they clearly understood what artificial intelligence is. The overall rate of correct answers to the objective true-or-false questions about artificial intelligence was 70.7%. Whereas 75.9% expressed their disagreement with the hypothesis that artificial intelligence would replace radiologists, only 41.9% disagreed with the hypothesis that the demand for radiologists would decrease in the future. Only 36.7% expressed concerns about the role of artificial intelligence related to choosing radiology as a specialty. A greater proportion of students in the early years of medical school agreed with statements that radiologists accept artificial-intelligence-related technological changes and work with the industry to apply them as well as with statements about the need to include basic training about artificial intelligence in the medical school curriculum. CONCLUSIONS: The students surveyed are aware of the impact of artificial intelligence in daily life, but not of the current debate about its potential applications in radiology. In general, they think that artificial intelligence will revolutionize radiology without having an alarming effect on the employability of radiologists. The students surveyed think that it is necessary to provide basic training about artificial intelligence in undergraduate medical school programs.

Colocación de stent y traqueobroncoplastia en el síndrome de Mounier-Kuhn: reporte de un caso / Stent placement and tracheobronchoplasty in Mounier-Kuhn syndrome: a case report

Se presenta el caso de un paciente diagnosticado a raíz de cuadros de disnea recurrentes de traqueobroncomegalia o Síndrome de Mounier-Kunh, patología congénita, muy infrecuente, clasificada como una clase de traqueomalacia del tipo cartilaginosa, cursando por ello con un colapso dinámico de la vía aérea causante de los episodios de disnea. Otros síntomas frecuentemente observados son la tos no productiva, retención de secreciones o infecciones recurrentes.El paciente es tratado inicialmente de forma conservadora mediante la colocación de una prótesis intratraqueal de silicona (Stent Dumon) en forma de "Y" que permite, de forma provisional, la estabilización de la vía aérea y mejoría de su calidad de vida. Posteriormente, se le practica un tratamiento quirúrgico definitivo o traqueobroncoplastia, que reconfigura la estructura traqueal evitando el colapso espiratorio y permitiendo la retirada del stent intratraqueal

We present the case of a patient diagnosed based on recurrent dyspnea from tracheobronchomegaly or Mounier-Kuhn syndrome, a very rare congenital disease classified as a type of cartilaginous tracheomalacia, leading to a dynamic collapse of the airway causing episodes of dyspnea. Other frequently observed symptoms are nonproductive cough, secretion retention and recurrent infections.The patient is initially treated conservatively by placing a Y-shaped silicone intratracheal prosthesis (Dumon stent) which provisionally allows for airway stabilization and improved quality of life. Later, the patient undergoes a definitive surgical treatment or tracheobronchoplasty, which reconfigures the tracheal structure, avoiding expiratory collapse and allowing the intratracheal stent to be removed

Fluctuation electron microscopy study of crystal nucleation in TiO2-SiO2 glass with heat treatment.

We have used fluctuation electron microscopy (FEM) to investigate the nucleation stage of TiO2 crystal formation in binary TiO2-SiO2 glasses with heat treatment. It was found that spatial fluctuations of electron scattering in the glass with 13 wt% TiO2 increases with heat treatment above 800 °C but before any crystals precipitate, i.e. before crystals are detectable by electron diffraction. We have attributed this to TiO2 clustering and increasing medium-range order due to gradual ordering of TiO2 phase. Moreover, we have found that FEM is sensitive to structural changes at temperatures as low as 400 °C but the nature of the changes yet to be determined. This demonstrates that FEM can be sensitive to structural changes in oxide glasses occurring during thermal treatment but preceding detection of the first crystals.

[Telemedicine, prison and illness associated with HIV]. / Telemedicina, centros penitenciarios y enfermedad por VIH.

OBJECTIVE: Communicate the activity of telemedicine, from its opening, between a hospital consultation of infectious diseases and a penitentiary center. METHODS: Descriptive study of the tele-consultation of infectious diseases of the Alcorcón Foundation University Hospital with the Navalcarnero penitentiary center from 2013 to 2017, which is carried out by videoconference. The reason and number of consultations, diagnosis of HIV, antiretroviral treatment (ART), immunovirological situation, diagnosis of hepatitis C virus (HCV= and intervention performed by the infectious expert were analyzed. RESULTS: A total of 75 patients were evaluated in a total of 168 consultations (in the first year 11 consultations and in the fifth year 62). The index of successive / new consultations was 1.24 and 85% of the patients required less than 1 year of follow-up. 84% of patients did not move to the hospital. 99% of patients accepted this modality. 96% were HIV positive, 94% of them took ART and 85% had undetectable viral load with 532 CD4/mL of medium. 90% had positive serology for HCV. 72% of the consultations were for the assessment of HCV treatment, which was sofosbuvir/ledipasvir by 63%. 40% changed their ART (70% to avoid interactions). CONCLUSIONS: Most of the evaluated patients have HIV infection. This type of consultation has a growing demand, is efficient (avoids transfers and is decisive) and has high acceptance. The most frequent reason for consultation was the treatment of HCV and more than a third of patients required ART change.

Telemedicina y consultas especializadas en las prisiones. El ejemplo de la hepatitis crónica por VHC / Telemedicine and specialised consultations in prisons. The example of HCV chronic hepatitis

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Caracterización de la enfermedad respiratoria baja en pacientes menores de 5 años, hospitalizados en un centro de 3º nivel / Characterization of low respiratory disease in patients under 5 years old, hospitalized in a center of 3º level / Caracterização da doença respiratória baixa em pacientes menores de 5 anos, hospitalizados em centro de 3 níveis

Introducción: Caracterizar la enfermedad respiratoria baja en pacientes hospitalizados basados en el panel viral, como parte del programa de vigilancia epidemiológica en Bogotá, Colombia. Población y métodos: Trabajo retrospectivo transversal entre enero de 2010 y junio de 2011 en un hospital de tercer nivel, involucrando menores de 5 años, mediante inmunofluorescencia indirecta en aspirado nasofaríngeo para virus sincitial respiratorio (VSR), parainfluenza 1, 2, 3, influenza A, B y adenovirus. Resultados: Se obtuvieron 1063 casos, encontrándose un mayor número en el primer semestre del segundo año (145%). Los meses de mayor afectación fueron abril y mayo, siendo los hombres los más afectados. El promedio de edad fue de 8,18 meses; los menores de 1 año representaron el 75% de los casos y los menores de 2 años el 93%. En el 67% de los eventos no se aisló ninguno de los virus estudiados y en el 28% el VSR. El promedio de estancia hospitalaria fue de 7,11 días, siendo mayor para el VSR que para los otros virus o resultado negativo. El 51% recibió antibióticos. Conclusiones: Resultados similares a los descritos en la literatura pero analizados a la altura de Bogotá y en una comunidad de condición socioeconómica baja.

Introduction: Characterization of lower respiratory disease in hospitalized patients based on the viral panel as part of epidemiological surveillance program in Bogota, Colombia. Population and methods: Transversal retrospective study between January 2010 and June 2011 from a tertiary level hospital was developed with children younger than 5 years old. Indirect immunofluorescence in nasopharyngeal aspirate for respiratory syncytial virus (RSV), parainfluenza 1, 2, 3; influenza A, B and adenoviruses were analyzed. Results: 1063 cases were obtained, finding a greater number of cases in the first half of year (145%). The months with higher affectation were April and May, men being the most affected. The average age was 8.18 months; children under 1 year old accounted for 75% of cases and children under 2 years old 93%. In 67% of the events none of the studied virus was isolated and in 28% RSV. The average hospital stay was 7.11 days, being greater for RSV than for other viruses or negative. 51% received antibiotics. Conclusion: The results were similar to those described in the literature but analyzed at the height of Bogota and in a community of low socio-economic status.

Introdução: Caracterização da doença respiratória inferior em pacientes hospitalizados com base no painel viral como parte do programa de vigilância epidemiológica em Bogotá, Colômbia. População e métodos: Estudo transversal retrospectivo entre jeiro de 2010 e junho de 2011 de um hospital de nível terciário foi desenvolvido com crianças menores de 5 anos. Imunofluorescência indireta em aspirado nasofaríngeo para o vírus respiratório sincitial (VSR), parainfluenza 1, 2, 3; Influenza A, B e adenovírus foram analisados. Resultados: Foram obtidos 1063 casos, encontrando-se um maior número de casos na primeira metade do ano (145%). Os meses com maior afetação foram abril e maio, sendo os homens os mais afetados. A média de idade foi de 8,18 meses; Crianças menores de 1 ano representaram 75% dos casos e crianças menores de 2 anos 93%. Em 67% dos eventos nenhum dos vírus estudados foi isolado e em 28% RSV. A média de internação hospitalar foi de 7,11 dias, sendo maior para RSV do que para outros vírus ou negativos. 51% receberam antibióticos. Conclusão: Os resultados foram semelhantes aos descritos na literatura, mas analisados na altura de Bogotá e em uma comunidade de baixo status socioeconômico.

[Extremely prolonged neuromuscular block after a single dose of rocuronium]. / Bloc neuromusculaire extrêmement prolongé après une dose unique de rocuronium.

Postoperative curarization in patients has been established. Nevertheless, extremely prolonged neuromuscular blockades are rare. We report the case of a prolonged neuromuscular blockade (lasting 10 hours) following a single dose of rocuronium, in an elderly patient with severe renal failure. We have studied the possible causes of prolonged curarization, and discussed the interest of the use of sugammadex in such cases.

Escala de valoración del riesgo del transporte interhospitalario de pacientes críticos: su aplicación en el Servicio de Urgencias Médicas de Madrid (SUMMA 112) / Application of a risk scale for interhospital transfer of critical patients by the SUMMA 112 emergency medical service of Madrid

Objetivo: Ponderar los traslados interhospitalarios (TIH) realizados por el Servicio de Urgencia Médica de Madrid (SUMMA 112), según la puntuación obtenida en el sistema de valoración de pacientes para el transporte secundario (SVPTS) en el supuesto de que hubiéramos aplicado, previo a cada traslado, esta escala de valoración. Método: Hemos realizado una revisión de las hojas clínico-asistencial e informes de enfermería de los TIH realizados por el SUMMA 112 durante el primer trimestre del 2008, hemos extraído los datos necesarios para aplicar el SVPTS. Resultados: El 16,7% (66) de los pacientes podrían haber sido trasladados en un ambulancia convencional (soporte vital básico) con dos técnicos de transporte sanitario(TTS), el 69,6% (275) en una ambulancia convencional medicalizada bajo los cuidados de un/a enfermero/a y uno/dos TTS (soporte vital intermedio) y únicamente el 13,7%(54) de los pacientes en una ambulancia tipo unidad de vigilancia intensiva (UVI) móvil(médico, enfermero y dos TTS).Conclusión: Si previamente al TIH de pacientes se hubiera aplicado el SVPTS, el 69,6% de los traslados podrían haber sido realizados sólo bajo los cuidados del personal de Enfermería, y se optimizarían los recursos y aumentarían así los tiempos de operatividad de la UVI móvil (AU)

Objective: To classify interhospital transfers by the SUMMA 112 emergency medical service of Madrid according toscores the patients would have received on the risk scale for auxiliary transport services, had the scale been used before the transfers. Methods: We reviewed records and nursing reports for SUMMA 112 interhospital transfers in the first quarter of 2008 to extract the data needed to apply the risk assessment scale. Results: Sixty-six patients (16.7%) could have been transferred by 2 attendants in a conventional ambulance (basic lifesupport), and 275 patients (69.6%) would have required a conventional ambulance under the care of a nurse plus 1 or 2 ambulance attendants (intermediate life support). Only 54 patients (13.7%) would have required a mobile intensive care unit with a physician, a nurse and 2 ambulance attendants. Conclusion: If the risk scale had been applied before the interhospital transfer of patients in the study period, 69.6% of the trips could have been carried out under the care of a nurse, leading to more efficient use of resources and increasing the amount of time in which mobile intensive care units were available (AU)

Iniciativa interdisciplinar y de enfoque transversal en la enseñanza de la química analítica / Interdisciplinary initiative and transversal approach in the teaching of analytical chemistry

El proceso de aprendizaje puede favorecerse mediante el uso de metodologías docentes que fomentenel tratamiento transversal de los temas, resultando más adecuado para el estudiante si es abordadodesde diferentes vertientes. Este tratamiento implica el trabajo conjunto de profesores con distintasformaciones que muestren la solución del problema de forma interdisciplinar. La disciplina AnálisisQuímico está en relación continua con otras áreas de conocimiento lo que la hace idónea para laimplementación de experiencias docentes mediante las cuales los alumnos experimenten la parteaplicada de la asignatura con el fin de favorecer la comprensión desde un punto de vista global.Este trabajo se ha desarrollado en un contexto real, poniendo en contacto a los alumnos con unproyecto de investigación con el fin de conseguir su implicación en la comprensión de la asignaturapermitiendo una visión real del planteamiento y resolución de problemas analíticos y favoreciendo laadquisición de competencias específicas y trasversales. Se ha contado con la participación dediferentes profesores y se ha desarrollado en varias etapas: Impartición de charlas, establecimiento delproblema analítico, colocación de material en plataforma virtual, análisis de muestras reales,información de resultados, encuesta opinión/satisfacción, evaluación y calificación.La utilización de esta herramienta de aprendizaje ha permitido fomentar en los alumnos la capacidadde aplicar los conocimientos teóricos adquiridos a la práctica, el trabajo en grupo, la identificación yresolución de problemas, la interdisciplinariedad y la colaboración. Y a los profesores evaluar losresultados del aprendizaje expresados en términos de competencias(AU)

The learning process can be favoured by using teaching methodologies that encourage the transversaltreatment of the issues, resulting more adequate for the student if it is approached from differentaspects. This treatment implies the joined work of professors with different trainings showing thesolution of the problem from an interdisciplinary way. Analytical Chemistry is continuously related toother knowing areas which make it suitable for the implementation of teaching experiences thatfavours the students to know the applied part of the subject with the aim of facilitating thecomprehension from a global point of view.This work has been developed in a real context, putting the students in contact with a research projectwith the aim of getting their implication in the comprehension of the subject and favouring theacquisition of specific and transversal competencies. The initiative has relied on the participation ofdifferent professors and has been developed in several stages: oral teaching, setting the analyticalproblem, putting material in the virtual platform, analysis of real samples, giving information of theresults, evaluation and grading.The use of this learning tool has allowed to encourage the students the ability to apply the theoreticalknowing to the practice, the making of decisions, the identification and solving of problems, theinterdisciplinary and the collaboration. And to the professors to evaluate the results of the learningprocess in terms of competencies(AU)

Intrabronchial instillation of amphotericin B lipid complex: a case report.

OBJECTIVE: We sought to present our results of topical intrabronchial installation of amphotericin B lipid complex (AmpB lipid). PATIENT AND METHODS: A deposit of fungal material was observed in a bilateral lung transplant recipient who experienced stenosis of the left anastomosis and have been fitted with a double endobronchial prosthesis. The deposit was adherent to the prosthetic material, causing marked local laceration, risk of perforation, and exacerbation of the bronchial stenosis. Upon cultivation of a bronchial aspirate (BAS), we isolated Aspergillus fumigatus, Scedosporium prolificans, and Candida glabrata. Systemic antifungal treatment was begun with oral voriconazole (200 mg every 12 hours) and inhaled AmpB lipid (25 mg once daily). The fungal deposit on the prosthetic material was treated by topical instillation of a solution of 25 mg AmpB lipid before and after each therapeutic fibrobronchoscopy (FB), which was performed weekly at 5 consecutive examinations. Tolerance was excellent. RESULTS: The improvement obtained after the procedure made it possible to withdraw one of the displaced prostheses. Subsequent cultivation for the fungi found in the BAS was persistently negative over a follow-up of 2 years. CONCLUSION: Topical intrabronchial instillation of AmpB lipid has proven effective and well tolerated for the treatment of localized fungal colonies. This use could be extended by protocol to FB in the early postoperative period after lung transplantation for antifungal prophylaxis.

Clearance of hepatitis C virus in HIV-infected patients with multiple chronic viral hepatitis.

Viral interferences between hepatitis C (HCV) and hepatitis B (HBV) viruses were investigated in a case-control study conducted in 107 human immunodeficiency virus (HIV)-infected patients with HCV antibodies. Overall, 15 (68%) of 22 hepatitis B surface antigen (HBsAg)-positive patients had negative serum HCV-RNA while it occurred in only nine (10%) of 85 HBsAg-negative counterparts (P = 0.02). After adjusting for age, antiretroviral therapy, plasma HIV-RNA and CD4 counts, being HBsAg-positive was strongly associated with having negative serum HCV-RNA (odds ratio: 23; 95% confidence interval: 6-59; P < 0.001). Thus, HBV may favour the elimination of HCV in HIV-infected patients, which may influence liver disease and therapeutic decisions.

Effects of phorbol 12,13-diacetate on human isolated bronchus.

Protein kinase C appears to be involved in the regulation of airway contractility. Phorbol 12,13-diacetate (PDA; 0.01-10 microM), a protein kinase C activator, produced a transient relaxation followed by a sustained contraction of human isolated bronchus. Different protein kinase C inhibitors (calphostin C, staurosporine and 1-(5-isoquinolinesulfonyl)-2-methylpiperazine) (H-7), nifedipine (NIF; 1 microM) or incubation with Ca(2+)-free medium, inhibited the spasmogenic response to phorbol, while ouabain (10 microM) suppressed only the initial relaxation. These results indicate that the initial relaxation, in response to PDA, is related to the activation of Na(+)/K(+)-ATPase, while the ensuing contraction depends on extracellular Ca(2+) entry.Incubation with PDA (1-5 microM) depressed the maximal relaxation to theophylline and caffeine obtained at 37 degrees C but augmented the spasmogenic responses to methylxanthines (10 mM) obtained in cooled preparations. These effects do not result apparently from increased extracellular entry of Ca(2+), but instead, from facilitation of the release of Ca(2+) from intracellular stores.

Tracheoplasty in a large tracheoesophageal fistula.

Postintubation tracheoesophageal fistulas (TEFs) are severe lesions that can be associated with tracheal stenosis and therapeutic difficulties. A case is reported of a woman with TEF and postintubation tracheal stenosis with 6.5 cm of affected trachea, and total esophageal exclusion. A tracheoplasty method is described patching the loss of the tracheal membranous wall with the posterior esophageal wall. In a final step, a self-expanded tracheal stent and esophagocolic bypass were added.

[Application of selection criteria in sequential double lung transplantation]. / Ampliación de los criterios de selección en el trasplante bipulmonar secuencial. Grupo de Trasplante Pulmonar de Valencia.

Since the first sequential double lung transplant was performed in 1986, such procedures have been increasing in number and the criteria used as indications for this type of surgery have broadened. Our aim was to reflect on the application of selection criteria and to describe the anesthetic and surgical techniques and postoperative follow-up of 72 patients who underwent this type of transplant surgery between March 1993 and December 1998. Actuarial survival five years after surgery was 74.4%. Among patients requiring transplantation after septic disease, actuarial survival was 90.8% for cystic fibrosis and 88.2% for bronchiectasis. Of the preoperative risk factors analyzed (prior surgery, pachypleuritis, multiresistant germs, poor nutrition, mechanical ventilation and corticoid therapy), only prior treatment with high doses of corticoids proved significant. Eleven patients have been diagnosed of bronchiolitis obliterans, four have died and only two continue to experience difficulties in daily living. The high survival rate and the restriction-free life after recovery lead us to consider sequential double lung transplantation to be the treatment of choice for all pulmonary diseases.

[Respiratory failure caused by megaesophagus and tracheomalacia]. / Détresse respiratoire par mégaoesophage et trachéomalacie.

We report a case of acute respiratory failure in an 83-year-old woman suffering from a megaoesophagus compressing the posterior tracheal wall. Naso-oesophageal aspiration did not allow tracheal extubation because of associated tracheomalacia. Treatment included tracheostomy and decrease of cardial tonus by administration of botulinic toxin, after weaning from mechanical ventilation.

Comparison of two dosage regimens of albuterol in acute asthma.

BACKGROUND: The standard therapy for acute episodes of asthma in the United States consists of three 2.5-mg doses of aerosolized albuterol given every 20 minutes. Whether this approach represents optimum therapy has never been tested. METHODS: This study employed a prospective, sequential design in which the effects of two doses of 5.0 mg of aerosolized albuterol administered during 40 minutes (high dose) were contrasted with the standard dose (three 2.5-mg doses). Improvements in pulmonary function, clinical resolution of the asthma attacks, and admission rates were used as primary endpoints. Both regimens were part of an overall care plan that involved objective, pretested decision algorithms. RESULTS: In an emergency department, 160 patients who presented with acute exacerbations of asthma received either standard (n = 80) or high-dose (n = 80) albuterol treatment. There were no significant baseline differences in gender, racial composition, clinical signs and symptoms, medication use, or peak expiratory flow (PEF) between the groups. Both treatment schedules were effective, but the high-dose regimen increased lung function more rapidly and to a greater extent than standard-dose therapy. It also resulted in lower charges to third party payers. More subjects attained the discharge criteria quicker and left the emergency department with peak expiratory flows closer to normal. Fewer patients in the high-dose group were admitted, but this trend did not quite reach statistical significance. CONCLUSIONS: Two 5.0-mg treatments of aerosolized albuterol at a 40-minute interval provide effective therapy for acute exacerbations of asthma. This combination of dose and frequency promotes maximum bronchodilatation, increases efficiency, and reduces the risks of undertreatment.

Observations on the effects of aerosolized albuterol in acute asthma.

To determine the dose of albuterol required to terminate acute episodes of asthma, 92 acutely ill subjects received three doses of 2.5 mg each by nebulization every 20 min. Peak expiratory flow rates (PEFR) and signs and symptoms were serially monitored. A dose-response increase in pulmonary function was found, but only 66% of the subjects improved sufficiently to be sent home. Of these, 56% required < or = 5.0 mg of drug to reach the discharge threshold, whereas the remainder needed 7.5 mg. In 34% of participants, albuterol was ineffectual. These individuals were characterized by more severe obstruction at presentation, and after three doses of medication their PEFR still did not exceed 40% of the expected value. Further treatment in the emergency department (ED) or hospital was not immediately helpful, and these patients ultimately required 3.8 +/- 0.4 d of inpatient care to become asymptomatic. There were no discernible differences between responders and nonresponders in the type or quantity of medications used. However, the nonresponders had more severe disease as measured by recurrent hospitalizations and ED visits. This study demonstrates that, in emergency situations, albuterol does not relieve acute airway obstruction in all asthmatic individuals with equal efficacy. Two-thirds of patients are sensitive, and in these patients 5 to 7.5 mg of albuterol provides optimal treatment. In the remainder, albuterol, even in high doses, has little effect for days.