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April 1992, Vol 146, No. 4 >
Article | April 1992

The Efficacy of Nebulized Metaproterenol in Wheezing Infants and Young Children FREE

Anthony J. Alario, MD; William J. Lewander, MD; Penelope Dennehy, MD; Ronald Seifer, PhD; Anthony L. Mansell, MD
[+] Author Affiliations

Accepted for publication October 18, 1991.

Presented in part at the 30th Annual Meeting of the Ambulatory Pediatric Association, Anaheim, Calif, May 11, 1990.

Reprint requests to Department of Pediatrics, Rhode Island Hospital, 593 Eddy St, Providence, RI 02903 (Dr Alario).


Am J Dis Child. 1992;146(4):412-418. doi:10.1001/archpedi.1992.02160160032008.
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• The benefit of β-adrenergic agonists in the treatment of acutely wheezing infants and young children has not been well documented in the outpatient setting. To determine the efficacy of nebulized metaproterenol sulfate, 74 children aged 36 months or younger with acute wheezing participated in a double-masked, randomized, placebo-controlled clinical trial. Children received nebulized metaproterenol, either as an initial treatment or after a control treatment with normal saline solution. At baseline and 20 minutes after each treatment, an assessment was made that included measurements of heart rate, respiratory rate, oxygen saturation, and clinical variables related to respiratory compromise with the use of a standardized respiratory distress index (RDI). Children who received saline solution as initial therapy had no significant differences from baseline in any of the assessment measures. After metaproterenol therapy, children demonstrated an increase in heart rate ([mean±SD] 147±14 beats per minute vs 153±16 beats per minute), a decrease in respirations (50/min±5/min vs 45/min±7/min), improvement (lower scores) on the RDI (24±4 vs 15±2), and an increase in oxygen saturation (94.1%±2.7% vs 95.3%±3.0%). Patients aged 12 months or younger (n = 37) benefited from metaproterenol treatment (improvement in respiratory rate and RDI) but not to the same degree as children aged 24 months or older (n = 23) (improvement in respiratory rate, RDI, and oxygen saturation). Compared with assessments made before metaproterenol treatment, patients with respiratory syncytial virus infection (n = 21) had improvement in respirations (52/min±7/min vs45/min±6/min) and RDI scores (22±4 vs 14±3). Based on a priori criteria (reduction in a premedication respiratory rate of 20% and an RDI score of 50%), responders to metaproterenol therapy included 45% of the entire sample and, respectively, 40% of those aged 12 months or younger, 52% of those aged 24 months or older, and 48% of patients who tested positive for respiratory syncytial virus. Although there appears to be an age-dependent degree of response, metaproterenol is effective in relieving the respiratory distress of young acutely wheezing children, including those with documented respiratory syncytial virus bronchiolitis.

(AJDC. 1992;146:412-418)

REFERENCES

1 +
Henderson FW, Clyde WA, Collier AM, et al.  The etiology and epidemiologic spectrum of bronchiolitis in pediatric practice . J Pediatr . 1979;;95:183-190.
2 +
Silverman M.  Bronchodilators for wheezy infants? Arch Dis Child . 1984;;59:84-87.
3 +
Nussbaum E, Gullant S.  Bronchodilator effects of oral metaproterenol sulfate in preschool children with asthma . J Pediatr . 1987;;110:148-151.
4 +
Robertson CF, Smith F, Beck R, Levison H.  Response to frequent low doses of nebulized salbutamol in acute asthma . J Pediatr . 1985;;106:672-674.
5 +
Garra B, Shapiro CC, Dorsett CS, Simons FER, Pierson WE, Bierman CW.  A double-blind evaluation of the use of nebulized metaproterenol and isoproterenol in hospitalized asthmatic children and adolescents . J Allergy Clin Immunol . 1977;;60:63-68.
6 +
Phelan PD, Williams HE.  Sympathomimetic drugs in acute viral bronchiolitis: their effect on pulmonary resistance . Pediatrics . 1969;;44:493-497.
7 +
Radford M.  Effect of salbutamol in infants with wheezy bronchitis . Arch Dis Child . 1975;;50:535-538.
8 +
Rutter N, Milner AD, Hiller EJ.  Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis . Arch Dis Child . 1975;;50:719-722.
9 +
Lenney W, Milner AD.  At what age do bronchodilator drugs work? Arch Dis Child . 1978;;53:532-535.
10 +
Lenney W, Milner AD.  Alpha and beta-adrenergic stimulants in bronchiolitis and wheezy bronchitis in children under 18 months of age . Arch Dis Child . 1978;;53:707-709.
11 +
Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW.  Dexamethasone and salbutamol in the treatment of acute wheezing infants . Pediatrics . 1983;;71:13-18.
12 +
Pearce J, Wesley H.  Children with asthma: will nebulized salbutamol reduce hospital admissions? BMJ . 1985;;290:595-597.
13 +
Lowell DI, Lister G, Van Koss H, McCarthy P.  Wheezing in infants: the response to epinephrine . Pediatrics . 1987;;79:939-945.
14 +
Motoyama E, Lister C, Mallory GB, Mestad PH, Rothstein G, Weng FT.  Evidence of bronchial hyperactivity in infants with severe bronchiolitis . Pediatr Res . 1982;;16:358.
15 +
Devaskar UP, Devaskar SU, Keenan WJ.  Acute bronchospasm resembling status asthmaticus during the neonatal period . Crit Care Med . 1986;;14:472-475.
16 +
Prendiville A, Green S, Silverman M.  Airway responsiveness in wheezy infants: evidence for functional beta-adrenergic receptors . Thorax . 1987;;42:100-104.
17 +
Duncan PG, Brink C, Douglan JS.  Beta receptors during ageing in respiratory tissues of guinea pigs . Eur J Pharmacol . 1982;;78:45-52.
18 +
McIntosh K.  Bronchiolitis and asthma: possible common pathogenic pathways . J Allergy Clin Immunol . 1976;;57:595-604.
19 +
Lough MD, Doerschuk CF, Stern RC. Pediatric Respiratory Therapy . St Louis, Mo: Mosby—Year Book; 1985;:140-141.
20 +
Bierman CW, Pierson WE.  The pharmacologic management of status asthmaticus in children . Pediatrics . 1974;;54:245-247.
21 +
Wood DW, Downes JJ, Leckes HI.  A clinical scoring system for the diagnosis of respiratory failure . AJDC . 1972;;123:227-228.
22 +
McCarthy PL, Lembo RM, Baron MA, Fink HD, Cicchetti DV.  Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children . Pediatrics . 1985;;76:167-171.
23 +
Cohen J.  Weighted kappa: normal scale agreement with provision for scale disagreement or partial credit . Psychol Bull . 1968;;65:1090-1095.
24 +
Cohen J.  A coefficient of agreement for nominal scales . Educ Psychol Measures . 1960;;20:37-46.
25 +
Thomas EE, Book LE.  Comparison of two rapid methods for detection of respiratory syncytial virus (RSV) (TestPack RSV and Ortho RSV ELISA) with direct immunofluorescence and virus isolation for the diagnosis of pediatric RSV infection . J Clin Microbiol . 1991;;29:632-635.
26 +
Beck GJ.  Controlled clinical trial of a new dosage form of metaproterenol . Ann Allergy . 1980;;44:19-22.
27 +
Tal A, Pasterkamp H, Leahy F.  Arterial oxygen desaturation following salbutamol inhalation in acute asthma . Chest . 1984;;86:868-869.
28 +
Prendiville A, Rose A, Maxwell DL, Silverman M.  Hypoxaemia in wheezy infants after bronchodilator treatment . Arch Dis Child . 1987;;62:997-1000.
29 +
Schuh S, Canny G, Reisman JJ, et al.  Nebulized albuterol in acute bronchiolitis . J Pediatr . 1990;;117:633-637.
30 +
Milner AD.  Ribavirin and acute bronchiolitis in infancy: not needed for those who were previously well . BMJ . 1988;;297:998-999.
31 +
Wald ER, Dashefsky B, Green M.  In re ribavirin: a case of premature adjudication? J Pediatr . 1988;;112:154-158.
32 +
Sharland M, Whitehouse N, Qureshi S.  Ribavirin in respiratory syncytial virus infection . Arch Dis Child . 1989;;64:425.
33 +
 Assessing exposures of health-care personnel to aerosols of ribavirin—California . MMWR . 1988;;37:560-563.
34 +
Gladu JM, Ecobichon DJ.  Evaluation of exposure of health care personnel to ribavirin . J Toxicol Environ Health . 1989;;28:1-12.
35 +
Godfrey S, Beardsmore CS, Maayan C, Bar-Yishay E.  Can thoracic gas volume be measured in infants with airway obstruction? Am Rev Respir Dis . 1986;;133:245-251.
36 +
Woolcock AJ, Read J.  Improvement in bronchial asthma not reflected in forced expiratory volume . Lancet . 1965;;2:1323.
37 +
Marks MB.  Management of obstructive airways disease in patients with newbeta-sympathomimetic bronchodilators . Chest . 1978;;73:1010-1011.
38 +
Pierson WE, Shapiro GG, Furukawa CT, Bierman CW.  Albuterol syrup in the treatment of asthma . J Allergy Clin Immunol . 1985;;76:228-233.
39 +
Lee H, Evans HE.  Lack of cardiac effect from repeated doses of albuterol aerosol . Clin Pediatr (Phila) . 1986;;25:345-352.

Figures

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

References

1 +
Henderson FW, Clyde WA, Collier AM, et al.  The etiology and epidemiologic spectrum of bronchiolitis in pediatric practice . J Pediatr . 1979;;95:183-190.
2 +
Silverman M.  Bronchodilators for wheezy infants? Arch Dis Child . 1984;;59:84-87.
3 +
Nussbaum E, Gullant S.  Bronchodilator effects of oral metaproterenol sulfate in preschool children with asthma . J Pediatr . 1987;;110:148-151.
4 +
Robertson CF, Smith F, Beck R, Levison H.  Response to frequent low doses of nebulized salbutamol in acute asthma . J Pediatr . 1985;;106:672-674.
5 +
Garra B, Shapiro CC, Dorsett CS, Simons FER, Pierson WE, Bierman CW.  A double-blind evaluation of the use of nebulized metaproterenol and isoproterenol in hospitalized asthmatic children and adolescents . J Allergy Clin Immunol . 1977;;60:63-68.
6 +
Phelan PD, Williams HE.  Sympathomimetic drugs in acute viral bronchiolitis: their effect on pulmonary resistance . Pediatrics . 1969;;44:493-497.
7 +
Radford M.  Effect of salbutamol in infants with wheezy bronchitis . Arch Dis Child . 1975;;50:535-538.
8 +
Rutter N, Milner AD, Hiller EJ.  Effect of bronchodilators on respiratory resistance in infants and young children with bronchiolitis and wheezy bronchitis . Arch Dis Child . 1975;;50:719-722.
9 +
Lenney W, Milner AD.  At what age do bronchodilator drugs work? Arch Dis Child . 1978;;53:532-535.
10 +
Lenney W, Milner AD.  Alpha and beta-adrenergic stimulants in bronchiolitis and wheezy bronchitis in children under 18 months of age . Arch Dis Child . 1978;;53:707-709.
11 +
Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW.  Dexamethasone and salbutamol in the treatment of acute wheezing infants . Pediatrics . 1983;;71:13-18.
12 +
Pearce J, Wesley H.  Children with asthma: will nebulized salbutamol reduce hospital admissions? BMJ . 1985;;290:595-597.
13 +
Lowell DI, Lister G, Van Koss H, McCarthy P.  Wheezing in infants: the response to epinephrine . Pediatrics . 1987;;79:939-945.
14 +
Motoyama E, Lister C, Mallory GB, Mestad PH, Rothstein G, Weng FT.  Evidence of bronchial hyperactivity in infants with severe bronchiolitis . Pediatr Res . 1982;;16:358.
15 +
Devaskar UP, Devaskar SU, Keenan WJ.  Acute bronchospasm resembling status asthmaticus during the neonatal period . Crit Care Med . 1986;;14:472-475.
16 +
Prendiville A, Green S, Silverman M.  Airway responsiveness in wheezy infants: evidence for functional beta-adrenergic receptors . Thorax . 1987;;42:100-104.
17 +
Duncan PG, Brink C, Douglan JS.  Beta receptors during ageing in respiratory tissues of guinea pigs . Eur J Pharmacol . 1982;;78:45-52.
18 +
McIntosh K.  Bronchiolitis and asthma: possible common pathogenic pathways . J Allergy Clin Immunol . 1976;;57:595-604.
19 +
Lough MD, Doerschuk CF, Stern RC. Pediatric Respiratory Therapy . St Louis, Mo: Mosby—Year Book; 1985;:140-141.
20 +
Bierman CW, Pierson WE.  The pharmacologic management of status asthmaticus in children . Pediatrics . 1974;;54:245-247.
21 +
Wood DW, Downes JJ, Leckes HI.  A clinical scoring system for the diagnosis of respiratory failure . AJDC . 1972;;123:227-228.
22 +
McCarthy PL, Lembo RM, Baron MA, Fink HD, Cicchetti DV.  Predictive value of abnormal physical examination findings in ill-appearing and well-appearing febrile children . Pediatrics . 1985;;76:167-171.
23 +
Cohen J.  Weighted kappa: normal scale agreement with provision for scale disagreement or partial credit . Psychol Bull . 1968;;65:1090-1095.
24 +
Cohen J.  A coefficient of agreement for nominal scales . Educ Psychol Measures . 1960;;20:37-46.
25 +
Thomas EE, Book LE.  Comparison of two rapid methods for detection of respiratory syncytial virus (RSV) (TestPack RSV and Ortho RSV ELISA) with direct immunofluorescence and virus isolation for the diagnosis of pediatric RSV infection . J Clin Microbiol . 1991;;29:632-635.
26 +
Beck GJ.  Controlled clinical trial of a new dosage form of metaproterenol . Ann Allergy . 1980;;44:19-22.
27 +
Tal A, Pasterkamp H, Leahy F.  Arterial oxygen desaturation following salbutamol inhalation in acute asthma . Chest . 1984;;86:868-869.
28 +
Prendiville A, Rose A, Maxwell DL, Silverman M.  Hypoxaemia in wheezy infants after bronchodilator treatment . Arch Dis Child . 1987;;62:997-1000.
29 +
Schuh S, Canny G, Reisman JJ, et al.  Nebulized albuterol in acute bronchiolitis . J Pediatr . 1990;;117:633-637.
30 +
Milner AD.  Ribavirin and acute bronchiolitis in infancy: not needed for those who were previously well . BMJ . 1988;;297:998-999.
31 +
Wald ER, Dashefsky B, Green M.  In re ribavirin: a case of premature adjudication? J Pediatr . 1988;;112:154-158.
32 +
Sharland M, Whitehouse N, Qureshi S.  Ribavirin in respiratory syncytial virus infection . Arch Dis Child . 1989;;64:425.
33 +
 Assessing exposures of health-care personnel to aerosols of ribavirin—California . MMWR . 1988;;37:560-563.
34 +
Gladu JM, Ecobichon DJ.  Evaluation of exposure of health care personnel to ribavirin . J Toxicol Environ Health . 1989;;28:1-12.
35 +
Godfrey S, Beardsmore CS, Maayan C, Bar-Yishay E.  Can thoracic gas volume be measured in infants with airway obstruction? Am Rev Respir Dis . 1986;;133:245-251.
36 +
Woolcock AJ, Read J.  Improvement in bronchial asthma not reflected in forced expiratory volume . Lancet . 1965;;2:1323.
37 +
Marks MB.  Management of obstructive airways disease in patients with newbeta-sympathomimetic bronchodilators . Chest . 1978;;73:1010-1011.
38 +
Pierson WE, Shapiro GG, Furukawa CT, Bierman CW.  Albuterol syrup in the treatment of asthma . J Allergy Clin Immunol . 1985;;76:228-233.
39 +
Lee H, Evans HE.  Lack of cardiac effect from repeated doses of albuterol aerosol . Clin Pediatr (Phila) . 1986;;25:345-352.

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