Journal Article

7771 Safety and length of stay outcomes for children discharged on 10 puffs versus 5 puffs of salbutamol

O’Hagan Kate, O’Connor Margaret, Neame, Matthew, Hall, Annette, Musuka Phoebe, Lee, Kalvin, Varadpande Nayana

2025

Overview

ObjectivesExacerbations of asthma and viral induced wheeze are leading causes of morbidity and hospital admission in children and young people. Salbutamol is a mainstay of treatment for these conditions, however there is limited evidence to inform the optimal salbutamol dosing regimen at discharge.1 2 We aimed to investigate the effect of updated salbutamol discharge dosing guidance (1000 microgram 4 hourly) versus the previously followed guidance of 500 microgram 4 hourly in a specialist children’s hospital.MethodsData from the hospital’s electronic patient record was used to identify inpatients with diagnoses of asthma or viral wheeze treated in the year before and two years after the dosing guidance was updated in November 2020. Data from 491 patient records (227 pre-update, 264 post-update) was analysed for salbutamol discharge doses, readmission rates and length of stay.ResultsFollowing the change in guidance, the proportion of patients discharged on 10 puffs of salbutamol 4 hourly, increased significantly from 6.2% to 49.2% (Mann Whitney U value 17057, p <0.05).The seven-day readmission rate increased from 0.0% (n = 0/227) to 2.7% (n = 7/264) (Fisher’s exact test value 0.0168, p <0.05). However, the readmission rates were not significantly different between the cohort of children who were discharged on five puffs of salbutamol (n = 4/134, 3.0%) compared to the group discharged on ten puffs (n = 3/130, 2.3%) (Chi-square statistic = 0.1173, p = 0.739).There was a non-statistically significant reduction in median length of stay between the two periods (27 hours vs. 23 hours (Mann-Whitney U-value = 17177.5, p = 0.9676)).(See table 1)There were no reported clinical incidents associated with the use of salbutamol on discharge.ConclusionDischarging patients on ten puffs of salbutamol proved to be feasible, was associated with a trend towards a reduced length of stay and was not associated with any adverse events. Although there was an increased readmission rate in the period following the change in the dosing guidance, this did not seem to be related to the discharge dose of salbutamol.We conclude that the key factor in guiding patient discharge is the ability to remain clinically stable in the four-hour interval in between the doses of salbutamol rather than the dose of salbutamol itself. Further research, ideally using high-quality prospective study designs, is required to confirm these findings so that clinicians can make evidence-based decisions.Abstract 7771 Table 1[Image Omitted. See PDF.]ReferencesAndrzejowski P, Carroll W. Salbutamol in paediatrics: pharmacology, prescribing and controversies. Archives of Disease in Childhood-Education and Practice 2016 Aug 1;101(4):194–7.Babl FE, Sheriff N, Borland M, Acworth J, Neutze J, Krieser D, Ngo P, Schutz J, Thomson F, Cotterell E, Jamison S. Paediatric acute asthma management in Australia and New Zealand: practice patterns in the context of clinical practice guidelines. Archives of disease in childhood 2008 Apr 1;93(4):307–12.

• Publisher: BMJ Publishing Group LTD
• Subject: Archives & records / Asthma / Children / Dosage / Guidance / Hospitals / Length of stay / Morbidity / Patients / Pediatrics / Pharmacology / Salbutamol / Statistical analysis