Inhaled Steroids as a Booster for Salbutamol-Induced Bronchodilation?

Nebulizer

The mainstay of asthma treatment is the beta-2-mimetic salbutamol (or albuterol) which is also first line in critical care. Researchers have previously observed that inhaled glucocorticosteroids potentiated salbutamol-induced airway vascular smooth muscle relaxation.

As a consequence of these observations Eliana S. et al. performed a small double-blind pilot study on fifteen patients clinical obstructive asthma. The influence of inhaled steroids (mometasone) compared to placebo 30min before inhalation of salbutamol was measured by looking at the change in FEV1 (ΔFEV1) for airway smooth muscle and the airway blood flow (ΔQaw) for airway vascular smooth muscle within 15 min after drug inhalation.

This pilot study showed that in adult patients with obstructive asthma with airflow obstruction, a single standard dose of an inhaled steroid can acutely increase the FEV1 response to a standard dose of inhaled salbutamol… especially when administered 30min before.

This might become a helpful finding in the future! We’ll keep the eyes open!
Eliana S. et al. Chest. 2015;147(4):1037-1042.

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Dexmedethomidine is Expensive, but Cheaper

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Dexmedetomidine has become increasingly popular in critical care and seems to become an attractive alternative to standard sedation drugs like midazolam and propofol. Especially in the context of moderate to light sedation and when weaning the patient form mechanical ventilation there are two European randomized double-blind studies (PRODEX, MIDEX) showing that dexmedetomidine is non inferior to propofol and midazolam in maintaining target sedation levels in mechanically ventilated intensive care unit patients. Additionally, dexmedetomidine shortened the time to extubation versus both standard sedatives, suggesting that it may reduce ICU resource needs and thus lower ICU costs.

The authors decided to take a closer look at the cost factor by performing a secondary, cost-minimization analysis assessing the economics of dexmedetomidine versus standard care sedation.
Without going into details it seems that dexmedetomidine actually reduces costs in intubated patients with light to moderate sedation… and this mainly by reducing the time to extubation.

It is noteworthy that all these data and their conclusions derive from one international research team and that the pharmaceutical company providing dexmedotomidine was involved by sponsoring.

Nevertheless, these robust results indicate:

– Dexmedetomidine is an attractive sedative for moderate to light sedation in the intubated
patient
– Seems to shorten time to extubation
– … and might actually be cheaper compared to ‘standard’ sedation
Turinen H et al. Critical Care 2015, 19:67 OPEN ACCESS

Jacob SM et al. JAMA. 2012;307(11):1151-1160. OPEN ACCESS