Abstract

COMPARISON OF IMPROVEMENT IN CLINICAL, SPIROMETRIC AND OXYGENATION PARAMETERS AFTER NEBULISATION WITH LEVOSALBUTAMOL AND FORMOTEROL-BUDESONIDE IN MODERATE TO SEVERE ASTHMA

Author(s): Revathi Mogilappa1, Atmakuru Siva Mourya Gupta2, Meruva Penchala Narasimha

BACKGROUND Asthma is characterized by recurrent attacks of breathlessness and wheezing, which vary in severity and frequency from person to person,1 because asthma is a clinical syndrome, there is no gold standard for its diagnosis. As such, physicians employ non-standardized algorithms for making the diagnosis, such as a history of wheezing or a parental history of asthma in conjunction with a favourable response to a bronchodilator at spirometry to identify the asthmatic patient. Effective inhaled bronchodilator and steroid therapy is the cornerstone of asthma management. The aim of this study is to compare the improvement in clinical, spirometric and oxygenation parameters after nebulisation with levosalbutamol and formoterol-budesonide in moderate to severe persistent asthma patients. MATERIALS AND METHODS This is a prospective, analytical study conducted among clinically diagnosed moderate and severe persistent asthma patients in the Department of Pulmonary Medicine, SVRR Govt. General Hospital, Tirupati between June 2018 and July 2018, i.e., over a period of 1 month. 60 asthmatics (27 males and 33 females) who satisfied the clinical and spirometric essential criteria of moderate and severe persistent asthma were included. Spirometry was done prior to nebulisation. Consecutively, the patients were nebulised with Levosalbutamol or Formoterol-Budesonide. Clinical improvement, Spirometry and clinical parameters (pulse rate, respiratory rate, SpO2) were noted at 15 min after nebulisation and again after 1 hr. The results were tabulated. RESULTS Breathlessness and wheeze improved in 100% of the patients after 15 min. Oxygen saturation (SpO2) also improved in 100% of the patients with in 15 min. However, FEV1 with Levosalbutamol showed a moderate improvement (about 60% of predicted value) after 15 min but reached a plateau and continued to be the same at 1 hr. On the other hand, after nebulisation with Formoterol-Budesonide there was moderate to good improvement after 15 min of nebulisation and this continued to improve and after 1hr, in most patients it had reached normalcy (80%). No side-effects were reported in any of the patients. CONCLUSION Symptomatic improvement and improvement in Oxygenation were 100% within 15 min after nebulisation with both Levosalbutamol and Formoterol-Budesonide. However, FEV1 showed early improvement with Levosalbutamol but had reached a plateau and continued to be the same after 1hr of nebulisation. On the other hand, after nebulisation with Formoterol-Budesonide there was very good improvement after 15 min and this continued to increase & by 1hr had reached normal value (>80%) in almost all the patients.