Comparison of as-required versus regular weaning inhaled salbutamol post-acute wheezing
Background: Children often receive regular weaning doses of inhaled salbutamol upon discharge following acute wheezing attacks, despite limited evidence supporting this practice. The Global Initiative for Asthma recommends using relievers as needed upon discharge. In Cambridge University Hospitals, the regular weaning inhaled salbutamol (RWIS) regimen was replaced by an as-required inhaled salbutamol (ARIS) regimen on 12-Sep-2023. Objectives: To evaluate the safety of the ARIS regimen compared to the RWIS regimen post-acute wheezing attacks Methods: A single-center retrospective observational cohort study was conducted, comparing the number of re-presentations to the Paediatric Emergency Department (PED) within 28 days, among children aged 0-17 years presenting to PED with asthma or viral-induced wheeze between 12-Sep and 5-Dec (84 days) in 2021, 2022, and 2023. Statistical significance was assessed using odds ratios and the chi-squared test of independence Results: In year 2021, 2022, and 2023, there were 333, 260, and 322 PED presentations for acute wheezing, respectively, with 56, 49, and 49 re-presentations within 28 days. The odds ratio for PED re-presentations with the ARIS regimen was 0.834 (0.576 – 1.208, p value 0.337) Conclusion: The use of the ARIS regimen post-acute wheezing attacks resulted in a lower rate of PED re-presentations, although not statistically significant. This suggests that the ARIS regimen is as safe as the conventionally used RWIS regimen. When used correctly, this approach can prevent overuse of salbutamol, mitigate the masking effect of deterioration, and empower patients to manage their asthma effectively.