Sunday, March 26, 2017

1991: Study finds albuterol works just as well as epinephrine

In my quest to write a little history of Sus-phrine (epinephrine) I finally found an article I'd been looking for for quite some time. The article was regarding a study comparing the long-acting version of epinephrine with Ventolin (albuterl). It was a breakthrough study. It's basically why we give albuterol breathing treatments for asthma instead of epinephrine injections.

Before I delve into the study, I think a little background is pertinent here. Epinephrine was established as a very effective treatment for asthma during the first few decades of the 19th century. So, if you suffered from severe asthma and went to your doctor with an asthma attack, there's a good chance you were given an epinephrine injection.

Epinephrine was great because it opened airways within only a few short minutes. The down side was that it only lasted 3-4 hours. This often meant that repeated injections were needed to keep airways open long-term. This problem was solved in the 1970's with the introduction of Sus-phrine, which was essentially a long-acting epinephrine: it lasted 6-8 hours.

During the 1970's and 80's if you went to your doctor for severe asthma, you might be given a Sus-phrine shot instead of the traditional epinephrine. My mom kept track of this kind of stuff for me when I was a kid, and I know I was given Sus-hrine in the early 1970's. In 1976, when I was only six-years-old and my family wanted to travel from Michigan to California, my doctor wrote a note saying that if this boy has a severe asthma episode, Sus-phrine works great.

I was initially given these shots in the doctor's office. However, later on I had to go to the hospital. It got to the point that, by 1980, I was literally asking for "the shot." An I got it every time. This came to an end in 1991. This year I went to the emergency room and I asked for "the shot." But, the doctor had never heard of what I was asking for. I said, "It's called Sus-phrine."

After talking with the pharmacist he was able to find one. He gave me the shot. This was the last time I was ever given a Sus-phrine shot. A few months later I had another asthma attack and went to the emergency room. This time I was given a bunch of albuterol breathing treatments. They worked just as well as the shot at opening me up. And, as a bonus, I didn't feel like doing laps when I was done; my heart didn't feel like it was going to explode.

This probably wasn't the only such study, but a 1991 study published in Pediatric Emergency Care tiled, "Effect of injected long-acting epinephrine in addition to aerosolized albuterol in the treatment of acute asthma in children." The study basically showed that Sus-phrine was no better than albuterol at opening airways and ending asthma attacks. 

Considering side effects of albuterol are essentially negligible, and the fact that doctor's generally feel comfortable giving high doses of it in the emergency room when needed, the study was a breakthrough study. It pretty much removed epinephrine as a top-line treatment for severe asthma attacks and moved albuterol up to the top. 

As anyone who works as a respiratory therapist knows, albuterol has remained at the top ever since. In fact, albuterol is considered so safe by the medical community. that it's given indiscriminately to anyone who comes into the emergency room with shortness of breath or wheezes regardless of the cause. If it works, great. If it doesn't work, it was worth a try. 

References and further reading:

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