Reacciones adversas por salbutamol en pacientes asmáticos: reflexiones acerca del uso en las exacerbaciones / Adverse reactions from salbutamol in asthmatic patients: reflections on its use and exacerbations / Reações adversas ao salbutamol em pacientes asmáticos: reflexões sobre o seu uso e exacerbações

Las afecciones respiratorias agudas son la primera causa de consulta e ingreso hospitalario en los meses de invierno, y entre ellas el asma ocupa un lugar preponderante. El salbutamol es un broncodilatador con eficacia demostrada en las exacerbaciones y se utiliza de primera línea en el tratamiento. El objetivo de la presente comunicación es analizar dos casos clínicos de niños asmáticos que presentaron efectos adversos al salbutamol y requirieron el ingreso en la Unidad de Terapia Intensiva. Se propone revisar los efectos adversos del salbutamol empleado en crisis asmáticas y analizar las alternativas terapéuticas en esta enfermedad. Los síntomas de los efectos secundarios pueden confundirse con los causados por la propia enfermedad, por lo que puede usarse el fármaco de modo excesivo y es importante conocer el perfil posológico y caracterizar los posibles efectos secundarios en los pacientes para usar de manera racional y segura este medicamento.

Acute respiratory conditions are the first cause of consultation and hospital admission in the Winter months, being asthma the most important. Salbutamol is a bronchodilator with proven efficacy in exacerbations used first-line in treatment. The objective of this paper is to analyze two clinical cases of asthmatic children who presented adverse effects to salbutamol and required admission to the Intensive Care Unit. It is proposed to review the adverse effects of salbutamol used in asthmatic crises and to analyze therapeutic alternatives in this disease. Symptoms of side effects can be confused with those caused by the disease itself, determining the excessive use of this drug, thus, it is important to know the dosage profile and characterize the possible side effects to make rational and safe use of this drug.

As doenças respiratórias agudas são a primeira causa de consultas e internações nos meses de inverno e a asma ocupa é a mais importante. O salbutamol é um broncodilatador com eficácia comprovada nas exacerbações e é usado como tratamento de primeira linha. O objetivo desta comunicação é analisar dois casos clínicos de crianças asmáticas que apresentaram efeitos adversos ao salbutamol e necessitaram de internação em Unidade de Terapia Intensiva. Propõe-se revisar os efeitos adversos do salbutamol utilizado na crise asmática e analisar as alternativas terapêuticas nessa doença. Os sintomas de efeitos colaterais podem ser confundidos com os causados pela própria doença, determinando o uso excessivo desse medicamento, sendo importante conhecer o perfil posológico e caracterizar os possíveis efeitos colaterais nos pacientes para fazer um uso racional e seguro desse medicamento.

Broncodilatadores en pacientes con bronquiolitis / Bronchodilators for bronchiolitis

La bronquiolitis es una infección respiratoria aguda baja de causa viral, de aparición invernal, que es común en bebés de 0a 12 meses de edad. Conduce a que las vías respiratorias pequeñas se inflamen y se llenen de desechos, obstruyéndose.El bebé tiene una tos fuerte, secreción nasal, generalmente fiebre y puede presentar sibilancias dificultad respiratoria ydesaturación de oxígeno. Tras la presentación de un caso en la guardia se generó una controversia científica sobre lautilidad de los broncodilatadores en pacientes con bronquiolitis. Luego de realizar una búsqueda bibliográfica y seleccionarla evidencia más reciente y de mejor calidad, se concluye que la evidencia no apoya el uso de broncodilatadores enpacientes con bronquiolitis.(AU)

Bronchiolitis is a low acute respiratory lower respiratory tract infection of viral origin, winter appearance, which is commonin babies from 0 to 12 months of age. It causes the small airways in the lungs to become inflamed and fill with debris. Theinfant has a harsh cough, runny nose, usually fever and may have wheezing, respiratory distress and oxygen desaturation.After the presentation of a case in the emergency department, a scientific controversy was generated about the usefulnessof bronchodilators in patients with bronchiolitis. After conducting a literature search and selecting the most recent and bestquality evidence, it is concluded that evidence does not support the use of bronchodilators in patients with bronchioliTIS.(AU)

Mioclonías inducidas por salbutamol / Myoclonus induced by salbutamol: A case report

Resumen El salbutamol es un agonista adrenérgico β2 ampliamente empleado en pacientes con enfermedades pulmonares obstructivas y restrictivas. Sus principales efectos secundarios son la taquicardia y el temblor. Las mioclonías son contracciones musculares involuntarias, irregulares, bruscas, breves y repentinas, y pueden ser generalizadas, focales o multifocales. Se presenta el caso de un paciente de 61 años con mioclonías de difícil manejo que solo presentó mejoría tras la suspensión definitiva del agonista adrenérgico β2. Se describen los hallazgos clínicos, las intervenciones y el resultado en las mioclonías asociadas con el uso de salbutamol y se discuten la posible génesis y la importancia de este efecto adverso. Para documentar el caso, se siguieron las recomendaciones de las guías para el reporte de casos (CAse REport, CARE). Aunque en diversos estudios se han descrito mioclonías secundarias al uso de diferentes fármacos, hasta donde se sabe, este sería el cuarto reporte de un caso asociado específicamente con el uso del salbutamol.

Abstract Salbutamol is a β2 adrenergic agonist widely prescribed in patients with obstructive and restrictive lung diseases. The main side effects associated with its use are tachycardia and tremor. Myoclonus is an involuntary, irregular, abrupt, brief and sudden muscular contraction, which can be generalized, focal or multifocal. We report the case of a 61-year-old patient presenting with myoclonus difficult to treat who showed improvement only after the definitive discontinuation of the β2 adrenergic agonist. We describe the clinical findings, the interventions, and the outcomes related to the onset of myoclonus secondary to the use of salbutamol, as well as the possible genesis and importance of this adverse effect. We used the CARE guidelines to delineate the clinical case. Although myoclonus secondary to the use of different drugs has been described in the literature, as far as we know this is the fourth report of salbutamol-induced myoclonus to date.

Efecto del uso de los broncodilatadores sobre el esmalte dentario de niños con afecciones respiratorias - asma / Erosive loss in children treated and not-treated with bronchodilators

El asma es una enfermedad inflamatoria crónica que provoca que las vías respiratorias se estrechen y dificulta la respiración. La medicación para el asma incluye broncodilatadores y fármacos anticolinérgicos. Objetivo: determinar la prevalencia de erosión dental en los niños que reciben salbutamol cmo medicación broncodilatadora y establecer diferencias con aquellos sin afecciones respiratorias. Métodos: la muestra incluyó 100 niños, 50 de ellos medicados usaqndo un inhalador de salbutamol a lo largo de los 9 meses anteriores al estudio (Md 5 años 6m) y 50 sin patología respiratoria. Los padres de los niños completaron un cuestionario del consumo de bebidas. Se llevaron a cabo exámenes dentales y se determinó la pérdida de tejido dental según índice de SyK y CDHS. Procesamiento estadístico: se utilizaron media, mediana, DS, distribución de frecuencias y chi cuadrado. Resultados: se observó erosión dental en el 52 por ciento de los niños medicados y en el 42 por ciento de los no medicados. Los niños con medicación y consumo de bebidas diarias presentaron erosión en un 64,7 por ciento y consumo fines de semana 50 por ciento. Los niños sin medicación y consumo de bebidas diarias presentaron erosión enb un 34,8 por ciento y consumo fines de semana 31,2 por ciento. No se observó asociación entre medicación y erosión dental. No ser observaron diferencias estadísticas entre grupos ni en la frecuencia de consumo de bebidas ácidas. Conclusión: en ambos grupos existe una alta prevalencia de erosión dental, no mostrando asociación entre la medicación y la erosión dental...

Terbutaline versus salbutamol for suppression of preterm labor: a randomized clinical trial

Preterm labor [PTL] is a common medical problem during pregnancies and is associated with neonatal mortality and morbidity. Beta-adrenergic agonists are among the most commonly used tocolytic agents. The aim of this study was to compare the effectiveness, safety and adverse effects of terbutaline with those of salbutamol in the prolongation of pregnancy beyond 48 hours and until 37 weeks of gestation. Two hundred women with PTL were randomly assigned to receive subcutaneous terbutaline [250 micro g] or intravenous salbutamol [0.1 mg] followed by oral terbutaline [20 mg/d] or oral salbutamol [24 mg/d] as maintenance. The efficacy, side effects and complications after 48 hours and until 37 weeks of gestation were analyzed and compared. There was no significant difference between the two groups in success rate within 48 hours [P= .091]. Gestational age at delivery [P=.031] and the number of days for which the gestation was prolonged [P=.024] were significantly higher in those receiving terbutaline. Adverse effects, including tachycardia [P=.007] and anxiety [P=.006], were experienced more in the salbutamol group. Birth weight was significantly lower in the salbutamol group [P=.001]. Terbutaline provided more effective tocolysis with fewer adverse effects and a better neonatal outcome. However, terbutaline and salbutamol are equally effective in the first 48 hours

External cephalic version with salbutamol-Success rate and predictors of success

To determine the success rate of External Cephalic Version [ECV] with 0.25 mg Salbutamol in singleton term breech and to identify the predictors of success. Quasi experimental study. Mother and Child Health Centre, Pakistan Institute of Medical Sciences, Islamabad, from January 2000 to March 2005. Women, presenting with uncomplicated breech, between 37-40 completed weeks gestation, underwent ECV in day care ward. Fifteen minutes before the procedure, injection salbutamol 0.25 mg was administered subcutaneously. Cases with contraindication to ECV or Salbutamol injection were excluded from the study. The outcome measures included success rate of ECV [in terms of conversion from breech to cephalic presentation at the completion of procedure confirmed through ultrasound], association of maternal and fetal demographic characteristics with successful version and adverse effects related to the procedure in terms of fetal bradycardia, ante-partum still birth, antepartum hemorrhage and preterm labour. Rate of reversion to breech and drug-related side effects were also recorded as secondary outcome measures. Chi-square test was used for categorical variables and independent sample t-test for continuous variables. Of the 101 ECV procedures, 41 [40.5%] were successful. Success rate was significantly lower in nullipara [p=0.01] and with AFI 7 cm or less [p=0.04]. No significant association was found between success rate and gestational age [p=0.35] or fetal birth weight [p=0.57]. None of the patient suffered from serious maternal complications. Salbutamol related minor effects [tremors, anxiety and palpitations] were observed in 36 [35.6%] patients. Fetal tachycardia was seen in 17 [16.8%], reversible fetal bradycardia in 3 [2.9%] and intractable fetal bradycardia in one patient. External cephalic version with 0.25 mg Salbutamol was safe and a feasible option in term breech presentation in this series. Administration of tocolytic agent improved the success rate and reduced complication rate of the procedure. Major determinants of success were amniotic fluid index and parity

Medicação antipânico e função pulmonar em pacientes com transtorno de pânico / Antipanic drugs and pulmonary function in panic disorder patients

CONTEXTO: Estudos sugerem uma associação entre transtorno de pânico (TP) e prejuízos na função pulmonar. OBJETIVOS: Avaliar a função pulmonar em 11 pacientes com TP assintomáticos e investigar efeitos da medicação antipânico na função respiratória. MÉTODO: A função pulmonar foi avaliada em duas ocasiões diferentes (com medicação antipânico e após "washout"). Consistiu de uma avaliação espirométrica e do teste de broncodilatação (inalação de salbutamol). Subjective Units of Disturbance Scale (SUDS) foi aplicada antes e após cada teste espirométrico. RESULTADOS: Um paciente apresentou obstrução leve de vias aéreas. Antes do teste de broncodilatação, o volume expiratório forçado no primeiro segundo (VEF1) e o fluxo expiratório forçado entre 25 por cento e 75 por cento da capacidade vital forçada (FEF25-75) foram significativamente maiores em pacientes com medicação antipânico do que no período de "washout". Após a inalação de salbutamol, apenas o VEF1 foi significativamente maior em pacientes com medicação antipânico em comparação ao outro grupo, embora tenha sido detectado aumento significativo em VEF1 e FEF25-75 em pacientes sem medicação antipânico depois da inalação de salbutamol. O nível de ansiedade subjetiva não foi diferente entre os pacientes em ambos os dias de testes. CONCLUSÃO: Os resultados sugerem uma possível ação benéfica da medicação antipânico na função pulmonar em pacientes com TP.

BACKGROUND: Studies suggest an association between panic disorder (PD) and impairment of lung function. OBJECTIVES: To evaluate lung function in 11 asymptomatic PD patients and to investigate antipanic drug effects on respiratory function. METHOD: Lung function was evaluated on two different occasions (with antipanic drugs and after drug washout). It was comprised of a spirometric evaluation and a bronchodilation test (salbutamol inhalation). Subjective Units of Disturbance Scale (SUDS) was applied before and after each spirometric assessment. RESULTS: One patient showed mild obstructive airway impairment. Before bronchodilation test forced expiratory volume in 1 sec (FEV1) and forced expiratory flow between 25 percent and 75 percent of the forced vital capacity (FEF25-75) were significantly higher in patients on antipanic drugs than in those in the washout period. After salbutamol inhalation, only FEV1 was significantly higher in patients with antipanic drugs in comparison to the other group, whereas a significant increase in FEV1 and FEF25-75 after salbutamol inhalation was detected in patients without antipanic drugs. The subjective anxiety level was not different among PD patients in both test days. DISCUSSION: These results suggest a possible beneficial effect of the antipanic drug on lung function in PD patients.

[Nicardipine versus salbutamol in the treatment of premature labor: comparison of their efficacy and side effects]

The objective of this study is to compare the tocolytic action and the side effects of nicardipine to those of salbutamol in patients presenting premature labor in order to propose nicardipine as a promising alternative to salbutamol in the treatment of premature labor. Forty eight patients admitted for premature labor were included in this prospective randomized study comparing nicardipine and salbutamol, administered with intra venous drip. The nicardipine group included 25 patients and the salbutamol group included 23 patients. The epidemiologic characteristics of the 2 groups are similar. No significant difference between the 2 groups was noted in the average time of disappearance of the uterine contractions. In nicardipine group, the pregnancy was prolonged more than 48 hours in 87.5% of the cases against 85.8% in salbutamol group [P: NS]. Adverse effects linked to tocolysis were recorded. In nicardipine group, 8% of the patients presented an intolerance of the molecule, against 47% of salbutamol group, the difference is significant [P=0.02]. The term of delivery was similar in both groups. The neonatal status of the infants was identical in the two groups. In the group of new born hospitalized, we did not note biological disorders concerning the glycemia and the calcemy. Nicardipine is at least as effective as salbutamol in tocolysis; but it has less secondary effects. Thus, nicardipine is proposed as the tocolytic of first intention instead of the salbutamol which is considered as reference molecule

Comparison of nifedipine with salbutamol as tocolytic agents in preterm labour

This study was carried out to evaluate the tocolytic efficacy for prolongation of pregnancy with oral nifedipine in comparison to salbutamol, and to evaluate side effects of nifedipine. It was an interventional study and was performed for a period of one year in Sir Ganga Ram hospital, and in the department of obstetrics and gynaecology, Fatima Jinnah Medical College. Sixty women were enrolled in this study. A questionnaire was filled for each patient. Once randomised the women received oral nifedipine or intravenous salbutamol in recommended dosage for acute tocolysis. Measurements of maternal pulse, blood pressure and foetal heart rate were recorded for upto 24 hours and compared over the treatment course. Outcome measures were prolongation of pregnancy as a result of tocolysis and recorded in hours and days, along with maternal and foetal side effects. Delivery was deferred for 48 hours, 3 to 7 days and more than 7 days in 30%, 6.66% and 3.33% respectively in nifedipine group compared with 26.66%, 3.33% and 3.33% of women respectively in salbutamol group [no significant difference P > 0.05]. Major maternal and foetal side effects were significantly less common in nifedipine group [0%] than in salbutamol group [13.33%] P value = 0.05. Nifedipine is almost as effective as salbutamol in suppressing preterm labour. Its use is associated with less frequent side effects

Acetaminophen mimics the action of salbutamol in relaxing gravid human uterus-in-vitro

Management of preterm labour was generally treated by salbutamol even with some expected disturbances is maternal pulmonary oedema, respiratory distress and cardiovascular side effects and neonatal low-size and cellularity of thymus and lymph nodes. This demands finding a substitute free of these side effects. Initially, acetaminophen was tested on rats uterine horns and on pregnant rats and reported an effective relaxation of the uterine horns and profound delay in parturition. These results justified an in-vitro study on strips of gravid human uterus ruptured during difficult labour. Acetaminophen [50 mg] reduced tension by 50% which was comparable to decrease in tension when 5 micro g of salbutamol was added. Profound drop in tension is care of adjunct use of both drugs, while repeated three doses of 50 mg acetoaminophen when added separately resulted in corresponding drops in tension down to below resting level. These findings encouraged future clinical trials on threatened women with abortion since the use of acetaminophen in the usual dosage is effective tocolytic agent without any maternal side effects but with mild possible neonatal lung congestion as a result of transient narrowing of ductus arteriosus especially in advanced gestational age

Benzalkonium Chloride Induced Bronchoconstriction in Patients with Stable Bronchial Asthma

BACKGROUND: Although benzalkonium chloride (BAC)-induced bronchoconstriction occurs in patients with bronchial asthma, BAC-containing nebulizer solutions are still being used in daily practice in Korea. The aim of this study was to evaluate the effects of inhaled aqueous solutions containing BAC. METHDOS: Thirty subjects with bronchial asthma and 10 normal controls inhaled up to three 600 microgram nebulized doses of BAC using a jet nebulizer. FEV1 (forced expiratory volume at one second) was measured 15 minutes after each dose. Inhalations were repeated every 20 minutes until FEV1 decreased by 15% or more (defined as BAC-induced bronchoconstriction) or the 3 doses were administered. RESULTS: The percent fall in FEV1 in response to BAC inhalation was significantly higher in asthmatics than in normal subjects (p<0.05). BAC administration in subjects with asthma reached a plateau (maximal effect). BAC-induced bronchoconstriction was found in 6 asthmatics (20%), with two responders after the 2nd inhalation and 4 after the 3rd inhalation. The percent fall in FEV1 in response to the 1st inhalation of BAC was significantly higher in asthmatics with higher bronchial hyperresponsiveness (BHR) than in those with lower BHR. CONCLUSIONS: This study suggests that the available multi-dose nebulized solution is generally safe. However, significant bronchoconstriction can occur at a relatively low BAC dose in asthmatics with severe airway responsiveness.

Transient lactic acidosis as a side effect of inhaled salbutamol therapy in asthmatic children

In spite of the effectiveness of inhaled beta-2 agonists as bronchodilator therapy in bronchial asthma management in children; they produce a number of biochemical changes. The clinical relevance of these biochemical changes is not clearly defined. One of these observed changes is the transient lactatemia. The aim of this study is to evaluate the presence of lactic acidosis as a transient side effect of inhaled salbutamol therapy during the management of asthmatic attacks. Thirty-six asthmatic children presenting in acute asthma, 20 males and 16 females with age range between 6 and 10 years [mean +/- SD: 7.47 +/- 1.13 years], were included in this study. All of them were subjected to full history taking, thorough clinical examination and lab evaluation including: Serum lactate levels before salbutamol inhalation therapy, one hour after start of inhalation therapy and 24 hours later. Blood gas analysis before and after inhalation therapy were also done. Salbutamol inhalation therapy was given to all patients in the form of 3-successive doses, 20 minutes apart, in a dose of 0.15 mg/kg/dose, thereafter intensive management was continued. A statistically highly significant increase in the early post treatment serum lactate level was found in comparison to both pre treatment and 24 hours post treatment levels. In spite of the return of serum lactate levels to normal limits, the difference between the 24-hour post treatment and pre treatment levels was also statistically highly significant. The results of this study confirm that transient lactic acidosis occurs as a side effect of inhaled salbutamol. Physicians should be aware of this side effect of bronchodilators, which might prove of clinical significance in the more severe cases where other causes of metabolic acidosis coexist. Abbreviation: S.I.T. = salbutamol inhalation therapy

Oral salbutamol for treatment of preterm labor.

OBJECTIVE: The aim of this study was to assess the value of oral salbutamol for the inhibition of preterm labor. MATERIAL AND METHOD: Medical records of the department from January 1, 1991 to December 31, 1999 were reviewed for all idiopathic preterm labors that were inhibited by oral salbutamol and statistically analyzed. RESULTS: Of 132 pregnancies, 81.1% (95%CI, 74.4, 87.7) were prolonged for more than 24 hours, 59.8% (95%CI, 51.5, 68.2) for more than 2 days, 32.6% (95%CI, 24.6, 40.6) for more than 1 week, and 8.3% (95%CI, 4.2, 14.4) for more than 4 weeks. Tachycardia (pulse rate > 100 beats/min) occurred in 85.6% of the patients, but those with a pulse rate higher than 140 beats/min occurred in only 3%. Hypotension occurred in only 0.8%. Neonatal complications occurred in 28%, while respiratory distress syndrome occurred in 22.7% of the babies. Perinatal mortality in the present study was 7.6 per 1,000 births. When comparing the pregnancy outcome between groups regarding the prolongation time, the pregnancy outcome was significantly better in the group that had a prolongation time of at least 48 hours. CONCLUSION: Oral salbutamol proved to be another effective method that inhibits preterm labor and consequently prolongs pregnancy. Because it requires no intensive medical nursing care and observations, and no discomfort of an intravenous line, oral salbutamol may be an alternative drug in the management of preterm labor.

cardiac arrhythmias during management of acute severe asthma in the intensive care unit

This study was carried out to evaluate the occurrence of cardiac arrhythmias during therapy with I.V. aminophylline infusion and nebulized salbutamol of 50 consecutive patients with acute severe asthma. Vital signs, arterial blood gases, PEFR, serum potassium and total magnesium were measured on admission in emergency department, on admission in ICU and one hour thereafter. Continuous ECG monitoring and recordings were performed to capture the occurrence of cardiac rhythm disturbance. The results showed that initially in emergency department there was increase in pH, decrease in PaO2, PaCO2 and PEFR together with mild decrease in levels of serum potassium and magnesium. On admission in ICU, the patients showed more decline in PaO2 and PEFR, with increase in PaCO2 and mild decrease in pH together with more decrease in serum potassium and magnesium. After one hour of initiation of treatment in ICU, there was improvement in pH, PaO2, PaCO2, PEFR und serum potassium and magnesium. Premature ventricular contractions [PVCs] occurred in 24 patients; 15 patients had occasional unifocal PVCs and only 9 patients developed severe ventricular arrhythmias: frequent PVCs more than 10/h [n = 5] multifocal PVCs [n = 2] and a short run of ventricular tachycardia [n = 2]. Serious supraventricular arrhythmias occurred in only 5 cases who developed runs of atrial tachycardia in 3 patients and atrial fibrillation in 2 patients. These arrhythmias were clinically well tolerated and spontaneously resolved without any antiarrhythmic treatment. It is concluded that cardiac dsyrhythmias, observed during the combined therapy with aminophylline and salbutamol, were self limited and possibly related to treatment as well as hypoxia and particularly in presence of hypokalemia and hypomagnesmia during episodes of acute severe asthma

Encuesta sobre conocimiento del tratamiento del asma aguda en un grupo de médicos pediatras de la Ciudad de Mérica, Yucatán, México / Survey on the knowledge of acute asthma treatment among a group of pediatricians in the city of Merida, Yucatan

Introducción. Objetivo. determinar el nivel de conocimiento sobre el tratamiento del asma aguda en un grupo de médicos pediatras por medio de un cuestionario de la American Academy of Pediatrics denominado:"Tratamiento del asma aguda infantil en el consultorio". Material y métodos. Diseño. estudio descriptivo, observacional y transversal. Lugar de la investigación: consultorios pediátricos privados de la Ciudad de Mérida, Yucatán, México. Unidades de estudio. se estudió una muestra probabilística formada por 48 pediatras seleccionados de los miembros activos del "Colegio de Pediatras de Yucatán" por muestreo aleatorio simple. Mediciones: el cuestionario incluyó preguntas sobre: equipo disponible en el consultorio para el tratamiento del asma aguda, clasificación de la intensidad de un episodio de la enfermedad, dosis de los medicamentos utilizados, dependiendo de la intensidad de la crisis y efectos adversos de los mismos. Resultados. Con relación al equipo disponible, 94 por ciento contaba con un inhalador de dosis medida o con un nebulizador, pero sólo 25 por ciento tenía flujómetro y 39 por ciento equipo para administrar oxígeno. El promedio de aciertos respecto de las otras preguntas fue de 49 por ciento. Conclusiones. Se encontraron deficiencias en el equipamiento y en el conocimiento necesarios para una adecuada atención de los niños asmáticos

Broncodilatadores en síndrome bronquial obstructivo del lactante / Bronchodilator agents in obstructive bronchial syndrome in infants

Se evalúa la respuesta clínica a diferentes broncodilatadores en 100 lactantes con síndrome bronquial obstructivo que, por la intensidad de éste requerían hospitalización, mediante un estudio prospectivo doble ciego, en el que se asignaron 25 niños menores de lactantes por grupo. Los niños del grupo I recibieron ipratropio (I), los del grupo II cloruro de sodio 9 por ciento (NaCI), en el grupo III se empleó fenoterol-ipratropio (FI) y en el grupo IV salbutamol (S), en todos los casos por nebulización. La calificación de Tal era similar al ingreso en los 4 grupos (día 0). Al día 1 del tratamiento era significativamente menor (p<0,05) en FI, como también el día 2 (p<0,01): (promedios día 1: 4,6 (I); 4,5 (NaCI); 3,8 (FI); 4,6 (S); día 2: 3,8 (I) 4,1 (NaCI); 2,1 (FI); 3,9 (S); día 3: 3,0 (I); 3,4 (NaCI); 1,6 (FI); 3,2 (S). El promedio de días estada fue I: 4,64 ñ 1,29; NaCI: 5,44 ñ 1,61; FI: 3,08 ñ 1,28; S: 5,28 ñ 1,69; p<0,001 a favor de FI. Los niños tratados con NaCI requirieron con mayor frecuencia terapia adicional con broncodilatadores (p<0,05) en claro contraste con los manejados con FI, que requirieron menos broncodilatadores adicionales que el resto (p<0,01) desde el día 1 del ingreso. No se registraron efectos secundarios indeseables con los diferentes regímenes aplicados