Efficacy and safety of a rapid-sequence metaproterenol protocol in the treatment of acute adult asthma

A 6-month prospective study was performed to examine the efficacy and safety of a rapid-sequence nebulized metaproterenol regimen for the treatment of acute asthma in adults. Patients 18 years of age or older who were not pregnant and who had not received β2-agonist therapy were identified and started on a rapid-sequence metaproterenol regimen (15 mg) by the triage nurse. Pretreatment and posttreatment peak flow, respiratory rate, pulse rate, and blood pressure were documented. Patients also gave a pretreatment and posttreatment rating of the clinical severity of their attack using a 1-to-10 visual analogue scale. Fifty patients were entered into the study, with an average age of 38 years (range, 19 to 87 years). Data were analyzed using the Wilcoxon matched-pairs signed rank test. Patients showed statistically significant increases in peak flow (193 to 328 L/min, P< .00001) and systolic blood pressure (136 to 143 mm Hg, P< .0054). Statistically significant decreases were shown for respiratory rate (25 to 22 beats/min, P< .0001) and clinical severity (6.2 to 3.2, P< .00001). Thirty-three patients (71%) who completed the protocol experienced an increase in pulse rate. Ten (21%) had a pulse rate increase of more than 30 beats/min. Two (4.2%) had pulse rate increases of more than 40 beats/min. Four patients were removed after one or two nebulizers because of severe side effects. One patientʹs pulse rate increased to more than 200 beats/min. Although effective in reversing bronchospasm, the side effects of metaproterenol when used in rapid sequence are of major concern.