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IV ß₂-Agonists: Not the Way to Go in the ED

A meta analysis found no evidence to support the use of IV ß₂-agonists for patients with severe asthma.

Administering ß₂-adrenergic agonists systemically rather than by inhalation in patients with severe asthma has potential advantages, because aerosols might not be able to reach or move beyond small, constricted conducting airways. However, intravenous use of these agents is controversial, and the National Asthma Education and Prevention Program guidelines do not recommend it. These authors performed a meta-analysis of randomized, controlled trials that have compared IV ß₂-agonists with standard treatments or placebo in patients with severe acute asthma.

In a systematic review of papers published before 2000, the authors identified 15 appropriate trials that involved 584 patients with severe acute asthma; all trials were conducted outside of North America. Compared with aerosol ß₂-agonists alone or in combination with IV ß₂-agonists and IV methylxanthines, treatment with IV ß₂-agonists alone did not result in clinically or statistically significant differences in vital signs, spirometric measures, adverse events, or disposition.

Comment: There is no evidence to support the use of IV ß₂-agonists, even in patients with severe asthma exacerbations, unless inhaled therapy is not feasible (e.g., in patients who are coughing excessively, are too weak to inspire adequately, or are moribund). In such patients, intubation with controlled ventilation and in-line ß₂-agonist aerosol therapy should still be considered the standard approach.

— Charles V. Pollack, Jr., MA, MD, FACEP

Published in Journal Watch Emergency Medicine December 30, 2002

Citation(s):

Travers AH et al. The effectiveness of IV ß-agonists in treating patients with acute asthma in the emergency department: A meta-analysis. Chest 2002 Oct; 122:1200-7.

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