A randomized controlled trial on the use of Budesonide/formoterol (symbicortr) as an alternative Reliever medication for mild to moderate asthmatic attack in Adult patients in emergency department, hospital universiti Sains malaysia
A RANDOMIZED CONTROLLED TRIAL ON THE USE OF BUDESONIDE/FORMOTEROL (SYMBICORT®) AS AN ALTERNATIVE RELIEVER MEDICATION FOR MILD TO MODERATE ASTHMATIC ATTACK IN ADULT PATIENTS IN EMERGENCY DEPARTMENT, HOSPITAL UNFVERSITI SAINS MALAYSIA. Nebulized Salbutamol has been commonly used as the conventiona...
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| Format: | Thesis |
| Language: | English |
| Published: |
2012
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| Subjects: | |
| Online Access: | http://eprints.usm.my/60990/1/DR%20HAMIZAH%20BINTI%20KAMARUDIN%20-%20e.pdf http://eprints.usm.my/60990/ |
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| Summary: | A RANDOMIZED CONTROLLED TRIAL ON THE USE OF
BUDESONIDE/FORMOTEROL (SYMBICORT®) AS AN ALTERNATIVE
RELIEVER MEDICATION FOR MILD TO MODERATE ASTHMATIC
ATTACK IN ADULT PATIENTS IN EMERGENCY DEPARTMENT, HOSPITAL
UNFVERSITI SAINS MALAYSIA. Nebulized Salbutamol has been commonly used as the conventional reliever in
the treatment of patients with acute exacerbations of asthma regardless of whether in
outpatient clinic settings or in the emergency departments. On the other hand,
Symbicort turbuhaler is a combination of Formoterol (long acting 02- agonist) and
Budesonide (steroid). Salbutamol and Formoterol are 02-agonist that acts as bronchodilators, but
Salbutamol is a short acting 02-agonist, whereas Formoterol is a long acting 02-agonist.
Budesonide is a steroid that plays a role as an anti-inflammatory agent that usually
occur in acute asthma attack. This research is done to evaluate the effectiveness of Symbicort turbuhaler which is a combined long acting 02-agonist and steroid as an alternative reliever in mild to moderate acute axacerbation of bronchial asthma and to
look at patient’s acceptance regarding the use of Symbicort turbuhaler and the feasibility in starting Symbicort maintanance and reliever therapy (SMART) in
emergency department. To evaluate the effectiveness of Symbicort therapy as an alternative reliever
in treating mild to moderate acute exacerbation of bronchial asthma. To evaluate control of asthma based on Asthma Control Test (ACT) among
adult asthmatic patients that presented to emergency department HUSM. To evaluate the effectiveness of Symbicort turbuhaler as an alternative
treatment for mild to moderate asthma exacerbation by using respiratory
rate, oxygen saturation and peak expiratory flow rate (PEFR) as objective
assessment tools for the severity of asthmatic attack and patient’s response to
treatment. To evaluate the effectiveness of symbicort turbuhaler as an alternative
treatment for mild to moderate asthma exacerbation by using Visual Analog
Score (VAS) and 5-point Likert Scale of breathlessness as subjective
assessment tools for the severity of asthmatic attack and patient’s response to
treatment. To understand patient’s acceptance regarding the use of Symbicort
turbuhaler as an acute asthma reliever and maintainance therapy (SMART). To evaluate the fraction exhaled nitric oxide (FENO) level in asthmatic
patient and its association with asthma control. A randomized controlled trial was done from March until August 2011 between
nebulizer Salbutamol and Symbicort turbuhaler in adult patients with mild to moderate
acute exacerbation of bronchial asthma who presented to Emergency Department
HUSM. Patients who fulfilled the criteria and agreed to participate in this study were
randomly assigned either nebulizer Salbutamol or Symbicort turbuhaler as the
treatment. Objective and clinical parameters such as respiratory rate (RR), oxygen
saturation (SPO2), peak expiratory flow rate (PEFR) and fraction of exhale nitric oxide
(FENO) were recorded before and after treatment. Parameters were analyzed using
SPSS version 18.0. A total of 32 patients fulfilled the inclusion criteria and consented to participate
in this study. After randomization, 17 patients were chosen to receive nebulized salbutamol and another 15 patients received symbicort turbuhaler. There were significant improvements in respiratory rate (RR), oxygen saturation (SPO2) and PEFR in patients received symbicort turbuhler (p=0.001, p=0.027 and p=<0.001 respectively). This result is as significant as patients received nebulized salbutamol.
When comparing the means difference between this two groups using ‘Independence ttest’,
it showed that there were no significant difference in terms of changes in
respiratory rate, SPO2 and PEFR (p=0.687,p=0.350 and p=0.507 respectively). In terms of subjective parameters using ‘Visual Analog Score’ and ‘5-point Likert Scale’
of breathlessness, it also showed that there were no significant difference in patients
who received symbicort turbuhaler or nebulized salbutamol (p=0.765 and p=0.688
respectively). Regarding asthma control based on Asthma Control Test (ACT) score, by using Me
Nemar test, there were no significant difference in asthma control in patients started on
SMART therapy or with MDI salbutamol plus MDI budesonide (p=0.754). We also found that SMART therapy were well accepted by most of the patients based on
questionnaires answered. From this randomized controlled trial study, it showed that symbicort turbuhaler
can be used as an alternative treatment for patients with mild to moderate exacerbation
of asthma as there were no significant difference improvements in objective parameters
and in subjective parameters compared to nebulized salbutamol. |
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