239 - Analysis of Continuous Albuterol Dosing and its Effect on Nausea and Vomiting in the Pediatric Emergency Department

Poster Number: 239
Publication Number: 239.2850

Background: Albuterol is a mainstay of treatment for children with acute asthma. Severe acute wheezing and asthma are often treated in the pediatric emergency department (ED) with continuously nebulized albuterol. While albuterol is generally well tolerated, it has several known adverse effects including nausea/vomiting. The relationship between continuous albuterol dose and nausea/vomiting has not been well established.

Objective: To evaluate variables associated with nausea/vomiting in pediatric ED patients receiving continuous albuterol.

Design/Methods: We performed a retrospective cohort analysis of ED patients treated between July 2019 and April 2021. We included patients < 18 years of age who received continuous albuterol therapy. We excluded patients given ondansetron prior to albuterol, and those who were immunosuppressed or had cardiopulmonary disease other than asthma. We compared subjects who were given ondansetron in the ED to those who were not. We evaluated the initial albuterol dose and total ED dose. We also compared demographics, vital signs, maximum Pediatric Asthma Score (PAS), other medications, hospital and ICU admission, and ED return visits within 72 hours. Medications provided after ondansetron were not included. Student t-test, chi-squared, Fisher’s exact, and Mann-Whitney-U tests were utilized for analysis.

Results: Continuous albuterol was administered during 1944 encounters throughout the study period. We excluded 229 encounters, resulting in 1715 encounters among 1417 subjects who met eligibility. The study population was 66% male with a mean age of 3.8 years. Ondansetron was administered during 142 encounters (8.3%, 95% CI 7.1 – 9.7). Subjects receiving ondansetron had significantly lower oxygen saturation and higher maximum PAS; other demographics and vital signs were similar. Subjects given ondansetron received a higher initial dose of albuterol (p = 0.008), though there was no difference in weight-adjusted initial dose (p = 0.74). Subjects given ondansetron received fewer albuterol treatments and a smaller total dose. Outcome measures were similar between groups.

Conclusion(s): Among 1715 encounters treated with continuous albuterol, subjects who were given ondansetron for nausea/vomiting had higher PAS scores, lower oxygen saturation, and received similar weight-adjusted initial doses of albuterol. This analysis does not support a clear relationship between continuous albuterol dose and nausea/vomiting, suggesting that nausea/vomiting may be more related to disease severity.