Continuous Versus Intermittent Short-acting β2-agonists Nebulization As First-line Therapy in Hospitalized Children with Severe Asthma Exacerbation: a Propensity Score Matching Analysis

Background: Short-acting β2-agonist (SABA) nebulization is commonly prescribed for children hospitalized with severe asthma exacerbation. Either intermittent or continuous delivery has been considered safe and efficient. The comparative efficacy of these two modalities is inconclusive. We aimed to compare these two modalities as the first-line treatments.

Methods: An efficacy research with a retrospective cohort study design was conducted. Hospital records of children with severe asthma exacerbation admitted to Hat Yai Hospital between 2015 and 2017 were retrospectively collected. Children initially treated with continuous salbutamol 10 mg per hour or intermittent salbutamol 2.5 mg per dose over 1-4 h nebulization were matched one-to-one using the propensity score. Competing risk and risk difference regression was applied to evaluate the proportion of children who succeeded and failed the initial treatment. Restricted mean survival time regression was used to compare the length of stay (LOS) between the two groups.

Results: One-hundred and eighty-nine children were included. Of these children, 112 were matched for analysis (56 with continuous and 56 with intermittent nebulization). Children with continuous nebulization experienced a higher proportion of success in nebulization treatment (adjusted difference: 39.5, 95% CI 22.7, 56.3,  < 0.001), with a faster rate of success (adjusted SHR: 2.70, 95% CI 1.73, 4.22,  < 0.001). There was a tendency that LOS was also shorter (adjusted mean difference - 9.9 h, 95% CI -24.2, 4.4,  = 0.176).

Conclusion: Continuous SABA nebulization was more efficient than intermittent nebulization in the treatment of children with severe asthma exacerbation.