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Effects of Benzalkonium Chloride in Children with Asthma Receiving Nebulized Continuous Albuterol
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  • Amy Kennedy,
  • Tristan Murray,
  • Kimberly Elder,
  • Lindsay Olmstead,
  • Adrian O'Hagan
Amy Kennedy
Norton Children's Hospital
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Tristan Murray
Norton Children's Hospital

Corresponding Author:[email protected]

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Kimberly Elder
Sullivan University College of Pharmacy
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Lindsay Olmstead
Norton Children's Hospital
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Adrian O'Hagan
Norton Children's Hospital
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Abstract

Objectives: Compare treatment length of continuous albuterol nebulization, hospital length of stay, and respiratory outcomes for pediatric patients with status asthmaticus treated with benzalkonium chloride-containing continuous albuterol nebulization (BAC-albuterol) versus preservative-free continuous albuterol nebulization (PF-albuterol). We hypothesized use of PF-albuterol results in decreased treatment duration, hospital length of stay, and improved respiratory outcomes when compared to the BAC-albuterol. Methods: Retrospective chart review of patients admitted for status asthmaticus during two time periods that corresponded with two different albuterol formulations, BAC-albuterol (October 2017-February 2018) and PF-albuterol (October 2018-February 2019). Patients eligible for analysis included those 3 to 17 years of age initiated on continuous albuterol nebulization for treatment of status asthmaticus. Patients were excluded if admitted for an alternative primary diagnosis, received terbutaline, or received continuous albuterol nebulization through a ventilator. Results: One-hundred patients received BAC-albuterol and 84 patients received PF-albuterol. There was no significant difference demonstrated in treatment duration of BAC-albuterol and PF-albuterol (median 14.9 hours vs 17.5 hours, respectively; p = 0.385). Patients treated with PF-albuterol had significantly decreased requirements for oxygen escalation, as well as escalation of other pharmacologic treatment, during continuous albuterol nebulization. Conclusions: There were no significant differences in time on continuous albuterol nebulization or hospital length of stay between groups. However, high-flow oxygen requirements, as well as pharmacologic escalation, during continuous albuterol nebulization were significantly decreased with PF-albuterol. Prospective data may help further discern the impact of BAC-albuterol on clinical outcomes for pediatric patients admitted for treatment of status asthmaticus.