Aaron Miller
10/24/97
Question:
Does the use of albuterol and/or erythromycin change the course of acute bronchitis?
Clinical Bottom Line :
1. Erythromycin 250 mg QID x 7 d given to patients with acute bronchitis, but otherwise
healthy, does not seem to change their course.
2. Inhaled albuterol used for symptoms of acute bronchitis appears to decrease the number
of patients with continued cough by day 7 and speeds return to work
Selection:
18-65 yr. old patients from two community-based FP centers in Kentucky & Wisconsin
with <30 days of productive cough were eligible.
Exclusion: clinical or radiological evidence of pneumonia, asthma, COPD, cardiac dz,
pregnant, allergies to medications tested, previous abx in past 2 weeks.
Numbers: designed for 132 pts, split 4 ways, but stopped after results from first 46
analyzed.Randomized with no significant differences between albuterol and control group.
Data: demographics, smoking status, daily diary of: cough, night cough, work status, side
effects, OTC meds (no restrictions), "general level of well-being." Followed up
with visit in 7-8 days.
Outcomes After 7 days of Treatment with Albuterol
Metered-Dose Inhaler vs. Placebo
| Outcome | Albuterol Group (n=23) | Control Group (n=23) | P Value |
| Still coughing, % | 61 | 91 | .02 |
| Productive cough present, % | 57 | 48 | NS |
| Night cough persists*,% | 26 | 45 | NS |
*Analysis limited to patients who initially presented with night cough.
1. Decreased number still coughing at 7 days in albuterol group (61% vs. 91% p=0.02).
2. Albuterol group more likely to return to work by day 4 (78% vs 52% p=0.05)..
4. Use of erythromycin does not change #1 or #2.
5. Smokers did not show any special benefit form albuterol treatment.
Comments
1. Well-designed randomized-controlled study in theory. Ended with small number of
patients after analysis or first1/3 of enrolled patients showed a statistically
significant finding in one outcome parameter More and clearer benefits from albuterol
might have been born out if the study had been completed.
2. The whole erythromycin arm is not addressed. The paper claims that there is no
change in the albuterol findingswhen stratified by antibiotic use, but no numbers are
provided at all.
3. This study does not pertain to patients with known pulmonary disease, although many of
these people will alreadybe using inhalers.
4. As with many of the acute bronchitis studies, there is poor definition of "acute
bronchitis." Many of the study outcomes (night cough, level of well-being) are also
highly subjective.
5. The study patients were taught to use inhalers by an office nurse, and then provided
with written instructions. It is not clear how well patients are taught to use inhalers at
our pharmacies.
6. The use of bronchodilators in the setting of acute bronchitis does make physiologic
sense. Other studies havedemonstrated similarities in PET measurements between asthma and
acute bronchitis. No PFT studies were done in this paper.