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By Martha Kerr

ORLANDO (Reuters Health) - More than half of children who receive high-dose inhaled albuterol (or salbutamol) for respiratory distress develop diastolic hypotension, investigators at the University of Pittsburgh reported here this week.

A study of 90 children with respiratory symptoms suggestive of asthma and requiring emergency transport to Children's Hospital of Pittsburgh was presented at the 36th annual meeting of the Society of Critical Care Medicine by Dr. Syana Sarnaik

The median age of the study population was 71.8 months, with a range of 24 to 243 months. Three-quarters of the children had a history of asthma.

Children received at least 10 mg inhaled albuterol for respiratory distress. The maximum NIH-recommended dose for children is 0.15-0.3 mg/kg per hour up to 10 mg per hour every 1-4 hours.

Dr. Sarnaik reported that 52 children, or 58%, who received high-dose albuterol developed diastolic hypotension, which was defined in this study as a diastolic pressure below the 5th percentile for age.

Older age and higher total dose were associated with diastolic hypotension

The median dose given for the entire study group was 13 mg per hour, given for two hours. Thirty-five percent of children between 24-59 months developed hypotension, compared with 65% of children between 60-143 months and 100% of the subjects between 144-243 months.

Length of stay in the ICU and total number of days in the hospital were the same for both normotensive and hypotensive children.

Troponin levels were drawn in nine children. In five, who had no history of asthma, troponin levels were elevated and two children complained of chest pain. ST segment depression was seen in one child, which Dr. Sarnaik said was "suggestive of ischemia."

Dr. Sarnaik told meeting attendees that beta-2 agonists are considered safe for children. However, the findings of this study indicate that high-dose inhaled albuterol carries a high risk of diastolic hypotension.

"The age-specific effect of inhaled albuterol on diastolic blood pressure may result from differences in drug deposition and in beta-receptor physiology," Dr. Sarnaik proposed while acknowledging that aggressive fluid management and asthma severity was not controlled for in this study and may have affected the results.

Dr. Sarnaik said that prospective studies of the safety of high-dose albuterol in children with respiratory distress are indicated. In addition, the incidence of ST segment changes, troponin levels and the incidence of myocardial injury with this treatment should be investigated.