Albuterol oral administration
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Oral Albuterol Administration: Efficacy and Safety in Respiratory Conditions
Oral Albuterol for Bronchiolitis in Infants
Multiple studies have evaluated the effectiveness of oral albuterol in infants with bronchiolitis. Randomized, double-blind, placebo-controlled trials found that oral albuterol did not significantly improve symptoms or outcomes compared to placebo in infants with mild-to-moderate acute viral bronchiolitis. There were no differences in time to resolution of illness, feeding, sleeping, breathing, or cough between the albuterol and placebo groups, and health care revisit and admission rates were similar . Other studies confirmed these findings, showing no significant improvement in respiratory distress, clinical scores, or oxygen saturation with oral albuterol compared to placebo or nebulized forms. The only notable effect was an increase in heart rate in some cases, but no clinical benefit was observed 18. These results suggest that oral albuterol is not effective for treating bronchiolitis in infants and its widespread use in this context is not recommended 158.
Oral Albuterol in Chronic Obstructive Pulmonary Disease (COPD)
In adults with stable COPD, oral bronchodilators such as aminophylline and terbutaline were compared to inhaled albuterol. Inhaled albuterol produced a significantly greater improvement in lung function (measured by FEV1) than oral medications. Additionally, oral therapy was associated with more side effects, while inhaled albuterol was better tolerated. The study concluded that inhaled bronchodilators are more effective and have fewer side effects than oral therapy for COPD .
Pharmacokinetics and Side Effects of Oral Albuterol
Oral albuterol is absorbed and metabolized differently than inhaled forms. Its oral bioavailability is relatively low (10–20%), and it has a long distribution phase with a terminal half-life of 3–8 hours. Oral administration can lead to dose-related side effects, including increased heart rate, tremor, and metabolic changes such as altered potassium and glucose levels. These side effects are more common and pronounced with oral or parenteral administration compared to inhaled forms, which deliver lower systemic concentrations and are generally better tolerated 26.
Oral Albuterol and Glucose Tolerance
Short-term administration of oral albuterol (16 mg/24 h for 7 days) in elderly individuals did not significantly alter glucose tolerance or insulin concentrations during an oral glucose tolerance test. This suggests that, at least in the short term, oral albuterol does not impair glucose metabolism and should not be contraindicated for this reason .
Oral Nutrition During Continuous Albuterol Therapy in Children
For children hospitalized with critical asthma receiving continuous nebulized albuterol, providing oral nutrition was found to be well tolerated. No cases of aspiration-related respiratory failure were observed, even among those receiving nutrition while on noninvasive ventilation. This suggests that withholding oral nutrition during continuous albuterol administration may not be necessary, although further prospective studies are needed .
Conclusion
Oral albuterol is not effective for treating bronchiolitis in infants and is associated with more side effects compared to inhaled forms. In COPD, inhaled albuterol is superior to oral bronchodilators in both efficacy and safety. While oral albuterol does not appear to impair glucose tolerance in the short term, its use should be carefully considered due to its side effect profile and limited clinical benefit in most respiratory conditions. In hospitalized children receiving continuous albuterol, oral nutrition appears safe and should not be routinely withheld.
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