A survey of consultant practice: intravenous salbutamol or aminophylline for acute severe childhood asthma and awareness of potential hypokalaemia

Abstract

British Thoracic Society guidelines recommend intravenous salbutamol or aminophylline for acute severe asthma in children. In the survey reported here, 133 consultant paediatricians completed a questionnaire aimed at evaluating their choice of intravenous bronchodilator for acute severe asthma and their awareness of subsequent hypokalaemia. Of the non-Paediatric Intensive Care Unit (PICU) consultants who responded, 82%, including respiratory paediatricians, reported using aminophylline; in contrast, PICU consultants were significantly more likely to use salbutamol (p=<0.001). There was a lack of awareness that hypokalaemia occurs with aminophylline: 50% of the consultants suggested that hypokalaemia was rare or did not occur. Consultants using intravenous aminophylline were significantly less likely to recheck serum potassium levels than those using intravenous salbutamol (p=0.03). Based on the completed questionnaires, salbutamol infusions are rarely used outside the PICU, and the awareness of potential hypokalaemia following intravenous bronchodilator treatment is variable. It would appear, therefore, that standardised clinical practice is required in order to recognise and treat potential hypokalaemia.