Effect of Continuous Albuterol Dosing on Nausea and Vomiting in a Pediatric Emergency Department

BACKGROUND AND OBJECTIVES Severe acute asthma is often treated in the pediatric emergency department (ED) with continuously nebulized albuterol. While albuterol is generally well-tolerated, its relationship with nausea or vomiting is not well established. METHODS We performed a retrospective cohort analysis of ED patients treated between 7/2019 – 4/2021. Patients < 18 years who received continuous albuterol ≥ 10 mg/hr were included. Those who received ondansetron before albuterol, were immunosuppressed, or had cardiopulmonary disease other than asthma were excluded. Ondansetron administration was utilized as a proxy for nausea/vomiting. We compared patients who received ondansetron to those who did not, analyzing factors such as albuterol dosage, demographics, vital signs, modified Pediatric Asthma Score (PAS), and hospital admissions. RESULTS Among the 1714 eligible patient encounters, 141 patients (8.2%) received ondansetron. Ondansetron recipients had lower oxygen saturation and higher PAS. Patients given ondansetron received higher initial albuterol doses (p = 0.009) and albuterol density (p < 0.001). Among patients < 40 kg, those initially treated with 20 mg/hr were more likely to receive ondansetron than those treated with 10 mg/hr (p = 0.01). Logistic regression showed that an increase in initial albuterol dose by 5 mg/hr was associated with 1.53 times higher odds of ondansetron administration (95% CI 1.13–2.18). Additionally, Black patients had lower odds of receiving ondansetron compared to White patients. CONCLUSIONS Higher initial albuterol doses were associated with nausea and/or vomiting, particularly in smaller patients. Further prospective studies are needed to determine optimal dosing and address racial disparities in ondansetron administration.