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LAPORAN EBM

(TERAPI)
COMPARISON OF TERBUTALINE AND
SALBUTAMOL INHALATION IN
CHILDREN WITH MILD OR MODARETE
ACUT EXACERBATION OF ASTHMA

ANNISA EKA NOVA WULANDARI


1102011032

Skenario
Ny. S datang ke klinik bersama anak laki-laki bernama AZ
yang berusia 8 tahun dengan keluhan sesak napas. Keluhan ini
dirasakan ananknya sejak kemarin siang setelah pulang sekolah,
sebelum nya anak tersebut sedang mengikuti pelajaran olahraga
dilapangan.
Saat anamnesis ibu pasien menyatakan pasien memiliki
penyakit asma sejak kecil. Setelah di lakukan pemeriksaan fisik
pada anak didapatkan napas 30x/menit, HR 115x/menit, keadaan
anak lemas dan saat auskultasi mengik terdengar saat ekspirasi.
Dokter mendiagnosis pasien mengalami kekambuhan
asma dan akan memberikan obat terbutaline inhalasi. Tapi ibu
pasien mengatakan dokter sebelum nya sering memberikan obat
salbutamol dan setelah memakai obat tersebut anak nya sering
mengeluh tangan dan kaki nya gemetar. Ibu pasien menanyakan
apakah obat terbutaline tidak memberikan efek samping
gemetar juga?

Foreground Question
Apakah obat terbutaline inhalasi memberikan kemungkinan
efek samping tremor yang lebih kecil dibandingkan
salbutamol inhalasi?

PICO
opulation : Anak laki-laki 8 tahun dengan serangan
asma akut

ntervention : Terbutaline

omparison : Salbutamol

utcome
: Eefek samping tremor pada terbutaline lebih
rendah di banding pada salbutamol

Hasil Bukti Pencarian

ebsite

: http://web.b.ebscohost.com/ehost/search
K

eyword

:Asthma AND children AND terbutalin AND salbutamol


H

asil : 6
J

udul yang ambil :

Comparison Terbutaline and Salbutamol Inhalation in Children


with Mild or Moderate Acute Exacerbation of Asthma

REVIEW JOURNAL

Introduction
Beta-agonist such as salbutamol and terbutaline are
widely used in treatment of asthma, particularly in acute
exacerbations. In clinical practice, salbutamol is prescribe
more frequently than terbutaline. Studies comparing the
clinical efficacy and side effect of the two b2-agonist in
acute exacerbations are limited and those present give
conflicting views.

Methods
The study was conducted in the pediatric chest clinic of a tertiary
care hospital in north India. The study subjects were children in
the age group of 5-15 years old who presented with a mild or
moderate acute exacerbation of asthma. Mild exacerbation was
defined by presence of cough and wheezing without any forn of
distress, cyanosis, increased respiratory rate , or impairment of
activity, ability to speak in between breaths.

Baseline clinical assessment of the child was done by one of the


authors after obtaining consent from the parents. This author
was unaware of the drug that is going to be administered. The
children were then randomized by using a random number table
to receive salbutamol or terbutaline.

Result
After drug administration, all the studied variable
showed significant improvement within each group.
However, there were no statistically significant difference
when the two groups were compared with each other (table
2). However this difference was not statistically significant.

Discussion
The authors reported equal efficacy in treatment of acute
bronchospasm. The authors also reported similar onset of action
for all the drug. Unlike the present study, they used nebulization
for administration of the drug. It has been demonstrated that the
delivery of the drug by metered dose inhaler with spacer is as
effective as that achieved by nebulization.
The other concern has been the side effects. Salbutamol
may have a lesser risk of side effects compared with terbutaline
because of its greater affinity for B2-receptors than for B1receptors. However the present study and the other studies did
not demonstrated any significant difference between two groups.
We conclude that terbutaline and salbutamol, when
administered by MDI with spacer, are equally efficacious in
children with mild or moderate acute exacerbation of asthma.

VALIDITY

1.) A. Was the assignment of


patient to treatments randomized ?
Ya, pada penelitian ini dilakukan randomisasi

1.) B. Were the group similar at the


start of the trial?
Ya, kedua group memiliki karakteristik yang sama. Bisa
dilihat pada table 1 karakteristik anak yang di obati pada
kedua group, seluruh karakteristik nya nilai P value nya
tidak ada yang lebih kecil dari 0.05 yang berarti tidak ada
prbedaan bermakna

2.) A. Aside from the allocated


treatments, were the group treated
equally?
idak ada keterangan mengenai perlakuan diluar treatment
yang di berikan.

2.) B. Were all patients who entered the trial


accounted for? and were they analysed in the
groups to which they were randomized?
Ya, semua pasien yang megikuti penelitian ini di
perhitungkan karena jumlah yang mengikuti pada awal
penelitian dan total jumlah pasien pada tabel outcome
(tabel 2) sama

3.) Were measures objective or were the


patients and clinicians kept blind to which
treatment was being received?
Ya, dilakukan dengan cara double blind karena pasien tidak
mengetahui obat apa yang di dapatkan dan peneliti juga
tidak mengetahui jenis obat mana yang di dapat pada
masing masing group.

RESULT

Berapakah besar efek terapi


(CER,EER,ARR,ARI,NNT) ?

Experimenta

l event rate (EER) = a/ (a+b) = 3/31 = 0.09 = 9%


Control

event rate (CER) = c/ (c+d) = 4/29 = 0.13 = 13%


Relative

Risk (RR) = EER / CER = 0.09/0.13 = 0.69 = 69%


OR =ad/bc

= 75/112 = 0.66 = 66%


Relative risk

reduction (RRR) = CER-EERCER or 1-RR = 0.31 = 31%


Absolute

risk reduction (ARR) = CEREER = 0.13 0.09 = 0.04 = 4%


Number

needed to treat (NNT) = 1/ARR = 25

Berapakah presisi estimasi


efek terapi ?
onfidence interval (CI) pada table 2 atau table outcome
tertulis 95%

Apakah ada kemungkinan


penerapan pada pasien (spektrum
pasien dan setting) ?

P
enerapan pada pasien anak AZ jika dilihat dari usia nya sesuai
karena pada penelitian sampel nya berusia 5-15 tahun dan
pasien ini berusia 8 tahun

T
erapi terbutalin juga tersedia di Indonesia

T
etapi dari segi harga cukup berbeda di Indonesia
Harga Salbutamol Inhalasi (contoh : VENTHOLIN Inhaler -> Rp. 92.000)
Harga Terbutaline Inhalasi (contoh : Bricasma Inhaler -> Rp. 191.000)

Apa potensi keuntungan dan


kerugian bagi pasien?
Bagi pasien ada kemungkinan timbul nya efek samping
yang lebih sedikit
Tetapi dari segi biaya yang dikeluarkan lebih besar

THANK YOU

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