UF Health researchers find preservative in asthma treatment may delay recovery

Children hospitalized with severe asthma may be receiving a preservative which slows their recovery, according to researchers at University of Florida Health.

Leslie Hendeles
Leslie Hendeles, Pharm.D.

In a study published in the journal Pediatrics, UF Health researchers examined nearly 500 hospitalized pediatric asthma patients and found that more than 15% of those receiving medicines with the preservative benzalkonium chloride, or BAC, required continuous inhaled albuterol more than 24 hours compared to less than 6% of similar patients treated with preservative-free albuterol. The patients receiving BAC also required eight hours more of oxygen support than patients receiving the preservative-free medication.

“BAC is known to cause bronchospasm in patients with severe asthma and appears to prolong the recovery,” said Leslie Hendeles, Pharm.D., a professor emeritus in the UF College of Pharmacy and one of the study’s lead authors. “Our findings suggest that using a preservative-free albuterol formulation is a safer approach for continuous treatment of children with severe asthma.”

Continuous albuterol treatments help to relax the muscles in the airway and increase the flow of oxygen into the lungs. The way that hospital pharmacists prepare the medication has come under the scrutiny of UF Health researchers who have found some hospitals are using multidose dropper bottles containing the harmful preservative, BAC, instead of preservative-free unit-dose vials.

“It is faster and easier for hospitals to use 20-mL multidose dropper bottle of albuterol to treat acute asthma than using a preservative-free single dose,” Hendeles said.

There are a few ways hospital pharmacies can provide preservative-free solutions without delaying the start of continuous nebulization, including preparing a stock solution in advance that could be used for individual patients when rapid treatment is needed. In addition, a pharmaceutical company has begun making 20 mL vials of preservative-free albuterol in May 2020.

The article, “Continuous Albuterol With Benzalkonium in Children Hospitalized With Severe Asthma,” was published in the April edition of Pediatrics, the official journal of the American Academy of Pediatrics.