salbutamol (Inspiryl Turbuhaler)

Nebulized Magnesium Sulfate as an Adjunct to Standard Therapy in Infants with Acute Bronchiolitis: A Double Blind Randomized Controlled Trial.

Karimian Pegah P, Dehghani Mohammadabadi Fahimeh F, Charmduzi Forugh F, Khoshnezhad Ebrahimi Hamidreza H et al.

The evidence regarding the efficacy of magnesium sulfate (MgSO₄) in bronchiolitis is conflicting, and high-quality trials involving very young infants are limited. To compare the efficacy of nebulized magnesium sulfate, salbutamol, and 3% hypertonic saline against nebulized salbutamol and 3% hypertonic saline in infants aged 1-6 months who are admitted with a first episode of mild-to-moderate bronchiolitis. The primary outcomes were physiological parameters including oxygen saturation (SpO₂), respiratory rate (RR), and pulse rate (PR). Length of hospital stay (LOS), and Respiratory Distress Assessment Instrument (RDAI) score were evaluated as exploratory outcomes, along with escalation of care and adverse events. In this parallel, double-blind randomized controlled trial conducted from August 2022 to February 2023, 62 eligible infants were allocated (1:1) to receive three consecutive 20-minute nebulizations of salbutamol, MgSO₄, and 3% saline (intervention) or salbutamol and 3% saline (control), followed by identical doses every 6 hours for up to 72 hours. All caregivers, clinicians, and outcome assessors were blinded. Outcome assessments were performed at baseline (pre-intervention), 1 hour after the initial dose, and every 24 hours thereafter (± 2 hours) until discharge or 72 hours, whichever occurred first. LOS was defined as the duration (in hours) from randomization until predefined discharge criteria were met (SpO₂ ≥ 94% in room air for ≥ 12 hours, adequate oral intake, respiratory rate within age norms, RDAI ≤ 3). Among the 62 infants, 33 (53.2%) received triple-drug therapy, while 29 (46.8%) received standard dual therapy. The baseline characteristics were comparable, with a mean age as 3.6 ± 1.25 months and 56.5% male. The median Length of stay (LOS) was shorter in the MgSO₄ group (6.0 days, IQR 5-7) compared to the control group (7.0 days, IQR 6-9; P = 0.046, Mann-Whitney U). No significant differences were observed between groups for daily RDAI, RR, PR, or SpO₂ (repeated-measures ANOVA, P > 0.05). None of the infants required intensive care, mechanical ventilation, or experienced serious drug-related events. This double-blind randomized trial did not demonstrate a statistically significant effect on its prospectively registered primary outcomes (oxygen saturation, respiratory rate, heart rate). The observed difference in length of hospital stay (a secondary, unregistered outcome; median 6.0 vs. 7.0 days; unadjusted P = 0.046) did not reach statistical significance after Bonferroni correction for multiple comparisons (corrected threshold: P < 0.01) and should be regarded as exploratory and hypothesis-generating only. This trial should be interpreted as null and inconclusive. Adequately powered, prospectively registered confirmatory trials are necessary before any clinical recommendations can be made.

South Africa shifts away from salbutamol-only asthma relief.

Adepoju Paul P

Beyond Tuberculosis: Late Diagnosis of Cystic Fibrosis in an Adolescent with Bronchiectasis and Recurrent Pseudomonas aeruginosa Isolation: A Case Report.

Mihailov Oana Mariana OM, Luțenco Valerii V, Țocu Lavinia L, Mihailov Raul R et al.

Background and Clinical Significance: Cystic fibrosis may remain undiagnosed until adolescence, when recurrent respiratory infections and bronchiectasis are attributed to a previous severe infection. Case Presentation: We report the case of a male adolescent in whom approximately five years elapsed between microbiologically confirmed pulmonary tuberculosis in July 2021 and recognition of cystic fibrosis in August 2026. Archived records documented two sputum specimens that were acid-fast bacilli smear-positive (1+) and culture-positive (1+) for Mycobacterium tuberculosis complex. During adolescence, persistent bronchiectasis, recurrent Gram-negative respiratory infections, digital clubbing, and repeated Pseudomonas aeruginosa isolation prompted etiologic reassessment. A single documented sweat chloride concentration was 114 mmol/L. CFTR analysis of blood collected on 18 August 2026, reported on 16 September 2026, identified homozygous c.1521_1523delCTT (p.Phe508del; F508del), providing molecular confirmation. Spirometry showed FEV1 2.69 L (79.6% predicted), FVC 3.73 L (91.56% predicted), and FEV1/FVC 72.01% (z-score -2.58), consistent with airflow obstruction; without total lung capacity measurements, restriction or a mixed ventilatory defect could not be confirmed. The previously recorded azithromycin regimen was 500 mg orally three times weekly. Tobramycin inhalation solution 300 mg/5 mL was prescribed as one ampoule twice daily for 28 days, followed by 28 days off, with three planned cycles and salbutamol 15 min before administration. Management of cystic fibrosis also included airway-clearance therapy, dornase alfa 2.5 mg once daily, a high-calorie diet, pancreatic enzyme replacement, and vitamin supplementation. Longitudinal post-treatment spirometry, anthropometry, and validated quality-of-life measurements were not available. Conclusions: Previous pulmonary tuberculosis should not terminate etiologic investigation when bronchiectasis, repeated Pseudomonas aeruginosa isolation, digital clubbing, or progressive structural lung disease persists. Earlier recognition may permit earlier coordinated cystic fibrosis care and genotype-appropriate CFTR-modulator assessment.

Fluorescent aptamer sensing of clenbuterol and salbutamol in artificial urine and construction of a proof-of-concept screening model.

Dong Qinfeng Q

A proof-of-concept differential dual-modal aptamer array was developed for clenbuterol (CLB) and salbutamol (SAL) screening in artificial urine. A CLB-selective aptamer and AP-Ago, a broad β2-agonist aptamer, were coupled to graphene-oxide fluorescence resonance energy transfer and to methylene-blue/ferrocene-labelled gold electrodes. Their four responses formed an analyte fingerprint by combining CLB-selective recognition with the broader response of AP-Ago. Seventy-two blind-coded samples represented six matrices, four screening classes and three independent preparation batches. Batches 1-2 (n = 48) supported model development, whereas batch 3 (n = 24; six samples per class) was locked for external assessment. Weighted calibration gave provisional procedural limits of detection of 0.083 ng mL-1 for CLB and 0.164 ng mL-1 for SAL. Mean external prediction-to-reference ratios were approximately 96% for CLB and 81% for SAL, distinct from controlled spike recoveries; intraday precision was 3.7% and interbatch precision was 5.8%. Against isotope-dilution LC-MS/MS, concordance correlation coefficients were 0.939 for CLB and 0.793 for SAL. A regularized multinomial logistic model achieved external balanced accuracy of 0.833, macro-F1 of 0.836 and Matthews correlation coefficient of 0.791. The reported bootstrap 95% confidence interval for balanced accuracy was 0.656-0.969, reflecting the small external set. The results support a candidate front-end triage strategy within the tested artificial matrices: differential signals identify presumptive CLB, SAL-associated high-response and mixed patterns, while any presumptive positive is referred for confirmatory LC-MS/MS rather than used for an anti-doping adjudication.