Salbutamol

Often, adverse reactions occur in young children of 2-6 years of age than in older children or
adults, particularly excitability and anxiety, which occur in roughly 20% and 15% of young
children respectively. Gastrointestinal problems such as nausea and vomiting have been reported
in about 2% of young children who use salbutamol. The most common adverse reactions
associated with use of salbutamol inhalation aerosol are palpitations (occurring in less than 10%
of patients), sinus tachycardia (less than 10%), anxiety (less than 10%), tremors (less than 15%
of patients) and increased blood pressure (approximately 5%), occasionally resulting in
hypertension. Other side effects include nausea and vomiting (6%), throat irritation (6%),
dyspepsia (5%), insomnia (3%), heachaches (3%), epistaxis (3%), cough (2%), dizziness (1%),
nightmares (1%), and hostility (1%). Some cases of urticaria, angioedema, maculopapular rash,
bronchospasm, hoarseness, and oropharyngeal edema have also been reported after use of
inhaled salbutamol. Salbutamol nebulizers produce adverse effects similar to those observed with
the inhalation aerosol.

Pneumonia

Symptoms of pneumonia caused by bacteria usually come on quickly. They may include:

 Cough. You will likely cough up mucus (sputum) from your lungs. Mucus may be rusty or green or
tinged with blood.

 Fever.

 Fast breathing and feeling short of breath.

 Shaking and "teeth-chattering" chills. You may have this only one time or many times.

 Chest pain that often feels worse when you cough or breathe in.

 Fast heartbeat.

 Feeling very tired or feeling very weak.

 Nausea and vomiting.

 Diarrhea.
The effect of pneumonia on mortality among patients
hospitalized for acute stroke
I. L. Katzan, MD MS, R. D. Cebul, MD, S. H. Husak, BA, N. V. Dawson,
MD and D. W. Baker, MD MPH
From the Center for Health Care Research & Policy (Drs. Katzan, Cebul, Dawson, and Baker, and S.H. Husak) and
Departments of Medicine and Epidemiology and Biostatistics (Drs. Cebul, Dawson, and Baker), Case Western
Reserve University at MetroHealth Medical Center, Cleveland; and Department of Neurology (Dr. Katzan),
Cleveland Clinic Foundation, OH.

Abstract:

To determine the effect of pneumonia on 30-day mortality in patients hospitalized for acute
stroke.
Subjects in the initial cohort were 14,293 Medicare patients admitted for stroke to 29 greater
Cleveland hospitals between 1999 and 2005. The relative risk (RR) of pneumonia for 30-day
mortality was determined in a final cohort (n = 11,286) that excluded patients dying or having a
do not resuscitate order within 3 days of admission. Clinical data were obtained from chart
abstraction and were merged with Medicare Provider Analysis and Review files to obtain deaths
within 30 days. A predicted-mortality model (c-statistic = 0.78) and propensity score for
pneumonia (c-statistic = 0.83) were used for risk adjustment in logistic regression analyses.
Pneumonia was identified in 6.9% (n = 985) of all patients and in 5.6% (n = 635) of the final
cohort. The rates of pneumonia were higher in patients with greater stroke severity and features
indicating general frailty. Unadjusted 30-day mortality rates were six times higher for patients
with pneumonia than for those without (26.9% vs 4.4%, p < 0.001). After adjusting for admission
severity and propensity for pneumonia, RR of pneumonia for 30-day death was 2.99 (95% CI
2.44 to 3.66), and population attributable risk was 10.0%. In this large community-wide study of
stroke outcomes, pneumonia conferred a threefold increased risk of 30-day death, adding impetus
to efforts to identify and reduce the risk of pneumonia in patients with stroke.