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Metered-Dose Inhalers With Spacers vs Nebulizers for Pediatric Asthma

Metered-Dose Inhalers With Spacers vs Nebulizers for Pediatric Asthma Abstract Objective: To determine whether the administration of β-agonists by metered-dose inhaler (MDI) with a spacer device is as effective as the administration of β-agonists by nebulizer for the treatment of acute asthma exacerbations in children. Design: Randomized trial with two arms. Setting: Urban pediatric emergency department (ED) in Bronx, NY. Patients: Convenience sample of 152 children 2 years and older with a history of at least two episodes of wheezing presenting to the ED with an acute asthma exacerbation. Interventions: Patients were randomly assigned to receive standard doses of a β-agonist (albuterol) by an MDI with spacer or by a nebulizer. Dosing intervals and the use of other medications were determined by the treating physician. Measurements/Main Results: Baseline characteristics and asthma history were recorded. Asthma severity score, peak expiratory flow rate in children 5 years or older, and oxygen saturation were determined at presentation and before admission or discharge. The groups did not differ in age, sex, ethnicity, age of onset of asthma, or asthma severity score at presentation. There were no significant differences between the groups in outcomes, including mean changes in respiratory rate, asthma severity score, and peak expiratory flow rate, oxygen saturation, number of treatments given, administration of steroids in the ED, and admission rate. Patients given MDIs with spacers required shorter treatment times in the ED (66 minutes vs 103 minutes, P<.001). Fewer patients in the spacer group had episodes of vomiting in the ED (9% vs 20%, P<.04), and patients in the nebulizer group had a significantly greater mean percent increase in heart rate from baseline to final disposition (15% vs 5%, P<.001). Conclusions: These data suggest that MDIs with spacers may be an effective alternative to nebulizers for the treatment of children with acute asthma exacerbations in the ED.(Arch Pediatr Adolesc Med. 1995;149:201-205) References 1. Carr W, Zeitel L, Weiss KB. Variations in asthma hospitalizations and deaths in New York City . Am J Public Health . 1992;82:59-65.Crossref 2. Weiss KB, Wagener DK. Changing patterns of asthma mortality . JAMA . 1990; 264:1683-1687.Crossref 3. Weiss KB, Gergen PJ, Crain EF. Inner-city asthma . Chest . 1992;101( (suppl) ): 362S-367S. 4. Blake KV, Hoppe M, Harman E. Hendeles L. Relative amounts of albuterol delivered to lung receptors from a metered-dose inhaler and nebulizer solution . Chest . 1992;101:309-315.Crossref 5. New York State Health Department. Guidelines for Prevention of Tuberculosis Transmission . Albany: NY State Health Dept; 1992. 6. Turner JR, Corley KJ, Eckman D, Gelb AM, Lipavsky A, Sheppard D. Equivalence of continuous flow nebulizer and metered-dose inhaler with reservoir bag for treatment of acute airflow obstruction . Chest . 1988;93:476-481.Crossref 7. Salzman GA, Steele MT, Pribble JP, Elenbaas RM, Pyszczyuski DR. Aerosolized metaproterenol in the treatment of asthmatics with severe airflow obstruction . Chest . 1989;95:1017-1020.Crossref 8. Mestitz H, Copland JM, McDonald C. Comparison of outpatient nebulized vs metered-dose inhaler terbutaline in chronic airflow obstruction . Chest . 1989; 96:1236-1240.Crossref 9. Pendergast J, Hopkins J, Timms B, Van Asperen PP. Comparative efficacy of terbutaline administered by Nebuhaler and by nebulizer in young children with asthma . Med J Aust . 1989;151:406-408. 10. Summer W, Elston R, Tharpe L, Nelson S, Haponik E. Aerosol bronchodilator delivery methods . Arch Intern Med . 1989;149:618-623.Crossref 11. Shim CS, Williams MH. Effect of bronchodilator therapy in administration by canister versus jet nebulizer . J Allergy Clin Immunol . 1984;73:387-390.Crossref 12. Jasper AC, Mohsenifar Z, Kahan S, Goldberg HS, Koerner SK. Cost-benefit comparison of aerosol bronchodilator delivery methods in hospitalized patients . Chest . 1987;91:614-618.Crossref 13. Benton G, Thomas RC, Nickerson BG, McQuitty JC, Okikawa J. Experience with a metered-dose inhaler with a spacer in the pediatric emergency department . AJDC . 1989;143:678-681. 14. Bowton DL, Goldsmith WM, Haponik EF. Substitution of metered-dose inhalers for hand-held nebulizers . Chest . 1992;101:305-308.Crossref 15. Idris AH, McDermott MF, Raucci JC, Morrabel A, McGorray S, Hendeles L. Emergency department treatment of severe asthma . Chest . 1993;103:665-672.Crossref 16. Becker AB, Nelson NA, Simons ER. The pulmonary index . AJDC . 1984;138: 574-576. 17. National Asthma Education Program, US Department of Health and Human Services. Executive Summary: Guidelines for the Diagnosis and Management of Asthma . Bethesda, Md: US Dept of Health and Human Services; (June) 1991. 18. Levinson H, Reilly PA, Worsley GH. Spacing devices and metered-dose inhalers in childhood asthma . J Pediatr . 1985;107:662-668.Crossref 19. Hickey RW, Gochman RF, Chande V, Davis HW. Albuterol delivered via metereddose inhaler with spacer for outpatient treatment of young children with wheezing . Arch Pediatr Adolesc Med . 1994;148:189-194.Crossref 20. Kerem E, Levison H, Schuh S, et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma . J Pediatr . 1993:123: 313-317.Crossref 21. DiGiulio GA, Kercsmar CM, Krug SE, Alpert SE, Marx CM. Hospital treatment of asthma: lack of benefit from theophylline given in addition to nebulized albuterol and intravenously administered corticosteroid . J Pediatr . 1993;122: 464-469.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Pediatrics & Adolescent Medicine American Medical Association

Metered-Dose Inhalers With Spacers vs Nebulizers for Pediatric Asthma

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
1072-4710
eISSN
1538-3628
DOI
10.1001/archpedi.1995.02170140083015
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To determine whether the administration of β-agonists by metered-dose inhaler (MDI) with a spacer device is as effective as the administration of β-agonists by nebulizer for the treatment of acute asthma exacerbations in children. Design: Randomized trial with two arms. Setting: Urban pediatric emergency department (ED) in Bronx, NY. Patients: Convenience sample of 152 children 2 years and older with a history of at least two episodes of wheezing presenting to the ED with an acute asthma exacerbation. Interventions: Patients were randomly assigned to receive standard doses of a β-agonist (albuterol) by an MDI with spacer or by a nebulizer. Dosing intervals and the use of other medications were determined by the treating physician. Measurements/Main Results: Baseline characteristics and asthma history were recorded. Asthma severity score, peak expiratory flow rate in children 5 years or older, and oxygen saturation were determined at presentation and before admission or discharge. The groups did not differ in age, sex, ethnicity, age of onset of asthma, or asthma severity score at presentation. There were no significant differences between the groups in outcomes, including mean changes in respiratory rate, asthma severity score, and peak expiratory flow rate, oxygen saturation, number of treatments given, administration of steroids in the ED, and admission rate. Patients given MDIs with spacers required shorter treatment times in the ED (66 minutes vs 103 minutes, P<.001). Fewer patients in the spacer group had episodes of vomiting in the ED (9% vs 20%, P<.04), and patients in the nebulizer group had a significantly greater mean percent increase in heart rate from baseline to final disposition (15% vs 5%, P<.001). Conclusions: These data suggest that MDIs with spacers may be an effective alternative to nebulizers for the treatment of children with acute asthma exacerbations in the ED.(Arch Pediatr Adolesc Med. 1995;149:201-205) References 1. Carr W, Zeitel L, Weiss KB. Variations in asthma hospitalizations and deaths in New York City . Am J Public Health . 1992;82:59-65.Crossref 2. Weiss KB, Wagener DK. Changing patterns of asthma mortality . JAMA . 1990; 264:1683-1687.Crossref 3. Weiss KB, Gergen PJ, Crain EF. Inner-city asthma . Chest . 1992;101( (suppl) ): 362S-367S. 4. Blake KV, Hoppe M, Harman E. Hendeles L. Relative amounts of albuterol delivered to lung receptors from a metered-dose inhaler and nebulizer solution . Chest . 1992;101:309-315.Crossref 5. New York State Health Department. Guidelines for Prevention of Tuberculosis Transmission . Albany: NY State Health Dept; 1992. 6. Turner JR, Corley KJ, Eckman D, Gelb AM, Lipavsky A, Sheppard D. Equivalence of continuous flow nebulizer and metered-dose inhaler with reservoir bag for treatment of acute airflow obstruction . Chest . 1988;93:476-481.Crossref 7. Salzman GA, Steele MT, Pribble JP, Elenbaas RM, Pyszczyuski DR. Aerosolized metaproterenol in the treatment of asthmatics with severe airflow obstruction . Chest . 1989;95:1017-1020.Crossref 8. Mestitz H, Copland JM, McDonald C. Comparison of outpatient nebulized vs metered-dose inhaler terbutaline in chronic airflow obstruction . Chest . 1989; 96:1236-1240.Crossref 9. Pendergast J, Hopkins J, Timms B, Van Asperen PP. Comparative efficacy of terbutaline administered by Nebuhaler and by nebulizer in young children with asthma . Med J Aust . 1989;151:406-408. 10. Summer W, Elston R, Tharpe L, Nelson S, Haponik E. Aerosol bronchodilator delivery methods . Arch Intern Med . 1989;149:618-623.Crossref 11. Shim CS, Williams MH. Effect of bronchodilator therapy in administration by canister versus jet nebulizer . J Allergy Clin Immunol . 1984;73:387-390.Crossref 12. Jasper AC, Mohsenifar Z, Kahan S, Goldberg HS, Koerner SK. Cost-benefit comparison of aerosol bronchodilator delivery methods in hospitalized patients . Chest . 1987;91:614-618.Crossref 13. Benton G, Thomas RC, Nickerson BG, McQuitty JC, Okikawa J. Experience with a metered-dose inhaler with a spacer in the pediatric emergency department . AJDC . 1989;143:678-681. 14. Bowton DL, Goldsmith WM, Haponik EF. Substitution of metered-dose inhalers for hand-held nebulizers . Chest . 1992;101:305-308.Crossref 15. Idris AH, McDermott MF, Raucci JC, Morrabel A, McGorray S, Hendeles L. Emergency department treatment of severe asthma . Chest . 1993;103:665-672.Crossref 16. Becker AB, Nelson NA, Simons ER. The pulmonary index . AJDC . 1984;138: 574-576. 17. National Asthma Education Program, US Department of Health and Human Services. Executive Summary: Guidelines for the Diagnosis and Management of Asthma . Bethesda, Md: US Dept of Health and Human Services; (June) 1991. 18. Levinson H, Reilly PA, Worsley GH. Spacing devices and metered-dose inhalers in childhood asthma . J Pediatr . 1985;107:662-668.Crossref 19. Hickey RW, Gochman RF, Chande V, Davis HW. Albuterol delivered via metereddose inhaler with spacer for outpatient treatment of young children with wheezing . Arch Pediatr Adolesc Med . 1994;148:189-194.Crossref 20. Kerem E, Levison H, Schuh S, et al. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma . J Pediatr . 1993:123: 313-317.Crossref 21. DiGiulio GA, Kercsmar CM, Krug SE, Alpert SE, Marx CM. Hospital treatment of asthma: lack of benefit from theophylline given in addition to nebulized albuterol and intravenously administered corticosteroid . J Pediatr . 1993;122: 464-469.Crossref

Journal

Archives of Pediatrics & Adolescent MedicineAmerican Medical Association

Published: Feb 1, 1995

References