Albuterol delivered via metered-dose inhaler with spacer for outpatient treatment of young children with wheezing
R. W. Hickey, R. F. Gochman, V. Chande and H. W. Davis
Department of Pediatrics, Columbus Children's Hospital, Ohio.
OBJECTIVE: To determine the efficacy of albuterol delivered via
metered-dose inhaler with spacer for the treatment of wheezing infants.
DESIGN AND SETTING: Double-blind, prospective, placebo-controlled, clinical
crossover trial undertaken at the emergency department of a
university-affiliated children's hospital. PARTICIPANTS: Forty-two patients
aged 1 to 18 months presenting to the emergency department with wheezing.
INTERVENTION: Subjects were randomly assigned to one of two blinded
treatment groups. Group 1 received two albuterol treatments followed by two
placebo treatments. Group 2 received two placebo treatments followed by two
albuterol treatments. Each treatment consisted of two puffs from a
metered-dose inhaler with spacer at 20-minute intervals. MEASUREMENTS/MAIN
RESULTS: On enrollment and 20 minutes after each treatment, a clinical
assessment was made by the principal investigator, which included heart
rate, respiratory rate, pulse oximetry, wheezing score (0 to 3), and
retraction score (0 to 3). Both treatment groups had statistically
significant improvement in mean wheezing score associated with albuterol
therapy (P < .05 using Dunnett's t test). Mean retraction score improved
over time in both groups only during drug therapy. However, the improvement
of only group 2 reached statistical significance (P < .05 using
Dunnett's t test). Scores were then classified as "improved" and "not
improved" for analysis with McNemar's test. Group 2 had a statistically
significant proportion of patients with improved retraction score related
to albuterol therapy. The remaining dichotomized results, while not
achieving statistical significance, showed a trend in the direction
expected from a beneficial drug effect. CONCLUSIONS: Albuterol delivered by
metered-dose inhaler with spacer to wheezing infants aged 1 to 18 months
reduces the severity of wheezing and retractions.
