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Katherine J. Chou, MD; Sandra J. Cunningham, MD; Ellen F. Grain, MD, PhD

Arch Pediatr Adolesc Med. 1995;149(2):201-205.

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)

Author Affiliations
From the Division of General Pediatrics (Emergency Medicine), Department of Pediatrics, Albert Einstein College of Medicine, and The Bronx Municipal Hospital Center, Bronx, NY.

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