Metered-Dose Inhaler Accessory Devices in Acute Asthma: Efficacy and Comparison With Nebulizers: A Literature Review

doi:10.1001/archpedi.1997.02170460014003

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Vol. 151 No. 9, September 1997

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Metered-Dose Inhaler Accessory Devices in Acute Asthma

Efficacy and Comparison With Nebulizers: A Literature Review

Israel Amirav, MD; Michael T. Newhouse, MD, FRCPC

Arch Pediatr Adolesc Med. 1997;151(9):876-882.

Abstract

Objectives
To evaluate the current literature about the efficacy of providinginhaled medications by metered-dose inhalers and accessory devices(MDI/ADs) to children with acute asthma and to compare it withthe current standard of care, small-volume nebulizers (SVNs).

Data Sources
Online computer and manual searches in English-language journalarticles published between 1980 and 1996.

Study Selection
Seventeen prospective clinical trials that have used MDI/ADsin the treatment of acute asthma in children were retrieved.Ten randomized controlled studies that included a comparisonwith SVN treatment were selected.

Data Extraction
Studies were assessed qualitatively by their subject characteristics,design, intervention procedures, outcome measures, and results.

Data Synthesis
There were marked variations in types of MDI/ADs and in dosesadministered between and within studies. Major outcome measuresincluded pulmonary function measurements and clinical scores.All studies found MDI/ADs to be effective in the treatment ofinfants and children with acute asthma. Among those who comparedthis treatment with SVN, 2 found the MDI/AD superior and therest found it as effective as the SVN.

Conclusions
The data support the effectiveness of MDI/ADs as first-linetreatment in acute childhood asthma. In view of clinical benefit,safety, lower cost, personnel time, and speed and ease of administrationof MDI/ADs compared with SVNs, MDI/ADs should be consideredthe preferred mode of treatment of children with acute asthma.

Arch Pediatr Adolesc Med. 1997;151:876-882

Author Affiliations

From The Children's Hospital of Philadelphia, University of Pennsylvania Medical School, Philadelphia, Pa (Dr Amirav), and the Barnett Medical Aerosol Research Laboratory, St Joseph's Hospital/McMaster University, Hamilton, Ontario (Dr Newhouse). Dr Amirav is now with the Department of Pediatrics, Rebecca Sieff Hospital, Safed, Israel.

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