Metered-Dose Inhaler
The Emergency Department Orphan
Irene Tien, MD;
David Dorfman, MD;
Beth Kastner, MPH;
Howard Bauchner, MD
Arch Pediatr Adolesc Med. 2001;155:1335-1339.
Objective Physicians providing emergency department care to children primarily
use nebulizers for the delivery of bronchodilators and these physicians have
misconceptions regarding the advantages and disadvantages of using metered-dose
inhalers (MDIs) with a spacer (MDI + S) for acute asthma exacerbations.
Design Self-administered mail survey.
Setting Emergency department.
Participants Emergency medicine section members of the American Academy of Pediatrics
and Canadian Pediatric Society.
Interventions Bronchodilator delivery methods in acute pediatric asthma.
Main Outcome Measures The 2 principal outcomes for bivariate analysis were self-reported nebulizer
use in all patients and MDI + S use in patients with mild acute asthma.
Results Of eligible physicians, 333 (51%) of 567 responded. The majority were
dual trained in pediatrics and pediatric emergency medicine (72%) and practiced
full time (83%) in an urban (83%) pediatric emergency department (80%). The
most commonly cited advantages of MDIs were their cost (33%) and speed of
use (28%). The most commonly cited disadvantages were patient or parent dissatisfaction
(24%) and relative ease of nebulizer use (23%). Only 10% to 21% of participants
used MDIs in the emergency department and reserved this delivery method for
children with mild asthma exacerbations. There were no significant associations
between selected respondent demographic variables and the use of MDIs.
Conclusions Misconceptions regarding the efficacy and safety of MDI + S for the
treatment of acute asthma exacerbations exist but are limited to a minority
of surveyed emergency medicine physicians caring for children. Nebulizers
remain the preferred method of routine bronchodilator delivery by physicians
providing care to pediatric asthmatics in the emergency department.
From the Divisions of Pediatric Emergency Medicine and General Pediatrics,
Boston Medical Center and Boston University School of Medicine, Boston, Mass.
Corresponding author and reprints: Irene Tien, MD, Division of Pediatric
Emergency Medicine, Boston Medical Center, 1 Boston Medical Center Place,
Maternity 6, Boston, MA 02118 (e-mail: irene.tien{at}bmc.org).
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