 |
|
Nebulizers vs Metered-Dose Inhalers With Spacers for Bronchodilator Therapy to Treat Wheezing in Children Aged 2 to 24 Months in a Pediatric Emergency Department
Annette Delgado, MD;
Katherine J. Chou, MD;
Ellen Johnson Silver, PhD;
Ellen F. Crain, MD, PhD
Arch Pediatr Adolesc Med. 2003;157:76-80.
Objective To determine if administration of albuterol by a metered-dose inhaler with a spacer device is as efficacious as administration of albuterol by nebulizer to treat wheezing in children aged 2 years and younger.
Design Double-blind, randomized, placebo-controlled clinical trial.
Setting Pediatric emergency department.
Patients From a convenience sample of wheezing children aged 2 to 24 months, 85 patients were enrolled in the nebulizer group and 83 in the spacer group.
Interventions The nebulizer group received a placebo metered-dose inhaler with a spacer followed by nebulized albuterol. The spacer group received albuterol by a metered-dose inhaler with a spacer followed by nebulized isotonic sodium chloride solution. Treatments were given every 20 minutes by a single investigator blinded to group assignment.
Main Outcome Measures The primary outcome was admission rate. Pulmonary Index score and oxygen saturation were measured initially and 10 minutes after each treatment.
Results The nebulizer group had a significantly higher mean (SD) initial Pulmonary Index score compared with the spacer group (7.6 [2.5] vs 6.6 [2.0]; P = .002). With the initial Pulmonary Index score controlled, children in the spacer group were admitted less (5% vs 20%; P = .05). Analyses also revealed an interaction between group and initial Pulmonary Index score; lower admission rates in the spacer group were found primarily in children having a more severe asthma exacerbation.
Conclusion Our data suggest that metered-dose inhalers with spacers may be as efficacious as nebulizers for the emergency department treatment of wheezing in children aged 2 years or younger.
From the Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center (Drs Delgado, Chou, and Crain), and the Department of Pediatrics, Albert Einstein College of Medicine (Drs Delgado, Chou, Silver, and Crain), Bronx, NY.
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
Summary of recommendations from the Canadian Asthma Consensus Guidelines, 2003
Becker et al.
CMAJ 2005;173:S3-S11.
FULL TEXT
Inhalation devices
CMAJ 2005;173:S39-S45.
FULL TEXT
Pressurised metered dose inhalers with spacers versus nebulisers for {beta}-agonist delivery in acute asthma in children in the emergency department
Boyd and Stuart
Emerg. Med. J. 2005;22:641-642.
ABSTRACT
| FULL TEXT
Automatic replacement of albuterol nebulizer therapy by metered-dose inhaler and valved holding chamber
Hendeles et al.
Am J Health Syst Pharm 2005;62:1053-1061.
ABSTRACT
| FULL TEXT
Device Selection and Outcomes of Aerosol Therapy: Evidence-Based Guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology
Dolovich et al.
Chest 2005;127:335-371.
ABSTRACT
| FULL TEXT
Inner-City Availability of Preservative-Containing Albuterol
Reznik et al.
CLIN PEDIATR 2004;43:615-617.
ABSTRACT
OTHER ARTICLES NOTED (24 Jan 03 to 18 Apr 03)
Evid. Based Nurs. 2003;6:e1-12.
FULL TEXT
Asthma Therapy: Metered-dose Inhalers Preferred for dose Infants and Toddlers
Paul and Randolph
AAP Grand Rounds 2003;9:49-50.
FULL TEXT
When Will We Quit Using Nebulizers?
JWatch Emergency Med. 2003;2003:8-8.
FULL TEXT
Inhalers with Spacers Are As Good As Nebulizers for Wheezing Infants
JWatch General 2003;2003:3-3.
FULL TEXT
|
