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Nebulizers vs. MDIs with Spacers for COPD or Asthma

Am Fam Physician. 1998 Jun 1;57(11):2836-2838.

Nebulizer treatment is recommended for the management of patients with acute exacerbations of chronic obstructive pulmonary disease (COPD) or asthma who visit the emergency department for urgent care. However, nebulizer treatment requires special equipment and regular maintenance, uses up to 10 times more medication than metered-dose inhalers (MDIs) and is a potential source of contamination. Mandelberg and associates compared nebulizer treatment with therapy administered with an MDI and a spacer.

The study group consisted of 50 patients who presented to an emergency department for treatment of a severe respiratory event. Each patient was randomized to one of two groups. The first group received an MDI and a spacer with placebo followed by a nebulized treatment with medication. The second group received an MDI and spacer with medication and a nebulized treatment with placebo. The assigned treatment was repeated every 15 minutes up to three times unless the patient suffered significant side effects. Spirometry was performed initially and after each treatment. The patients and an investigator rated symptom response after the treatments.

The results of spirometry did not differ between the two groups. Subjective improvement, as rated by the patients and the investigators, did not differ.

The authors conclude that even in patients who present to the emergency department for treatment of severe airflow limitations, treatment with an MDI and a spacer is appropriate. This therapy can be as effective as nebulizer therapy, and it may reduce the cost of treatment in these patients. The use of an MDI with a spacer requires less equipment, reduces the demand on personnel time and can reduce the risk of contamination.

Mandelberg A, et al. Nebulized wet aerosol treatment in emergency department—is it essential? Chest. December 1997;112:1501–5.


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