Am Fam Physician. 2003 Jul 15;68(2):365-366.
Reactive airway disease is a common reason for emergency department visits and hospital admissions in infants and young children. The treatment for reactive airway disease is bronchodilating agents, usually delivered by a nebulizer. This system of delivery can be costly and time consuming. Recent studies have suggested that, compared with nebulizers, bronchodilators delivered by a metered-dose inhaler with a spacer may provide the same, if not better, results in children and adults. Studies have examined the use of metered-dose inhalers with spacers in children with reactive airway disease, but there have been no well-designed studies in children two years and younger. Delgado and colleagues compared the administration of albuterol by a metered-dose inhaler with a spacer device versus a nebulizer in the treatment of wheezing in children two years and younger.
The double-blind, randomized, placebo-controlled study examined a convenient sample of children two to 24 months of age who presented to an emergency department with wheezing. The participants were randomly assigned to receive either active treatment with albuterol in a metered-dose inhaler followed by a placebo nebulizer treatment, or placebo metered-dose inhaler treatment followed by albuterol delivered by a nebulizer. The metered-dose inhaler had a spacer device with a mask that was held on the child's face during the administration of the contents. Treatments were repeated every 20 minutes. The outcome measures, which included admission rate, oxygen saturation, and Pulmonary Index score, were evaluated 10 minutes after each treatment. The Pulmonary Index score is a validated asthma severity score that includes four measures scored from zero to 3. In this study, mild asthma had a Pulmonary Index score of zero to 3, moderate asthma had a score of 4 to 7, and severe asthma had a score of 8 to 12.
During the initial assessment, the children who received albuterol by nebulizer had a significantly higher Pulmonary Index score than the children using metered-dose inhalers with spacers. When data were controlled for severity of asthma, children who received albuterol by metered-dose inhalers with spacers had fewer admissions than children in the nebulizer group. In addition, the group using metered-dose inhalers with spacers were significantly less likely to receive additional treatments or steroids, and had a lower mean increase in heart rate. There were no significant differences between the groups when comparing the percentage of improvement of Pulmonary Index score, final oxygen saturation, or percentage of patients who vomited.
The authors conclude that albuterol delivered by a metered-dose inhaler with a spacer device may be as effective as nebulizer delivery in children two years and younger who are wheezing. They add that metered-dose inhalers with spacer devices provide physicians with an easier and efficient method of delivering albuterol to infants and younger children.
Delgado A, et al. 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. Arch Pediatr Adolesc Med. January 2003;157:76–80.
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