Original ArticlesCosts and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma☆,☆☆
Section snippets
METHODS
Children were eligible if they were 1 to 4 years of age and presented with an acute exacerbation of asthma to the ED of the Starship Children’s Hospital in Auckland, New Zealand. Baselineobservations included heart rate, respiratory rate, chest findings on auscultation, and room air oxygen saturation (saturation measured noninvasively with Nellcor pulse oximeter). Wheezing, heart rate, and accessory muscle use were graded on a scale of 0 to 3 (Table I) and a summary asthma clinical severity
RESULTS
Sixty children entered the study: 30 in each treatment group. The treatment groups were similar with respect to age, but a higher proportion of the nebulizer group was male (80.0% vs 47%, P =.02). The groups were similar for measures of asthma severity in history, usual asthma therapy, and medication received in the 24 hours before presentation to ED (Table II); 78% of the spacer group had received inhaled bronchodilator in the previous 24 hours compared with 80% of the nebulizer group.
DISCUSSION
Comparisons between spacer and nebulizer treatment suggest they are equivalent methods of delivery of bronchodilator to children with mild or moderate asthma.13, 14, 15, 16, 17, 18 However, most studies specifically exclude children with severe asthma,14, 15, 16 and few include children <5 years of age.14, 26, 27, 28 Studies including young children with moderate and severe asthma have reported difficulties with valve movement in the spacer26 and a modest withdrawal rate because of lack of
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Supported by a grant from the Asthma and Respiratory Foundation of New Zealand and performed during Allen and Hanbury (Glaxo Wellcome) Paediatric Respiratory Research Fellowship (Drs Leversha and Campanella). Boehringer Ingelheim NZ Ltd supplied the AeroChambers. The analysis and article were completed during a Postgraduate Scholarship from the Health Research Council of New Zealand (Dr Leversha).
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Reprint requests: A. Leversha, MBChB, MPH, General Paediatrics, Starship Children’s Hospital, Private Bag 92-024, Auckland, New Zealand.