Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma

doi:10.1016/S0022-3476(99)70322-7

The Journal of Pediatrics

Volume 135, Issue 1, July 1999, Pages 22-27

https://doi.org/10.1016/S0022-3476(99)70322-7 Get rights and content

Abstract

Objective: In children with mild acute asthma, to compare treatment with a single dose of albuterol delivered by a metered dose inhaler (MDI) with a spacer in either a weight-adjusted high dose or a standard low-dose regimen with delivery by a nebulizer. Study design: In this randomized double-blind trial set in an emergency department, 90 children between 5 and 17 years of age with a baseline forced expiratory volume in 1 second (FEV₁ ) between 50% and 79% of predicted value were treated with a single dose of albuterol, either 6 to 10 puffs (n = 30) or 2 puffs (n = 30) with an MDI with spacer or 0.15 mg/kg with a nebulizer (n = 30). Results: No significant differences were seen between treatment groups in the degree of improvement in percent predicted FEV₁ (P = .12), clinical score, respiratory rate, or O₂ saturation. However, the nebulizer group had a significantly greater change in heart rate (P = .0001). Our study had 93% power to detect a mean difference in percent predicted FEV₁ of 8 between the treatment groups. Conclusion: In children with mild acute asthma, treatment with 2 puffs of albuterol by an MDI with spacer is just as clinically beneficial as treatment with higher doses delivered by an MDI or by a nebulizer. (J Pediatr 1999;135:22-7)

Section snippets

METHODS

The study design was a single-dose, double-blind, randomized, triple-dummy trial with 3 treatment arms. One group (subsequently referred to as “the higher dose MDI group”) received 6 to 10 puffs (100 μg/puff) of albuterol by an MDI (Glaxo Wellcome, Canada) with a clear plastic 140 mL spacer device with a mouthpiece (Aerochamber, Trudell Medical, London, Ontario, Canada). Children weighing <25 kg received 6 puffs, those between 25 and 34 kg received 8 puffs, and those weighing >34 kg received 10

RESULTS

During the study period from October 1, 1994, to February 28, 1997, approximately 6000 children were given the diagnosis of wheezing in our ED. Of these, 3853 were excluded because they were too young for the study. Further exclusions comprised 152 patients who were unable to perform spirometry, 240 patients with an FEV₁ 80% or more of the predicted, 200 children with a percent predicted FEV₁ <50, 58 children who had no history of wheezing or bronchodilator therapy, 68 patients excluded because

DISCUSSION

In this pediatric trial outpatients with mild acute asthma treated with a low dose of albuterol (200 μg) by MDI with spacer had a similar improvement in percent predicted FEV₁ to those children prescribed doses 3 to 5 times higher by an MDI and those treated by nebulizer. Furthermore, with the exception of changes in heart rate, no significant differences were seen among the 3 groups in outcome measures at 90 minutes.

Several adult studies have attempted to determine the albuterol dose needed by

Acknowledgements

We thank Dr Allan Coates for his helpful comments, our medical and nursing colleagues for their cooperation, and Michelle McKenna and Andrea Giggey for typing this article.

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^☆: Supported by grants from Physicians’ Services Incorporated, Trudell Medical, The Hospital for Sick Children Foundation and Department of Paediatrics, The Hospital for Sick Children.

^☆☆: Reprint requests: Suzanne Schuh, MD, FRCP(C), Emergency Department, The Hospital for Sick Children, 555 University Ave, Toronto, Ontario, Canada M5G 1X8.

^★: 0022-3476/99/$8.00 + 0 9/21/97894

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Comparison of albuterol delivered by a metered dose inhaler with spacer versus a nebulizer in children with mild acute asthma☆,☆☆,★

Abstract

Section snippets

METHODS

RESULTS

DISCUSSION

Acknowledgements

Chest

Chest

J Pediatr

Chest

Chest

Therapeutic aerosols-physical and practical considerations

Thorax

Improvement of pressurized aerosol deposition-with nebuhaler spacer device

Thorax

Control of asthma by aerosols

N Engl J Med

Aerosols: therapeutic use and delivery in childhood asthma

Ann Allergy

Deposition of pressurized aerosols in the human respiratory tract

Thorax

High-dose inhaled terbutaline in the management of chronic severe asthma; comparison of wet nebulization and tube-spacer

Thorax

Experience with a metered-dose inhaler with a spacer in the pediatric emergency department

Am J Dis Child