Chest
Volume 121, Issue 4, April 2002, Pages 1036-1041
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Clinical Investigations
ASTHMA
A Comparison of Albuterol Administered by Metered-Dose Inhaler and Spacer With Albuterol by Nebulizer in Adults Presenting to an Urban Emergency Department With Acute Asthma

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Study objectives

To determine the efficacy of albuterol by metered-dose inhaler (MDI) and spacer compared to a nebulizer.

Design

A prospective, open-label study.

Setting

Large urban emergency department (ED).

Patients

All consecutive adult asthma patients over a 2.5-year period.

Interventions

ED personnel used a standardized treatment algorithm, which included albuterol administered by nebulization, for patients presenting to the ED during the first 12 months of the study. The treatment algorithm then was switched to one that utilized albuterol administered by MDI/spacer as the primary mode of delivery for the following 18 months. As part of the conversion to MDI/spacer, ED staff counseled patients on self-management and supplied patients with a peak flowmeter, an MDI/spacer, and an inhaled steroid for home use.

Measurements

Pulmonary function, clinical outcome, laboratory data, and financial data were assembled and analyzed from 2,342 ED visits and 1,420 patients.

Results

While there was no significant difference in hospital admission rates between patients in the MDI/spacer group and the nebulizer group (13.2% and 14.6%, respectively), there was a statistically greater improvement in peak flow rates in the MDI/spacer group (126.8 vs 111.9 L/min, respectively; p = 0.002). The MDI/spacer group also spent significantly less time in the ED (163.6 and 175 min, respectively; p = 0.007), had a lower total albuterol dose (1,125 μg and 6,700 μg, respectively; p < 0.001), and showed a greater improvement in arterial oxygen saturation (p = 0.043). Relapse rates at 14 and 21 days were significantly lower (p < 0.01 and p < 0.05, respectively) among patients treated with the MDI/spacer and were associated with asthma education and the provision of a peak flowmeter, a spacer, and an inhaled corticosteroid for patients' home use.

Conclusions

Albuterol administered by MDI/spacer is an efficacious and cost-effective alternative to nebulization in adults with acute asthma who present at a large urban ED.

Section snippets

Patients

Patients who were admitted to the study were consecutive adult patients who were > 18 years of age and had presented to the ED of the University of Cincinnati Medical Center from October 1994 to April 1997 with an acute exacerbation of asthma. All patients with acute asthma who were seen by physicians in the ED during this period were included in the study. A total of 2,342 ED visits for acute asthma were recorded and statistically evaluated. Smoking was not an exclusion criterion in this study.

Results

The majority of patients participating in the study were African-American (75.4%). Most were women (58.6%), and the mean (± SD) age of participants was 35.5 ± 13.5 years. Data entries were gathered and compiled from a total of 2,342 ED visits. The total number of unique patients seen at these visits was 1,429. There were no significant differences in demographic characteristics between patients in phase 1 (nebulizer) and those in phase 2 (MDI/spacer) [Table 1].

Medication use at the time of

Discussion

This large study of 2,342 consecutive ED visits for acute asthma demonstrated that the delivery of albuterol by MDI/spacer was as effective as delivering albuterol by nebulizer. There was statistically greater improvement (13.3%) in PEFR values in the MDI/spacer group than in the nebulizer group. However, this did not result in a statistically significantly lower hospital admission rate, with 13.2% of patients in the MDI group and 14.6% of patients in the nebulizer group being admitted to the

References (23)

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This research was supported by the University of Cincinnati.

Dr. Newman is currently an employee of Forest Laboratories.

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