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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.

AbstractOBJECTIVE:
To determine if administration of albuterol by a metered-dose inhaler with a spacer device is as efficacious as administration of albuterol by nebulizer to treat wheezing in children aged 2 years and younger.
DESIGN:
Double-blind, randomized, placebo-controlled clinical trial.
SETTING:
Pediatric emergency department.
PATIENTS:
From a convenience sample of wheezing children aged 2 to 24 months, 85 patients were enrolled in the nebulizer group and 83 in the spacer group.
INTERVENTIONS:
The nebulizer group received a placebo metered-dose inhaler with a spacer followed by nebulized albuterol. The spacer group received albuterol by a metered-dose inhaler with a spacer followed by nebulized isotonic sodium chloride solution. Treatments were given every 20 minutes by a single investigator blinded to group assignment.
MAIN OUTCOME MEASURES:
The primary outcome was admission rate. Pulmonary Index score and oxygen saturation were measured initially and 10 minutes after each treatment.
RESULTS:
The nebulizer group had a significantly higher mean (SD) initial Pulmonary Index score compared with the spacer group (7.6 [2.5] vs 6.6 [2.0]; P =.002). With the initial Pulmonary Index score controlled, children in the spacer group were admitted less (5% vs 20%; P =.05). Analyses also revealed an interaction between group and initial Pulmonary Index score; lower admission rates in the spacer group were found primarily in children having a more severe asthma exacerbation.
CONCLUSION:
Our data suggest that metered-dose inhalers with spacers may be as efficacious as nebulizers for the emergency department treatment of wheezing in children aged 2 years or younger.
AuthorsAnnette Delgado, Katherine J Chou, Ellen Johnson Silver, Ellen F Crain
JournalArchives of pediatrics & adolescent medicine (Arch Pediatr Adolesc Med) Vol. 157 Issue 1 Pg. 76-80 (Jan 2003) ISSN: 1072-4710 [Print] United States
PMID12517199 (Publication Type: Clinical Trial, Journal Article, Randomized Controlled Trial)
Chemical References
  • Bronchodilator Agents
  • Albuterol
Topics
  • Albuterol (administration & dosage)
  • Bronchodilator Agents (administration & dosage)
  • Child, Preschool
  • Double-Blind Method
  • Emergency Service, Hospital
  • Female
  • Humans
  • Infant
  • Male
  • Metered Dose Inhalers
  • Nebulizers and Vaporizers
  • New York City
  • Respiration (drug effects)
  • Respiratory Sounds (drug effects)
  • Treatment Outcome

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