METERED-DOSE INHALERS WITH SPACERS VS NEBULIZERS FOR PEDIATRIC ASTHMA

Objective: To determine whether the administration of beta-agonists by metered-dose inhaler (MDI) with a spacer device is as effective as th e administration of beta-agonists by nebulizer for the treatment of ac ute asthma exacerbations in children. Design: Randomized trial with tw o arms. Setting: Urban pediatric emergency department (ED) in Bronx, N Y. Patients: Convenience sample of 152 children 2 years and older with a history of at least two episodes of wheezing presenting to the ED w ith an acute asthma exacerbation. Interventions: Patients were randoml y assigned to receive standard doses of a beta-agonist (albuterol) by an MDI with spacer or by a nebulizer. Dosing intervals and the use of other medications were determined by the treating physician. Measureme nts/Main Results: Baseline characteristics and asthma history were rec orded. Asthma severity score, peak expiratory flow rate in children 5 years or older, and oxygen saturation were determined at presentation and before admission or discharge. The groups did not differ in age, s ex, ethnicity, age of onset of asthma, or asthma severity score at pre sentation. There were no significant differences between the groups in outcomes, including mean changes in respiratory rate, asthma severity score, and peak expiratory flow rate, oxygen saturation, number of tr eatments given, administration of steroids in the ED, and admission ra te. Patients given MDIs with spacers required shorter treatment times in the ED (66 minutes vs 103 minutes, P<.001). Fewer patients in the s pacer group had episodes of vomiting in the ED (9% vs 20%, P<.04), and patients in the nebulizer group had a significantly greater mean perc ent increase in heart rate from baseline to final disposition (15% vs 5%, P<.001). Conclusions: These data suggest that MDIs with spacers ma y be an effective alternative to nebulizers for the treatment of child ren with acute asthma exacerbations in the ED.