ALBUTEROL DELIVERED VIA METERED-DOSE INHALER WITH SPACER FOR OUTPATIENT TREATMENT OF YOUNG-CHILDREN WITH WHEEZING

Objective: To determine the efficacy of albuterol delivered via metere d-dose inhaler with spacer for the treatment of wheezing infants. Desi gn and Setting: Double-blind, prospective, placebo-controlled, clinica l crossover trial undertaken at the emergency department of a universi ty-affiliated children's hospital. Participants: Forty-two patients ag ed 1 to 18 months presenting to the emergency department with wheezing . Intervention: Subjects were randomly assigned to one of two blinded treatment groups. Group 1 received two albuterol treatments followed b y two placebo treatments. Group 2 received two placebo treatments foll owed by two albuterol treatments. Each treatment consisted of two puff s from a metered-dose inhaler with spacer at 20-minute intervals. Meas urements/Main Results: On enrollment and 20 minutes after each treatme nt, a clinical assessment was made by the principal investigator, whic h included heart rate, respiratory rate, pulse oximetry, wheezing scor e (0 to 3), and retraction score (0 to 3). Both treatment groups had a respiratory rate, pulse oximetry, wheezing score (0 to 3), statistica lly significant improvement in mean wheezing score associated with alb uterol therapy (P<.05 using Dunnett's t test). Mean retraction score i mproved over time in both groups only during drug therapy. However, th e improvement of only group 2 reached statistical significance (P<.05 using Dunnett's t test). Scores were then classified as ''improved'' a nd ''not improved'' for analysis with McNemar's test. Group 2 had a st atistically significant proportion of patients with improved retractio n score related to albuterol therapy. The remaining dichotomized resul ts, while not achieving statistical significance, showed a trend in th e direction expected from a beneficial drug effect. Conclusions: Albut erol delivered by metered-dose inhaler with spacer to wheezing infants aged 1 to 18 months reduces the severity of wheezing and retractions.