TREATMENT OF ACUTE ASTHMA - SALBUTAMOL VIA JET NEBULIZER VS SPACER AND METERED-DOSE INHALER

Objective: To compare the efficacy of salbutamol delivered by jet nebu liser (JN) with salbutamol via a pressurised metered dose inhaler (PMD I) and a large volume spacer (Volumatic) for management of acute asthm a. Study population: A total of 160 children aged from 4 to 12 years p resenting to an Emergency Department with acute asthma. Methods: The s tudy was of multicentre (n=5) randomised, double blind, parallel desig n. Children weighing less than 25 kg received salbutamol 2.5 mg via th e JN or 600 mu g (six puffs) from the PMDI. Children over 25 kg receiv ed salbutamol 5 mg via the JN or 1200 mu g (12 puffs) via the PMDI. Cl inical score (range 0-12) and PEF (over 7 years) were recorded at base line and 15, 30, 45 and 60 mins post administration, Results: The impr ovement from baseline at 30 min in the clinical score was 1.87 for JN and 1.43 for PMDI (P=0.09) and at 60 min was 2.15 for JN and 1.12 for PMDI (P=0.0001). The improvement in PEF at 30 min was 51 L min(-1) for JN and 27 L min(-1) for PMDI (P=0.0007) and at 60 min was 57 L min(-1 ) for JN and 31.5 L min(-1) for PMDI (P=0.001). Conclusion: Administra tion of salbutamol via a PMDI and a large volume spacer device provide s effective relief in the management of acute asthma in children, but to a lesser extent than a jet nebuliser. This difference may represent a dose response effect.