Costs and effectiveness of spacer versus nebulizer in young children with moderate and severe acute asthma

Objective: To compare the costs and effectiveness of albuterol by metered d ose inhaler (MDI) and spacer versus nebulizer in young children with modera te and severe acute asthma. Design: Randomized, double-blind, placebo-controlled trial in an emergency department at a children's hospital. The participants were children 1 to 4 years of age with moderate to severe acute asthma. Patients assigned to the spacer group received albuterol (600 mu g) by MDI by spacer (AeroChamber) followed by placebo by nebulizer (n = 30). The nebulizer group received pla cebo MDI by spacer followed by 2.5 mg albuterol by nebulizer (n = 30). Trea tments were repeated at 20-minute intervals until the patient was judged to need no further doses of bronchodilator, or a total of 6 treatments. Results: Clinical score, heart rate, respiratory rate, auscultatory finding s, and oxygen saturation were recorded at baseline, after each treatment, a nd 60 minutes after the last treatment. Baseline characteristics and asthma severity were similar for the treatment groups. The spacer was as effectiv e as the nebulizer for clinical score, respiratory rate, and oxygen saturat ion but produced a greater reduction in wheezing (P = .03). Heart rate incr eased to a greater degree in the nebulizer group (11.0/min vs 0.17/min for spacer, P < .01). Fewer children in the spacer group required admission (33 % vs 60% in the nebulizer group, P = .04, adjusted for sex). No differences were seen in rates of tremor or hyperactivity. The mean cost of each emerg ency department presentation was NZ$825 for the spacer group and NZ$1282 fo r the nebulizer group (P = .03); 86% of children and 85% of parents preferr ed the spacer. Conclusion: The MDI and spacer combination was a cost-effective alternative to a nebulizer in the delivery of albuterol to young children with moderat e and severe acute asthma.