High-dose albuterol by metered-dose inhaler through an asthma spacer device in wheezy infants and young children.

High-dose albuterol by metered-dose inhaler through an asthma spacer device in wheezy infants and young children. Inhaled albuterol is the most frequently used bronchodilator for acute whee zing, and nebulization is the standard mode of delivery in hospital setting s. However, recent guidelines consider spacer devices as an easier to use a nd cost-saving alternative, and recommend the high-dose metered-dose inhale r bronchodilator. Our objective was to demonstrate clinical equivalence bet ween a spacer device and a nebulizer for albuterol administration. Methods. - Randomized double-blind parallel-group equivalence trial. Albute rol was administered through the spacer device (50 mug/kg) or through the n ebulizer (150 mug/kg) and repeated three times at 20-minute intervals. Pare nts completed a questionnaire. Outcome measures were pulmonary index change , hospitalization, ease of use, acceptability, and SaO(2) change. Results. - Sixty-four 12- to 60-month-old children with acute recurrent whe ezing (32 per group). The 90% confidence interval of the difference between treatment groups for the median absolute changes in pulmonary index values between T0 and T60 was -1 to +1 and was included in the equivalence interv al -1.5 to +1.5. Clinical improvement increased with time. Fewer than 10% o f the children (three in each group) required hospitalization (two in each group due to treatment failure). Parents considered administration of albut erol using the spacer device easier (94%) and better accepted by their chil dren (62%). Conclusions. - The efficacy of albuterol administered using the spacer devi ce was equivalent to that of the nebulizer. Given its high tolerance, repea ted 50 mug/kg doses of albuterol administered through the spacer device sho uld be considered in hospital emergency departments as first-line therapy f or wheezing. (C) 2001 Editions scientifiques et medicales Elsevier SAS.