METERED-DOSE INHALER ACCESSORY DEVICES IN ACUTE ASTHMA - EFFICACY ANDCOMPARISON WITH NEBULIZERS - A LITERATURE-REVIEW

Objectives: To evaluate the current literature about the efficacy of p roviding inhaled medications by metered-dose inhalers and accessory de vices (MDI/ADs) to children with acute asthma and to compare it with t he current standard of care, small-volume nebulizers (SVNs). Data Sour ces: Online computer and manual searches in English-language journal a rticles published between 1980 and 1996. Study Selection: Seventeen pr ospective clinical trials that have used MDI/ADs in the treatment of a cute asthma in children were retrieved. Ten randomized controlled stud ies that included a comparison with SVN treatment were selected. Data Extraction: Studies were assessed qualitatively by their subject chara cteristics, design, intervention procedures, outcome measures, and res ults. Data Synthesis: There were marked variations in types of MDI/ADs and in doses administered between and within studies. Major outcome m easures included pulmonary function measurements and clinical scores. All studies found MDI/ADs to be effective in the treatment of infants and children with acute asthma. Among those who compared this treatmen t with SVN, 2 found the MDI/AD superior and the rest found it as effec tive as the SVN. Conclusions: The data support the effectiveness of MD I/ADs as first-line treatment in acute childhood asthma. In view of cl inical benefit, safety, lower cost, personnel time, and speed and ease of administration of MDI/ADs compared with SVNs, MDI/ADs should be co nsidered the preferred mode of treatment of children with acute asthma .