A Novel, Portable MESH Nebulizer-An Alternative to Metered Dose Inhaler: Efficacy and Usability in Preschool Wheezers.

Nicola Ullmann,Annalisa Allegorico,Valentina Panetta,Paolo Maria Matricardi,Valentina Negro,Renato Cutrera,Antonio Di Marco,Fabiana Columbu,Salvatore Tripodi,Ekaterina Potapova,Maria Beatrice Chiarini Testa

doi:10.3389/fped.2020.598690

Abstract

Introduction and Objectives: Wheezing episodes are the first causes of doctor's consultation in preschool age. Treatment is usually administered with a metered dose inhaler (MDI) spacer. At variance, many parents and doctors prefer to use a compressor nebulizer, which cannot be easily carried. The study is aimed at testing whether a pocket mesh nebulizer has similar efficacy and acceptability than a standard MDI device.Materials and Methods: The IPAC study was a randomized, controlled, non-inferiority trial (number: 1616/2018, Ospedale Pediatrico Bambino Gesu'—IRCCS). The study had two arms: cases, using MicroAIR U100, and controls, using MDI+spacer device. Both devices were adopted for long-term treatment and for exacerbations. Follow-up was organized with clinical visits and a daily e-diary connected to an application for mobile phone.Results: One hundred patients were enrolled. The frequency of asthmatic symptoms showed a non-inferiority for MicroAIR U100 group vs. MDI. Accordingly, no significant difference was found in the average % of days with cough, wheezing, breathlessness after exercise, days lost at school, and not-programmed visits. Considering only patients with >1 day with symptoms, no significant sdifferences were found in the number of exacerbations nor in the cumulative days with symptoms. The acceptance and usability of both devices have been favorable. However, the MDI+AeroChamber® device showed better acceptability.Conclusions: Our study shows that MicroAIR U-100, a mesh nebulizer, has similar clinical efficacy but lower acceptance and usability than an MDI plus Aerochamber® in delivering therapy in preschool wheezers. Therefore, MicroAIR U-100 might be a valuable second choice, when the delivery of medication with an MDI plus Aerochamber® is not accepted, or wrongly used by the parents.

Highlights

Introduction and ObjectivesWheezing episodes are the first causes of doctor’s consultation in preschool age
The frequency of asthmatic symptoms showed a non-inferiority for MicroAIR U100 group vs. metered dose inhaler (MDI)
No significant difference was found in the average % of days with cough, wheezing, breathlessness after exercise, days lost at school, and not-programmed visits

Summary

Introduction

Introduction and ObjectivesWheezing episodes are the first causes of doctor’s consultation in preschool age. Viral infections of the upper and lower airways, along with wheezing, are the first causes of doctor’s consultation in the preschool age [1]. Their social and economic burden at worldwide level is enormous [2, 3]. Treatment for acute episodes is based on short-acting b2-agonists, usually administered, according to the international guidelines, with a metered dose inhaler (MDI) spacer [6,7,8]. The most frequent nebulizers used are based on a compressor, require electric power, take about 5–10 min for drug administration, and cannot be carried. Nebulizers are normally used only at home, and their use is often limited

Methods

Results

Conclusion