Fortes doses de salbutamol par aérosol doseur et chambre d’inhalation chez les nourrissons et les jeunes enfants siffleurs

Abstract

Inhaled albuterol is the most frequently used bronchodilator for acute wheezing, and nebulization is the standard mode of delivery in hospital settings. However, recent guidelines consider spacer devices as an easier to use and cost-saving alternative, and recommend the high-dose metered-dose inhaler bronchodilator. Our objective was to demonstrate clinical equivalence between a spacer device and a nebulizer for albuterol administration. Methods. – Randomized double-blind parallel-group equivalence trial. Albuterol was administered through the spacer device (50 μg/kg) or through the nebulizer (150 μg/kg) and repeated three times at 20-minute intervals. Parents 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 wheezing (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 interval –1.5 to +1.5. Clinical improvement increased with time. Fewer than 10% of the children (three in each group) required hospitalization (two in each group due to treatment failure). Parents considered administration of albuterol using the spacer device easier (94%) and better accepted by their children (62%). Conclusions. – The efficacy of albuterol administered using the spacer device was equivalent to that of the nebulizer. Given its high tolerance, repeated 50 μg/kg doses of albuterol administered through the spacer device should be considered in hospital emergency departments as first-line therapy for wheezing.