Nebulizers vs metered-dose inhalers with spacers for bronchodilator therapy to treat wheezing in children aged 2 to 24 months in a pediatric emergency department

Abstract

Delgado A, Chou KJ, Silver EJ, et al (Albert Einstein College of Medicine, Bronx, NY) The introduction of spacer devices for metered-dose inhalers (MDIs) has aided in the treatment of wheezing in infants and young children brought to the emergency department (ED). In a randomized, double-blind trial, albuterol administered by an MDI with a spacer was compared for efficacy with nebulizer-administered albuterol for the ED treatment of wheezing infants and children aged 2 to 24 months. The study population consisted of a convenience sample of infants and young children seen between August 1995 and December 1996. Exclusion criteria included chronic lung conditions other than asthma, a history of congenital heart disease, and signs of impending respiratory failure. Patients in the nebulizer group received a placebo MDI with a spacer followed by nebulized albuterol. The spacer group received albuterol by an MDI with a spacer followed by nebulized isotonic sodium chloride solution. Admission rate was the primary outcome. A total of 168 patients were enrolled (85 in the nebulizer group and 83 in the spacer group). The 2 groups were similar in demographic characteristics and baseline clinical findings, except that the nebulizer group had a significantly higher mean pulmonary index (PI) score. Patients in the spacer group had a significantly lower admission rate (5% versus 20% in the nebulizer group), received fewer treatments, had a lower mean increase in heart rate, and were less likely to receive steroids. The admission rate remained lower in the spacer group after controlling for initial PI scores. Lower admission rates in the spacer group were found primarily in children with a more severe asthma exacerbation. Acute wheezing episodes bring many infants and young children to the ED, and their treatment often requires considerable time and resources. The use of MDIs with spacers offers an easier, more efficient, and cost-effective way of delivering albuterol in such cases. Compared with nebulizers, MDIs with spacers are associated with a lower admission rate and a reduced increase in heart rate.