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

Annette Delgado, Katherine J. Chou, Ellen Johnson Silver, Ellen F. Crain

Research output: Contribution to journalArticle

74 Scopus citations

Abstract

Objective: To determine if administration of albuterol by a metered-dose inhaler with a spacer device is as efficacious as administration of albuterol by nebulizer to treat wheezing in children aged 2 years and younger. Design: Double-blind, randomized, placebo-controlled clinical trial. Setting: Pediatric emergency department. Patients: From a convenience sample of wheezing children aged 2 to 24 months, 85 patients were enrolled in the nebulizer group and 83 in the spacer group. Interventions: The nebulizer group received a placebo metered-dose inhaler with a spacer followed by nebulized albuterol. The spacer group received albuterol by a metered-dose inhaler with a spacer followed by nebulized isotonic sodium chloride solution. Treatments were given every 20 minutes by a single investigator blinded to group assignment. Main Outcome Measures: The primary outcome was admission rate. Pulmonary Index score and oxygen saturation were measured initially and 10 minutes after each treatment. Results: The nebulizer group had a significantly higher mean (SD) initial Pulmonary Index score compared with the spacer group (7.6 [2.5] vs 6.6 [2.0]; P=.002). With the initial Pulmonary Index score controlled, children in the spacer group were admitted less (5% vs 20%; P=.05). Analyses also revealed an interaction between group and initial Pulmonary Index score; lower admission rates in the spacer group were found primarily in children having a more severe asthma exacerbation. Conclusion: Our data suggest that metered-dose inhalers with spacers may be as efficacious as nebulizers for the emergency department treatment of wheezing in children aged 2 years or younger.

Original languageEnglish (US)
Pages (from-to)76-80
Number of pages5
JournalArchives of Pediatrics and Adolescent Medicine
Volume157
Issue number1
DOIs
StatePublished - Jan 1 2003

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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