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 J. Silver, Ellen F. Crain

Research output: Contribution to journalArticle

72 Citations (Scopus)

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
StatePublished - Jan 1 2003

Fingerprint

Metered Dose Inhalers
Nebulizers and Vaporizers
Bronchodilator Agents
Respiratory Sounds
Albuterol
Hospital Emergency Service
Pediatrics
Lung
Placebos
Therapeutics
Emergency Treatment
Sodium Chloride
Asthma
Randomized Controlled Trials
Research Personnel
Outcome Assessment (Health Care)
Oxygen
Equipment and Supplies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

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. / Delgado, Annette; Chou, Katherine J.; Silver, Ellen J.; Crain, Ellen F.

In: Archives of Pediatrics and Adolescent Medicine, Vol. 157, No. 1, 01.01.2003, p. 76-80.

Research output: Contribution to journalArticle

@article{d85a0a0c3869446db0e3a0500730bb1b,
title = "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 = "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.",
author = "Annette Delgado and Chou, {Katherine J.} and Silver, {Ellen J.} and Crain, {Ellen F.}",
year = "2003",
month = "1",
day = "1",
language = "English (US)",
volume = "157",
pages = "76--80",
journal = "JAMA Pediatrics",
issn = "2168-6203",
publisher = "American Medical Association",
number = "1",

}

TY - JOUR

T1 - 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

AU - Delgado, Annette

AU - Chou, Katherine J.

AU - Silver, Ellen J.

AU - Crain, Ellen F.

PY - 2003/1/1

Y1 - 2003/1/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0037235719&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037235719&partnerID=8YFLogxK

M3 - Article

C2 - 12517199

AN - SCOPUS:0037235719

VL - 157

SP - 76

EP - 80

JO - JAMA Pediatrics

JF - JAMA Pediatrics

SN - 2168-6203

IS - 1

ER -