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Arch Pediatr Adolesc Med. 2003 Jan;157(1):76-80.

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.

Author information

1
Division of Emergency Medicine, Department of Pediatrics, Jacobi Medical Center, 1400 Pelham Pkwy S, Room 1W20, Bronx, NY 10461, USA.

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.

PMID:
12517199
DOI:
10.1001/archpedi.157.1.76
[Indexed for MEDLINE]

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