COMPARATIVE EFFICACY OF TERBUTALINE SULFATE DELIVERED BY TURBUHALER DRY POWDER INHALER OR PRESSURIZED METERED-DOSE INHALER WITH NEBUHALER SPACER IN CHILDREN DURING AN ACUTE ASTHMATIC EPISODE
Drblik S, Lapierre G, Thivierge R, et al. Arch Dis Child. 2003;88:319–323
Purpose of the Study.
Several previous studies demonstrated that the bronchodilator effect of a metered-dose inhaler (MDI) with spacer was just as good as that of a nebulizer for treatment of acute asthma exacerbations among children. What about a MDI with spacer versus a dry powder inhaler (DPI)?
A total of 112 children with asthma, 6 to 16 years of age, who presented to an emergency department with asthma exacerbations were studied. Baseline forced expiratory volume in 1 second (FEV1) values were 25 to 60% of predicted values.
Patients were randomized to receive terbutaline through either a MDI with spacer or a DPI (Turbuhaler, AstraZeneca, Lund, Sweden). Doses were administered at 0 and 30 minutes, and FEV1 values were measured at 0, 30, and 60 minutes.
No differences in increases in FEV1 were seen at 30 minutes (MDI with spacer: 35%; DPI: 33%) or 60 minutes (MDI with spacer: 50%; DPI: 49%). There were also no differences in oxygen saturation or heart rates.
For treatment of acute asthma exacerbations among children ≥6 years of age, delivery of a bronchodilator with a DPI works just as well as delivery with a MDI with spacer.
The Environmental Protection Agency and the Food and Drug Administration are mandating that current MDIs be phased out, because of the adverse environmental effects of chlorofluorocarbon propellants. Inhaler manufacturers have complied either by using more environmentally friendly propellants (such as hydrofluoroalkanes) or by eliminating the propellant entirely in DPIs. It is reassuring to know that, even in acute asthma exacerbations, children ≥6 years of age can effectively use a DPI for delivery of bronchodilator.