PURPOSE OF THE STUDY.
To compare administration of bronchodilators by nebulizers with delivery by metered dose inhalers (MDIs) with spacers and to evaluate the clinical effect of the treatment of acute asthma in preschool children.
Children 0–6 years of age who presented to the emergency department with viral infection–associated wheezing or acute asthma flares.
A prospective randomized clinical trial in a pediatric emergency department (PED). Preschool children who were admitted for virus-induced wheezing or acute asthma exacerbation were randomly allocated to receive bronchodilator treatment by nebulizer or by MDI. Parents completed a questionnaire during the PED visit.
Baseline data were similar for both groups, except for family history of asthma and atopic disease being more frequently reported in the nebulizer group. The length of stay in the PED and rate of hospitalization were similar. No significant differences were seen in heart rate, respiratory rate, and oxygen saturation at baseline and after the treatment. No difference was seen in the parents' view of ease of use and device acceptance. According to the parents, 40% of the participants had asthma diagnosis, but up to 66% were previously prescribed some kind of asthma medication.
The results suggest that MDIs with spacers are at least as effective as nebulizers in the delivery of β agonists to treat preschool children with virus-induced wheezing or acute exacerbations of asthma in the PED. It is important to provide adequate information to the staff and parents to treat pediatric acute asthma successfully.
There are numerous studies that have addressed the efficacy of MDIs versus nebulized medication delivery in children. Despite evidence that either method is suitable for medication delivery, there remains the perception that nebulization is superior to MDI/spacer use, particularly in younger children. The authors highlight parents’ perceptions in an acute setting that both methods achieve acceptance if presented correctly. This information should encourage clinicians to distribute appropriate MDIs/spacer devices to preschool-aged children without hesitation.
- Copyright © 2017 by the American Academy of Pediatrics