Evaluating the effectiveness of evidence-based guidelines for the use of spacer devices in children with acute asthma

Area of Science:

• Pediatric Emergency Medicine
• Respiratory Medicine
• Clinical Practice Change

Background:

• Acute asthma exacerbations in children often require bronchodilator therapy.
• Nebulizers have been the traditional delivery method, but metered dose inhalers with spacers offer potential advantages.

Purpose of the Study:

• To evaluate the implementation of a practice change from nebulizers to metered dose inhalers and holding chambers (spacers) for children with mild to moderate acute asthma.
• To assess the impact of this change on clinical outcomes, including hospitalization and length of stay.

Main Methods:

• A before-and-after study comparing children with acute asthma presenting to a tertiary care children's hospital emergency department.
• Intervention involved developing evidence-based guidelines for spacer use and implementing a multifaceted guideline program.
• Data collected on physician prescribing practices and clinical outcomes (hospitalization, ICU admission, length of stay).

Main Results:

• The proportion of children treated with spacers in the emergency department increased from 0% in 1997 to 94% in 1999.
• Hospital admission rates remained similar between the two periods (29% vs. 30%).
• The median length of stay for children with asthma was comparable in both study years (1.7 days).

Conclusions:

• Standard practice for bronchodilator delivery in mild to moderate acute asthma in children was successfully shifted from nebulizers to spacers.
• This change in practice was achieved without adversely affecting the need for hospitalization or its duration.