Metered-dose inhaler: the emergency department orphan

Area of Science:

• Pediatric Emergency Medicine
• Respiratory Medicine
• Clinical Practice Research

Background:

• Nebulizers are commonly used for bronchodilator delivery in pediatric emergency departments.
• Physicians may hold misconceptions about the efficacy and safety of metered-dose inhalers with spacers (MDI+S) for acute pediatric asthma exacerbations.

Purpose of the Study:

• To investigate bronchodilator delivery methods used by emergency physicians for children with acute asthma.
• To identify physician knowledge and perceptions regarding metered-dose inhalers with spacers (MDI+S) versus nebulizers.

Main Methods:

• A self-administered mail survey was conducted among members of the American Academy of Pediatrics and Canadian Pediatric Society emergency medicine sections.
• The survey focused on bronchodilator delivery methods in acute pediatric asthma, with outcomes including nebulizer use and MDI+S use in mild asthma.

Main Results:

• A response rate of 51% (333/567) was achieved among eligible physicians.
• Most respondents (72%) were dual-trained in pediatrics and pediatric emergency medicine, practicing full-time in urban settings (83%).
• Commonly cited MDI advantages included cost (33%) and speed (28%), while disadvantages involved patient dissatisfaction (24%) and perceived ease of nebulizer use (23%). MDI+S use ranged from 10% to 21% for mild exacerbations.

Conclusions:

• Misconceptions regarding the efficacy and safety of MDI+S for acute pediatric asthma exist but are held by a minority of surveyed physicians.
• Nebulizers continue to be the primary method for routine bronchodilator delivery in pediatric emergency departments for asthma exacerbations.