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Experience with a metered-dose inhaler with a spacer in the pediatric emergency department
G Benton1, R C Thomas, B G Nickerson
1Childrens Hospital Medical Center, Oakland, CA 94609.
Insights
Metered-dose inhalers with spacers effectively treat acute pediatric asthma. Titrated doses significantly improve lung function and respiratory symptoms in children, offering a viable alternative to nebulizers.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Pharmacology
Background:
- Metered-dose inhalers with spacers (MDIS) are effective for bronchodilator delivery in adults.
- Limited data exists on MDIS efficacy in pediatric acute asthma.
Purpose of the Study:
- To evaluate the effectiveness of MDIS with dose titration for treating acute asthma in children.
- To compare MDIS treatment to traditional nebulizer therapy in a pediatric emergency setting.
Main Methods:
- 13 children with acute asthma received MDIS treatment.
- Doses were titrated up to 14 puffs until improvement plateaued.
- Peak expiratory flow (PEF), respiratory rate, heart rate, and breath sounds were monitored.
Main Results:
- PEF increased by 34% after the initial 2 puffs.
- PEF increased by 87% after dose titration.
- Respiratory rate decreased 12%, heart rate increased 2%, and 92% showed improved breath sounds.
Conclusions:
- MDIS with spacers is an effective bronchodilator delivery device for pediatric acute asthma.
- Dose titration with MDIS achieves significant bronchodilation in children.
- MDIS offers a practical and effective treatment option in pediatric emergency departments.
Abstract:
Studies of adults suggest that metered-dose inhalers with spacers are as effective as hand-held nebulizers for bronchodilator delivery. We studied 13 children with acute asthma. They received two puffs every 2 minutes from metered-dose inhalers with spacers (range, 4 to 14 puffs) titrated until improvement stopped. Peak expiratory flow increased 34% for metered-dose inhalers with spacers after the first 2 puffs and increased 87% for metered-dose inhalers with spacers after dose titration. After titration, respiratory rate decreased by 12%, heart rate increased by 2%, and breath sounds improved in 92% of the patients. We concluded that the metered-dose inhalers with spacers are an effective device for the treatment of asthma in the pediatric emergency department and that the use of metered-dose inhalers with spacers with titration can achieve significant bronchodilation in the treatment of patients with acute asthma.
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