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Metered-Dose Inhaler Versus Nebulizer Treatment for Acute Asthma Exacerbation: A Process Evaluation.
Christopher Graybill1, Colleen Paramesh2, Jason Gray2
1The University of Kansas School of Nursing, Kansas City, KS, USA cgraybill79@gmail.com.
Journal of Doctoral Nursing Practice
|November 13, 2024
Summary
Metered-dose inhalers (MDIs) with spacers proved more effective than nebulizers for pediatric asthma exacerbations. This approach reduced clinic return visits and emergency department visits within 30 days.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Healthcare Management
Background:
- Childhood asthma affects 6.5% of US children.
- A Federally Qualified Health Center (FQHC) shifted from nebulized albuterol to metered-dose inhalers (MDIs) with spacers during the COVID-19 pandemic.
- This change aimed to minimize pathogen aerosolization and reduce healthcare costs.
Purpose of the Study:
- To evaluate the safety, efficacy, and efficiency of switching asthma exacerbation treatment protocols.
- To compare nebulized albuterol with MDIs with spacers in pediatric patients.
Main Methods:
- Retrospective chart review of pediatric patients with asthma exacerbations.
- Comparison of nebulized albuterol versus MDI with spacer.
- Measured 30-day return-to-care rates (ED or clinic), total treatments, and concurrent oral steroid use.
Main Results:
- A statistically significant reduction in 30-day return-to-clinic visits was observed with MDIs.
- Zero patients treated with MDI and spacer returned to the clinic within 30 days.
- 61% of patients treated with nebulized albuterol returned within 30 days (p < .00001).
Conclusions:
- Albuterol MDI with a spacer is more effective than nebulizers for reducing follow-up visits.
- This MDI approach effectively reduces emergency department visits within 30 days.
- Using MDIs in primary care for asthma exacerbations is cost-effective and reduces airborne exposure.
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