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Allergists versus pediatricians: primary choice of metered-dose inhaler with spacer or nebulizer
1Division of Allergy and Immunology, Nemours Children's Health, Jacksonville (FL), U.S.A.
Insights
Pediatricians and allergists were surveyed on asthma exacerbation treatments for children under 5. Most pediatricians prefer metered dose inhalers (MDIs) with spacers, while allergists show mixed preferences, with some still favoring nebulizers despite evidence.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Respiratory Medicine
Background:
- Physicians often believe nebulizers are more effective than metered dose inhalers (MDIs) with spacers for asthma exacerbations.
- Evidence-based guidelines recommend MDIs with spacers for pediatric asthma management.
- This study investigates physician preferences and beliefs regarding asthma medication delivery devices.
Purpose of the Study:
- To compare the preferred methods of asthma exacerbation treatment delivery between pediatricians and allergists in children under 5 years old.
- To assess physician perceptions of the efficacy and safety of nebulizers versus MDIs with spacers for pediatric asthma.
- To identify discrepancies between clinical practice and evidence-based recommendations.
Main Methods:
- A cross-sectional survey was electronically distributed to a random sample of pediatricians and allergists.
- Respondents were categorized into primary care pediatricians (Group A) and practicing allergists (Group B).
- Response rate was 15.8% (430/2718), with data analyzed based on physician specialty.
Main Results:
- A majority of pediatricians (68.5%) preferred MDIs with spacers, viewing them as effective and associated with fewer adverse effects.
- A significant portion of allergists (55%) also preferred MDIs with spacers, but nearly half (48.9%) considered nebulizers effective.
- A majority of allergists (65.7%) incorrectly believed nebulizers cause more adverse effects than MDIs with spacers.
Conclusions:
- Contrary to evidence, a substantial number of allergists, more than pediatricians, favor nebulizers for pediatric asthma exacerbations.
- Half of surveyed allergists incorrectly perceive nebulizers as an effective delivery method.
- A majority of allergists hold misconceptions regarding the comparative safety of nebulizers versus MDIs with spacers.
Summary:
Background. Many physicians believe delivering medications for asthma exacerbation via nebulizers is more efficacious than using a metered dose inhaler (MDI) with spacer. This study aimed to evaluate pediatricians and allergists' chosen method in children under 5 years: MDI with spacer or nebulizer. Methods. A brief survey was sent via electronic mail to a randomly selected group of pediatricians and allergists. There was a 15.8% (430/2718) total response rate. We divided respondents into 2 groups. Group A comprised 289 primary care pediatricians, and Group B included 141 practicing allergists. Results. In Group A, 68.5% (196/286) respondents indicated an MDI with spacer as their method of choice to deliver bronchodilator therapy during an asthma exacerbation; 64.7% (187/289) reported an MDI with spacer is an effective method; and 48% (135/281) believe delivering medication through a nebulizer will produce increased adverse effects than MDIs with spacers. In Group B, 55% (77/140) of respondents indicated MDI with spacer as their method of choice; 48.9% (69/141) reported a nebulizer is an effective method; and 65.7% (90/137) believe delivering medication through a nebulizer will produce increased adverse effects. Conclusions. Contrary to evidence-based recommendations, most allergists, compared to pediatricians, are not only prescribing nebulizers as their first choice for delivering bronchodilator therapy, but also half of these asthma specialists consider nebulizers to be an effective mode of delivery. As far as safety is concerned, ironically, almost two-thirds of allergists believe more side effects are associated with delivering bronchodilator therapy through a nebulizer.
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