Procaterol via nebulizer versus metered-dose inhaler with a spacer for acute asthma exacerbation in children

To date, no studies have assessed the outcomes of different inhalation methods for procaterol, a short-acting β2-agonist frequently used in Japan to treat acute asthma exacerbations in children. The present study compared the efficacy and safety of procaterol using a nebulizer (NEB) and a metered-dose inhaler (MDI) with a spacer.

The present before-and-after study targeted patients aged 4-16 years with moderate to severe acute asthma exacerbations who visited the pediatric emergency department (PED). The primary outcome was a reduction in the Modified Pulmonary Index Score (MPIS), and the secondary outcomes were the hospitalization rate, length of stay (LOS), and incidence of adverse events. Propensity score matching and multiple regression analysis were conducted to adjust for confounding factors.

Forty-nine patients were selected from 70 and 77 patients in the NEB and MDI group, respectively, using propensity score matching. No statistically significant difference in MPIS reduction (3.7 vs. 4.3; p = 0.13) or the hospitalization rate (26.5% vs. 20.4%; p = 0.48) was found between the groups. The LOS (94 vs. 61 min; p < 0.001) was significantly shorter in the MDI group. Only one patient (2.0%) using an MDI experienced vomiting.

An MDI with a spacer was comparable to an NEB in effectiveness and was associated with a shorter LOS and lower incidence of adverse events. An MDI with a spacer may serve as an alternative to an NEB for administering inhaled procaterol in patients with acute asthma exacerbation in the PED.