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Comparison of the effects on lung function of two methods of bronchodilator administration
1Department of Child Health, King's College Hospital, London, U.K.
Insights
Administering salbutamol via a metered dose inhaler (MDI) avoids early lung function decline in premature infants compared to nebulizers. Both MDI and nebulizer provide similar long-term bronchodilation, making MDI the preferred delivery method.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Neonatology
Background:
- Premature infants often experience respiratory issues.
- Bronchodilator delivery methods (MDI vs. nebulizer) impact lung function.
- Paradoxical deterioration in lung function is a concern.
Purpose of the Study:
- To compare the efficacy of metered dose inhaler (MDI) versus nebulizer for salbutamol delivery in premature infants.
- To determine if MDI administration prevents early paradoxical airway resistance increase.
- To assess if both methods provide equivalent late bronchodilation.
Main Methods:
- Fifteen premature infants (median gestational age 27 weeks) were studied.
- Lung function (airway resistance) was measured using plethysmography.
- Salbutamol was administered via MDI and nebulizer in random order, with measurements taken at baseline, 5, and 15 minutes.
Main Results:
- Nebulized salbutamol caused a 16% increase in airway resistance at 5 minutes, while MDI salbutamol showed a 3% improvement (P < 0.03).
- At 15 minutes, both MDI and nebulizer groups showed similar bronchodilation (15% and 14% improvement, respectively).
- MDI administration avoided the early paradoxical deterioration in lung function.
Conclusions:
- Metered dose inhaler (MDI) administration of salbutamol is preferred for premature infants due to avoidance of early lung function deterioration.
- Both MDI and nebulizer delivery achieve comparable bronchodilation at 15 minutes.
- MDI use may be a safer and equally effective method for bronchodilator delivery in this population.
Abstract:
The aim of this study was to assess if administration of bronchodilator via a metered dose inhaler (MDI), rather than by a nebulizer, avoided the early paradoxical deterioration in lung function but, resulted in equally effective late bronchodilation. Fifteen children were studied at a median postnatal age of 9 months (range 9-18), all had been born prematurely at a median gestational age of 27 weeks (range 23-31). Lung function was measured by plethysmography before and 10 min after normal saline and 5 and 15 min after salbutamol given via an MDI and a nebulizer in random order. At 5 min, compared to baseline values, airways resistance (RAW) deteriorated by 16% after nebulized salbutamol but improved by 3% following salbutamol by the MDI (P < 0.03). At 15 min RAW improved by 14% following nebulized salbutamol and 15% after salbutamol via the MDI, there was no significant difference in the magnitude of bronchodilation between the two methods of administration. Our results therefore suggest, that as the early paradoxical deterioration in lung function is usually avoided by administering salbutamol via an MDI, this should be the preferred method of administration.