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Delivery of albuterol in a pediatric emergency department
J R Williams1, J P Bothner, R D Swanton
1Department of Pediatrics, University of Colorado School of Medicine, Children's Hospital, Denver, USA.
Insights
Metered-dose inhaler (MDI) with a spacer effectively delivers albuterol for acute asthma in children, matching nebulizer effectiveness. This MDI-spacer approach offers a comparable treatment option in pediatric emergency settings.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Therapeutics
- Clinical Effectiveness Research
Background:
- Acute asthma exacerbations are common in children presenting to emergency departments.
- Nebulized albuterol is a standard treatment, but alternative delivery methods are being explored.
Purpose of the Study:
- To compare the effectiveness of albuterol delivery via metered-dose inhaler (MDI) with a spacer versus nebulization in pediatric patients with acute asthma.
Main Methods:
- A prospective study randomized children aged six years and older with acute asthma exacerbation into nebulizer or MDI-spacer groups.
- Three albuterol treatments were administered over one hour, with a 6.9:1 dose ratio favoring nebulization.
- Outcomes were assessed by changes in percent predicted respiratory rate and peak expiratory flow rate (PEFR).
Main Results:
- Sixty patients were enrolled, and all treatment groups showed significant improvement in respiratory rate and PEFR.
- No statistically significant differences in outcome improvement were observed between the nebulizer and MDI-spacer groups for either metric.
Conclusions:
- Albuterol delivered via MDI with a spacer is as effective as nebulization for managing acute asthma in children aged six and older in a pediatric emergency department.
- MDI-spacer systems provide a viable and equivalent alternative to nebulizers for acute asthma treatment in this population.
Study Objective:
To determine if albuterol delivery by the combination of a metered-dose inhaler (MDI) with a spacer is equal in effectiveness to nebulization in a pediatric emergency department setting.
Design:
Prospective series.
Setting:
Urban children's hospital emergency department.
Participants:
Patients > or = six years of age with the diagnosis of acute asthma exacerbation. Exclusion criteria consisted of impending respiratory failure and corticosteroid administration within the preceding seven days.
Interventions:
Patients were randomized into either the nebulizer treatment group or one of two MDI-spacer treatment groups (two spacers were evaluated). Each patient received three albuterol treatments administered evenly over one hour. The dose ratio for albuterol by nebulizer versus MDI-spacer was 6.9:1. Outcome was assessed by comparing the pre- and posttreatment percent predicted respiratory rate and percent predicted peak expiratory flow rate (PEFR) for each patient.
Results:
Sixty patients were enrolled in the study. All three treatment groups showed significant improvement following albuterol therapy in both percent predicted respiratory rate and percent predicted PEFR. When comparing the three groups against each other in regard to outcome, no significant differences were found in improvement of percent predicted respiratory rate (P = 0.3258) or percent predicted PEFR (P = 0.9362).
Conclusion:
In a pediatric emergency department setting, aerosolized albuterol delivered by MDI-spacer was equal in effectiveness to nebulization in the acute asthma management of children > or = six years of age.