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Efficacy of bronchodilators administered by nebulizers versus spacer devices in infants with acute wheezing
R M Closa1, J M Ceballos, A Gómez-Papí
1Hospital Universitario de Tarragona Joan XXIII, Universidad Rovira i Virgili, Spain. rclosa@tinet.fut.es
Insights
Metered-dose inhaler-spacer devices and nebulizers are equally effective for delivering terbutaline to infants with acute wheezing. This randomized trial found no significant difference in clinical improvement between the two delivery methods.
Area of Science:
- Pediatric Pulmonology
- Emergency Medicine
- Pharmacology
Background:
- Acute wheezing is a common respiratory issue in infants and young children presenting to emergency departments.
- Effective delivery of bronchodilators like terbutaline is crucial for managing acute wheezing.
- Nebulizers and metered-dose inhaler with spacer (MDI-spacer) devices are common administration methods, but their comparative efficacy in infants is debated.
Purpose of the Study:
- To compare the clinical response of infants with acute wheezing to inhaled terbutaline administered via nebulizer versus MDI-spacer.
- To evaluate the efficacy of different delivery devices for beta-2 agonists in pediatric acute wheezing management.
Main Methods:
- A double-blind, randomized trial involving 34 infants (1-24 months) with acute wheezing.
- Participants received two doses of terbutaline (2 mg via nebulizer or 0.5 mg via MDI-spacer) at 20-minute intervals.
- Clinical scores, including respiratory rate, wheezing, retractions, cyanosis, color, and pulse oximetry, were assessed before and after treatments.
Main Results:
- No statistically significant difference was observed in the rate of clinical score improvement between the nebulizer group and the MDI-spacer group.
- Both administration methods resulted in comparable clinical outcomes for infants experiencing acute wheezing.
Conclusions:
- Metered-dose inhaler with spacer devices are as effective as nebulizers for delivering terbutaline to infants and young children with acute wheezing.
- MDI-spacers offer a potentially more convenient and accessible alternative for bronchodilator delivery in this pediatric population.
Abstract:
The aim of this study was to compare the response of infants with acute wheezing to treatments with inhaled terbutaline when administered by nebulizer or by metered-dose inhaler and spacer device (MDI-spacer). Thirty-four infants between the ages of 1 and 24 months who were seen in our emergency department for acute wheezing were studied in a double-blind, randomized trial. The participants received two treatments of terbutaline at 20-min intervals, either by a nebulizer (2 mg/dose in 2.8 mL of 0.9% saline solution) or by an MDI-spacer device (0.5 mg/dose). The outcome measure was a clinical score, based on respiratory rate, degree of wheezing, retractions, degree of cyanosis, color, and pulse oximetry data measured before treatment, 20 min after the first treatment, and again 20 min after the second treatment. There was no difference in the rate of improvement in the clinical score between infants who received terbutaline by nebulizer and those who received it by MDI-spacer. We conclude that MDI-spacers and nebulizers are equally effective means of delivering beta-2 agonists to infants and small children with acute wheezing.