A COMPARATIVE STUDY OF EFFICACY OF NEBULIZER AND METERED DOSE INHALER WITH SPACER IN THE TREATMENT OF ACUTE ASTHMA IN CHILDREN.

Corresponding Author:
Dr. Jeyaraman Balasubramanian,
Assistant Professor,
Department of Paediatrics,
Institute of Child Health & Research Centre,
Government Rajaji Hospital,
Madurai-625020,
Tamilnadu.
E-mail: drbaladch@yahoo.co.in

ABSTRACT

BACKGROUND

To compare the relative efficacy of Nebulizer and Metered Dose Inhaler (MDI) with spacer for the administration of aerosolized salbutamol in the treatment of acute asthma.

MATERIALS AND METHODS

A randomized, prospective, interventional study was conducted on 400 children aged 2-12 years with acute asthmatic attack. The subjects were randomly assigned to two groups for salbutamol administration, Group I was given salbutamol by jet nebulizer and Group II by metered dose inhaler with spacer. Baseline characteristics were recorded (Duration of illness, nature of medications, family history, allergy history, etc.). Children were categorized into low, middle and high grade according to clinical asthma score (Based on presence of wheezing, retractions, dyspnoea). Initial assessment was done at zero minutes. Clinical responses were assessed at 20, 40 and 60 minutes’ intervals after treatment. Poor response at 60 minutes were considered as treatment failure.

RESULTS

In low grade, there was no significant difference between both groups. In middle grade, Group II required less number of treatment (p value<0.001), which was statistically significant. In high grade also, the ‘p’ value is 0.032 and was significant. The overall clinical response among Group I and Group II was statistically significant. There was no statistical significance among the treatment failure in both groups.

CONCLUSION

MDI with spacer is an effective alternative to nebulizer for the administration of aerosolized drugs in acute asthmatic attack in paediatric emergency department. Use of MDI with spacer is more effective than nebulizer for the treatment of moderate-to-severe asthma. Nebulization has some limitations like inconvenience, slow implementation, high cost, power requirement and uncontrolled particle sizes, but none in case of MDI.

KEYWORDS

Nebulizer, Metered Dose Inhaler, Acute Asthma.