Author(s): Jeny Samuel*, Boby Johns George, SR. Betty Carla
Background: Despite the demonstrated equivalency, rapid delivery, and lesser use of personnel resources with the MDI/spacer combination, nebulized salbutamol remains the standard therapy for patients with acute asthma .23Patients’ perception of the nebulizer being more effective, the lack of coordination between MDI actuation and inhalation when using an MDI/spacer during acute asthma, especially for first time users, and the notion that delivery with non-disposable commercial spacers is more expensive, has limited the use of spacers in the ED.24
Objective: To compare the effectiveness of administration of salbutamol by metered-dose inhaler with spacer and administration of salbutamol by nebulizer to treat asthma exacerbation in children aged 1-5 years.
Methodology: The study was a prospective Randomized controlled trial, conducted in the pediatric emergency department of a tertiary care government hospital. Subjects n_75 received salbutamol with a nebulizer and the spacer group n_75 received salbutamol by MDI/spacer, symptom scores were monitored in the two groups.
Results: In the nebulizer group, 76%(57nos) patients had mild breathlessness, decrease in alertness, wheezing and mild suprasternal retactions and 24% (18nos) had moderate symptoms .After the therapy 76% were relieved from the symptoms and 24%had mild problems. In the MDI spacer group 92% (69nos) had mild symptoms and 8% (6nos) had moderate symptoms. After the therapy 92% were relieved of the symptom and 8% had mild problems.
Conclusion: It is concluded that MDI-spacer is as effective as a nebulizer for the aerosolized administration of salbutamol in an acute exacerbation of asthma in children. However, for developing countries, distinct advantages (economic and power requirement) argue strongly for utilization of MDI-spacer in preference to nebulizer.