A Randomized Trial Comparing Metered Dose Inhalers and Breath Actuated Nebulizers

Mark A. Snider, Jim Wan, Jonathan Jacobs, Rudy Kink, Barry Gilmore, Sandra Arnold

Research output: Contribution to journalArticle

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Abstract

Background: Despite little evidence for its effectiveness, the breath-actuated nebulizer (BAN) is the default albuterol delivery method in our pediatric emergency department. Objective: We compared the clinical efficacy of BAN and the metered-dose inhaler (MDI) in treating subjects patients 2 to 17 years of age who presented with mild to moderate asthma exacerbations. Methods: This is a randomized, nonblinded, noninferiority study conducted at a single pediatric tertiary care emergency department. Subjects presenting with a Pediatric Asthma Score ranging from 5 to 11 received albuterol by BAN or MDI via standard weight-based and symptom severity dosing protocols. Aerosolized ipratropium (via BAN) and intravenous magnesium sulfate were given when clinically indicated. The primary outcome was patient disposition. The noninferiority margin for the primary outcome was an admission rate difference ≤10%. Analyses were adjusted for confounders that were significant at p ≤ 0.10. Results: We enrolled 890 subjects between October 2014 and April 2015. BAN and MDI groups were comparable for age, gender, and race but not for pretreatment symptom severity; 51% in the MDI group had a Pediatric Asthma Score of moderate severity (8–11) vs. 63% in the BAN group (p < 0.003). Unadjusted admission rates were 11.9% for MDI and 12.8% for BAN, for an unadjusted risk difference of −0.9% (95% confidence interval −5% to 3%). After adjusting for baseline confounder severity, the risk difference was 2% (95% confidence interval −4% to 7%), which met the criteria for noninferiority. Conclusions: Albuterol therapy by MDI is noninferior to BAN for the treatment of mild to moderate asthma exacerbations in children 2 to 17 years of age.

Original languageEnglish (US)
Pages (from-to)7-14
Number of pages8
JournalJournal of Emergency Medicine
Volume55
Issue number1
DOIs
StatePublished - Jul 1 2018

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Metered Dose Inhalers
Nebulizers and Vaporizers
Albuterol
Asthma
Pediatrics
Hospital Emergency Service
Confidence Intervals
Ipratropium
Magnesium Sulfate
Tertiary Healthcare
Weights and Measures
Therapeutics

All Science Journal Classification (ASJC) codes

  • Emergency Medicine

Cite this

A Randomized Trial Comparing Metered Dose Inhalers and Breath Actuated Nebulizers. / Snider, Mark A.; Wan, Jim; Jacobs, Jonathan; Kink, Rudy; Gilmore, Barry; Arnold, Sandra.

In: Journal of Emergency Medicine, Vol. 55, No. 1, 01.07.2018, p. 7-14.

Research output: Contribution to journalArticle

Snider, Mark A. ; Wan, Jim ; Jacobs, Jonathan ; Kink, Rudy ; Gilmore, Barry ; Arnold, Sandra. / A Randomized Trial Comparing Metered Dose Inhalers and Breath Actuated Nebulizers. In: Journal of Emergency Medicine. 2018 ; Vol. 55, No. 1. pp. 7-14.
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