Inhalation therapy in asthma: Nebulizer or pressurized metered-dose inhaler with holding chamber? In vivo comparison of lung deposition in children

Wildhaber, Johannes H.; Dore, Nigel D.; Wilson, Jon; Devadason, Sunalene G.; Lesouëf, Peter

doi:10.1016/s0022-3476(99)70323-9

Cited by 167 publications

(74 citation statements)

References 26 publications

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“…In particular, we know that nebulized therapy will deliver about 5%-10% of the intended dose to the airways of cooperative older children, 25 to less than 1% in crying infants struggling against a face mask. 26 Thankfully, strategies now exist to dependably deliver about 2.5% of nebulized doses via a hood or head box.…”

Section: But If It's Asthma Then Why Don't Asthma Medications Work?mentioning

confidence: 99%

Maybe there is no such thing as bronchiolitis

Kuzik

2016

CMAJ

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Section: But If It's Asthma Then Why Don't Asthma Medications Work?mentioning

confidence: 99%

Maybe there is no such thing as bronchiolitis

Kuzik

2016

CMAJ

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“…28 The nebulizers varied significantly in the total delivery of fluid, the time required to deliver the fluid, and percent of the respirable fluid. Interestingly, compared to the trial by Wildhaber 27 that demonstrated equivalent delivery efficiency, the trial by Kerem 16 (Table 1) suggested the MDI+VHC was more efficient, in a 1:5 ratio, despite inappropriate use of the VHC (multiple actuations into the holding chamber prior to inhalation). However, Kerem et al utilized a large volume (750 mL) VHC compared to the 150 mL volume VHC used by Wildhaber et al, and the nebulizer used by Kerem et al was one of the least efficient nebulizers, which probably explains the apparent discrepancy.…”

Section: Devicementioning

confidence: 93%

“…However, using a facemask in young children (necessary in children < 5 years old) decreases lung delivery by one-half compared to inhalation through a mouthpiece for both VHCs and nebulizers. 27 Interestingly, investigators found no difference in delivery efficiency between MDI+VHC (Aerochamber) and nebulization (Pari Baby and Pari LC Star) using radiolabeled albuterol in children with stable asthma. The Pari nebulizers are among the most efficient jet nebulizers.…”

Section: Devicementioning

confidence: 99%

“…However, Kerem et al utilized a large volume (750 mL) VHC compared to the 150 mL volume VHC used by Wildhaber et al, and the nebulizer used by Kerem et al was one of the least efficient nebulizers, which probably explains the apparent discrepancy. 15,[27][28][29] Interestingly, the trials by Delgado et al and Leversha et al used two of the least efficient nebulizers for producing respirable particles. 14,15,[28][29][30] These findings emphasize the importance of the type of nebulizers used in the trials when comparisons are made.…”

Section: Devicementioning

confidence: 99%

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MDI versus Nebulizers for Acute Asthma

Raissy

Kelly

2004

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVE: To evaluate studies comparing metered dose inhalers with holding chambers to nebulizers in the emergency department for the treatment of asthma exacerbation. DATA SOURCE: Primary articles and systematic review provided by the Cochrane Airways Review Group of the Cochrane Library identified by MEDLINE search (1966–February 2004) and through secondary sources. DATA SYNTHESIS: The Cochrane review included 21 randomized clinical trials conducted in hospital emergency departments comparing clinical outcomes following β2 agonist administration via a nebulizer or a metered dose inhaler with holding chamber. Although the relative risk ratio of hospital admission with metered dose inhaler and holding chamber did not differ in children or in adults compared to the nebulizer delivery, none of the individual studies reviewed were powered to detect a difference in the rate of hospital admission. Specific factors in the treatment of acute asthma such as assessment of severity, appropriate outcome selection, appropriate dose selection, and appropriate delivery systems need to be considered to critically evaluate the literature. CONCLUSION: Although available randomized clinical trials suggest equivalency of metered dose inhaler plus holding chambers and nebulized delivery of inhaled β2 agonists, these trials are biased to show no difference in response. There is no data to support the advantage of one method over the other in mild to moderate asthmatic patients either clinically or economically.

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“…Aynı çalışmada ağlayan iki yaşındaki bir hastada salbutamolün akciğerde depolanma oranı her iki yolla da ortalamaya göre çok daha düşük saptanmıştır. Ayrıca yaşı daha büyük olan hasta grubunda gastrointestinal depolanma oranı nebülizer kullanımında anlamlı olarak yük-sek saptanmıştır (16 1 ve PEF değerlerinde bÖDİ/aracı tüp kullanan grupta nebülizer kullanan gruba göre anlamlı olarak daha fazla artış elde edilmiştir. Basınçlı ÖDİ/aracı tüp kullanan grupta oksijen satürasyonu değeri daha iyi olmasına rağmen nebülizer grubunda ortalama oksijen satürasyonu değeri daha düşük bulunmuş, bu grupta tedavi sonrası satürasyonda artma yerine azalma saptanmış iki grup arasındaki bu farklılık istatistiksel olarak anlamlı bulunmuştur.…”

Section: Araci Tüpunclassified