Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs. jet nebulizer in young children with wheezing

Deerojanawong, Jitladda; Manuyakorn, Wiparat; Prapphal, Nuanchan; Harnruthakorn, Chanthana; Sritippayawan, Suchada; Samransamruajkit, Rujipat

doi:10.1002/ppul.20204

Cited by 42 publications

(42 citation statements)

References 27 publications

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“…A survey from 1996 showed that 85% of neonatal ICUs never used a pMDI for bronchodilator administration and relied more on jet nebulizers (unpublished data). 63 A survey from 2002 showed that 57% of neonatal ICUs used pMDIs/spacers, and 31% of the centers surveyed provided spacers in-line with the ventilator, and 56% removed the patient and provided a pMDI with a spacer using a manual resuscitator. 63 A survey of large pediatric patients has never been conducted, but it is likely that there are large variations in practice.…”

Section: Optimizing Nebulizer Performance During Mechanical Ventilationmentioning

confidence: 99%

“…60 There is an emerging large body of clinical evidence that indicates that a pMDI/spacer is at least as effective as a small-volume nebulizer for bronchodilator delivery in infants and children. 59,[61][62][63][64][65][66][67][68] A recent Cochrane review 69 assessed outcomes from randomized trials regarding bronchodilator use with a pMDI/spacer or a small-volume nebulizer in adults and children (Ͼ 2 y old) with asthma. A total of 1,897 children and 729 adults in 39 trials were included.…”

Section: Jet Nebulizer Versus Pressurized Metered-dose Inhaler/spacermentioning

confidence: 99%

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Clinical Controversies in Aerosol Therapy for Infants and Children

DiBlasi

2015

Respir Care

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Pediatric patients are different from adult patients with respect to airway anatomy and breathing patterns. They are also incapable of following commands and often reject breathing treatments. For these reasons, aerosol drug delivery is one of the most technically challenging aspects for clinicians providing respiratory care to young children. Improvements in nebulizer technology have provided better delivery options for pediatric patients. This review highlights research related to pediatric nebulizer and interface devices and how they can be used to provide the safest and most efficient treatments with the array of treatment delivery options. Also addressed are clinical controversies and debates in pediatric aerosol science, including drug delivery in crying versus resting infants, pressurized metered-dose inhalers and small-volume nebulizers for bronchodilator administration, continuous nebulization, noninvasive drug delivery options, and optimization of nebulizer performance during infant and large pediatric conventional and high-frequency ventilation.

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Section: Optimizing Nebulizer Performance During Mechanical Ventilationmentioning

confidence: 99%

Section: Jet Nebulizer Versus Pressurized Metered-dose Inhaler/spacermentioning

confidence: 99%

Clinical Controversies in Aerosol Therapy for Infants and Children

DiBlasi

2015

Respir Care

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“…For most children, the MDI plus spacer is favored as it is more efficient than the nebulizer 61,110,111 (Evidence A) for bronchodilator delivery. The initial dose is two puffs of salbutamol (100 µg per puff) or equivalent.…”

Section: Emergency Treatment and Pharmacotherapymentioning

confidence: 99%

Global strategy for the diagnosis and management of asthma in children 5 years and younger

Pedersen

Hurd

Lemanske

et al. 2010

Pediatric Pulmonology

263

207

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Asthma is the most common chronic disease of childhood and the leading cause of childhood morbidity from chronic disease as measured by school absences, emergency department visits, and hospitalions1. During the past two decades, many scientific advances have improved our understanding of asthma and our ability to manage and control it effectively. However, in children 5 years and younger, the clinical symptoms of asthma are variable and non‐specific. Furthermore, neither airflow limitation nor airway inflammation, the main pathologic hallmarks of the condition, can be assessed routinely in this age group. For this reason, to aid in the diagnosis of asthma in young children, a symptoms‐only descriptive approach that includes the definition of various wheezing phenotypes has been recommended2. In 1993, the Global Initiative for Asthma (GINA) was implemented to develop a network of individuals, organizations, and public health officials to disseminate information about the care of patients with asthma while at the same time assuring a mechanism to incorporate the results of scientific investigations into asthma care. Since then, GINA has developed and regularly revised a Global Strategy for Asthma Management and Prevention. Publications based on the Global Strategy for Asthma Management and Prevention have been translated into many different languages to promote international collaboration and dissemination of information.In this report, Global Strategy for Asthma Management and Prevention in Children 5 Years and Younger, an effort has been made to present the special challenges that must be taken into account in managing asthma in children during the first 5 years of life, including difficulties with diagnosis, the efficacy and safety of drugs and drug delivery systems, and the lack of data on new therapies. Approaches to these issues will vary among populations in the world based on socioeconomic conditions, genetic diversity, cultural beliefs, and differences in healthcare access and delivery. Patients in this age group are often managed by pediatricians and general practitioners routinely faced with a wide variety of issues related to childhood diseases. Pediatr Pulmonol. 2011; 46:1–17. © 2010 Wiley‐Liss, Inc.

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“…(25) Lower deposition of drug and fewer systemic side effects (namely tachycardia with SABA) categorically sway the balance toward MDI+S. (24,26) Well-recognised guidelines such as the Global Initiative for Asthma (GINA) and British Thoracic Society (BTS) guidelines now recommend the use of MDI+S for the management of acute wheeze in children, and nebulisers are no longer recommended or required for mild/moderate exacerbations.…”

Section: Have Spacers Been Found To Be Effective In the Local Healthcmentioning

confidence: 99%

Wheeze in childhood: is the spacer good enough?

Rajkumar¹,

Rajendra²,

How³

et al. 2014

smedj

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Wheezing in children is one of the most common chronic problems in childhood encountered by medical professionals in all healthcare settings. The prevalence of childhood asthma is high (8.9%), and the majority of asthmatic children are managed in the primary care setting.(1) The high prevalence of wheezing in children can be attributed to the increasing trends of atopic disease in the region, as well as the well-known association between allergy and asthma. Inadequate control is a common issue when it comes to management of wheeze in childhood in the community, and this in turn poses a significant challenge to primary care physicians. Appropriate management, including correct inhalational technique, is crucial to acute and long-term outcomes. Today, the inhalation method is the recommended administration route for acute management of wheeze. Although the characteristics of various drug delivery systems, including drug dose delivery, feasibility of use and age appropriateness, have been extensively studied, the perfect inhalation device still eludes us. Pressurised metered dose inhalers (MDIs) and spacers have been available for many decades. This article analyses the established evidence in support of the use of MDI with spacers (MDI+S) over nebulisers for the management of wheeze in children. Other aerosol delivery methods and pharmacological management of asthma are not discussed in this article. AEROSOLS AND THEIR IMPORTANCE IN ASTHMA MANAGEMENTAerosols are liquid or solid particles suspended in a carrier gas. Aerosol administration is painless and convenient, delivering adequate concentrations of the drug directly into the lung. It has quicker onset of action and is categorically better than the systemic route. What are the different aerosol delivery devices?Nebulisers Nebulisers have been the traditional aerosol delivery mechanism for many decades. They work on the Venturi principle, where negative pressure is used to create aerosol from a drug suspension. The original nebuliser has undergone several modifications, and these include the pneumatic jet nebuliser, ultrasonic nebuliser and mesh nebuliser, with differences in aerosol droplet size, respirable dose, nebulisation time, ease of cleaning, sterilisation and costs. The well-known disadvantages of nebulisers include feasibility of use, cost and side effects of medication, namely tachycardia in the case of short-acting beta-2 agonists (SABA). Errors in the use of the nebuliser by patients, caregivers or nurses could compromise drug delivery and treatment efficacy (Table I).Pressurised metered dose inhalers MDIs, the most commonly used aerosol delivery devices, have the following advantages: small size; portability; low cost; and convenience of use.(3) The key components of an MDI device are the canister, propellant, drug formulation, metering valve and actuator. The drug is stored as either a solution or a suspension. The metering valve helps in drug dosing and the actuator aids the formation of aerosol. Shaking and priming of the MDI before use is vita...

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Randomized controlled trial of salbutamol aerosol therapy via metered dose inhaler-spacer vs. jet nebulizer in young children with wheezing

Cited by 42 publications

References 27 publications

Clinical Controversies in Aerosol Therapy for Infants and Children

Clinical Controversies in Aerosol Therapy for Infants and Children

Global strategy for the diagnosis and management of asthma in children 5 years and younger

Wheeze in childhood: is the spacer good enough?

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