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. 1995 Mar;72(3):214–218. doi: 10.1136/adc.72.3.214

Metered dose inhaler and nebuliser in acute asthma.

Y Z Lin 1, K H Hsieh 1
PMCID: PMC1511067  PMID: 7741566

Abstract

One hundred and eleven children with acute asthma were studied to compare delivery of terbutaline by either a metered dose inhaler (MDI) with a valved holding chamber or a nebuliser driven by air. Eligible patients were randomised; the MDI group received three puffs (0.75 mg) of terbutaline and the nebuliser group received 2 ml (5.0 mg) terbutaline solution diluted with 2 ml 0.9% saline for inhalation over 10 minutes. Patients were evaluated by spirometry, pulse oximetry, and clinical severity scoring system at baseline and again 15 minutes after the beginning of treatment. The baseline data of the two groups were not significantly different. All parameters of spirometry, except the peak expiratory flow (PEF) for the nebuliser group, and clinical severity score for both groups significantly improved after terbutaline treatment. Compared with the nebuliser group, the MDI group after treatment had better mean (SD) oxygen saturation (SaO2; 96.82 (1.63)% v 95.44 (1.88)%), frequency of oxygen desaturation (23.2% v 47.3%), absolute increase of PEF (32.6 (37.7) l/min v 10.2 (34.7) l/min), and SaO2 (0.54 (1.64)% v -0.47 (1.84)%). There was also a mean (SD) per cent increase of forced expiratory volume in one second (22.9 (21.0)% v 15.4 (16.1)%), PEF (27.7 (38.4)%) v 7.7 (25.1)%), and SaO2 (0.58 (1.72)% v -0.47 (1.93)%). In conclusion, aerosol treatment by MDI (with a valved holding chamber) in this study proved to be superior to nebuliser treatment in terms of SaO2 and some measurements of spirometry. Respiratory therapists working with children with severe asthma should be aware of the possibility of oxygen desaturation, especially when using room air as the driving gas for nebulisation.

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Selected References

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  1. Becker A. B., Nelson N. A., Simons F. E. Inhaled salbutamol (albuterol) vs injected epinephrine in the treatment of acute asthma in children. J Pediatr. 1983 Mar;102(3):465–469. doi: 10.1016/s0022-3476(83)80679-9. [DOI] [PubMed] [Google Scholar]
  2. Berenberg M. J., Baigelman W., Cupples L. A., Pearce L. Comparison of metered-dose inhaler attached to an Aerochamber with an updraft nebulizer for the administration of metaproterenol in hospitalized patients. J Asthma. 1985;22(2):87–92. doi: 10.3109/02770908509079893. [DOI] [PubMed] [Google Scholar]
  3. Bowton D. L., Goldsmith W. M., Haponik E. F. Substitution of metered-dose inhalers for hand-held nebulizers. Success and cost savings in a large, acute-care hospital. Chest. 1992 Feb;101(2):305–308. doi: 10.1378/chest.101.2.305. [DOI] [PubMed] [Google Scholar]
  4. Chick T. W., Nicholson D. P., Johnson R. L., Jr Effects of isoproterenol on distribution of ventilation and perfusion in asthma. Am Rev Respir Dis. 1973 May;107(5):869–873. doi: 10.1164/arrd.1973.107.5.869. [DOI] [PubMed] [Google Scholar]
  5. Choo-Kang Y. F., Grant I. W. Comparison of two methods of administering bronchodilator aerosol to asthmatic patients. Br Med J. 1975 Apr 19;2(5963):119–120. doi: 10.1136/bmj.2.5963.119. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Clay M. M., Pavia D., Newman S. P., Lennard-Jones T., Clarke S. W. Assessment of jet nebulisers for lung aerosol therapy. Lancet. 1983 Sep 10;2(8350):592–594. doi: 10.1016/s0140-6736(83)90679-7. [DOI] [PubMed] [Google Scholar]
  7. Colacone A., Afilalo M., Wolkove N., Kreisman H. A comparison of albuterol administered by metered dose inhaler (and holding chamber) or wet nebulizer in acute asthma. Chest. 1993 Sep;104(3):835–841. doi: 10.1378/chest.104.3.835. [DOI] [PubMed] [Google Scholar]
  8. Cushley M. J., Lewis R. A., Tattersfield A. E. Comparison of three techniques of inhalation on the airway response to terbutaline. Thorax. 1983 Dec;38(12):908–913. doi: 10.1136/thx.38.12.908. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Desager K. N., Van Bever H. P., Stevens W. J. Osmolality and pH of anti-asthmatic drug solutions. Agents Actions. 1990 Nov;31(3-4):225–228. doi: 10.1007/BF01997612. [DOI] [PubMed] [Google Scholar]
  10. Dolovich M., Ruffin R., Corr D., Newhouse M. T. Clinical evaluation of a simple demand inhalation MDI aerosol delivery device. Chest. 1983 Jul;84(1):36–41. doi: 10.1378/chest.84.1.36. [DOI] [PubMed] [Google Scholar]
  11. Epstein S. W., Manning C. P., Ashley M. J., Corey P. N. Survey of the clinical use of pressurized aerosol inhalers. Can Med Assoc J. 1979 Apr 7;120(7):813–816. [PMC free article] [PubMed] [Google Scholar]
  12. Fuglsang G., Pedersen S. Comparison of Nebuhaler and nebulizer treatment of acute severe asthma in children. Eur J Respir Dis. 1986 Aug;69(2):109–113. [PubMed] [Google Scholar]
  13. Goodall R. J., Earis J. E., Cooper D. N., Bernstein A., Temple J. G. Relationship between asthma and gastro-oesophageal reflux. Thorax. 1981 Feb;36(2):116–121. doi: 10.1136/thx.36.2.116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Harris L. Comparison of the effect on blood gases, ventilation, and perfusion of isoproterenol-phenylephrine and salbutamol aerosols in chronic bronchitis with asthma. J Allergy Clin Immunol. 1972 Feb;49(2):63–71. doi: 10.1016/0091-6749(72)90057-7. [DOI] [PubMed] [Google Scholar]
  15. Kerem E., Levison H., Schuh S., O'Brodovich H., Reisman J., Bentur L., Canny G. J. Efficacy of albuterol administered by nebulizer versus spacer device in children with acute asthma. J Pediatr. 1993 Aug;123(2):313–317. doi: 10.1016/s0022-3476(05)81710-x. [DOI] [PubMed] [Google Scholar]
  16. Lin Y. Z., Hsieh K. H., Shih T. Y., Chen W., Wu K. W. Effects of nebulized terbutaline on oxygen saturation in acute asthmatic children. Zhonghua Min Guo Xiao Er Ke Yi Xue Hui Za Zhi. 1994 Sep-Oct;35(5):377–384. [PubMed] [Google Scholar]
  17. Macfarlane J. T., Lane D. J. Irregularities in the use of regular aerosol inhalers. Thorax. 1980 Jun;35(6):477–478. doi: 10.1136/thx.35.6.477. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Mestitz H., Copland J. M., McDonald C. F. Comparison of outpatient nebulized vs metered dose inhaler terbutaline in chronic airflow obstruction. Chest. 1989 Dec;96(6):1237–1240. doi: 10.1378/chest.96.6.1237. [DOI] [PubMed] [Google Scholar]
  19. Newman S. P., Millar A. B., Lennard-Jones T. R., Morén F., Clarke S. W. Improvement of pressurised aerosol deposition with Nebuhaler spacer device. Thorax. 1984 Dec;39(12):935–941. doi: 10.1136/thx.39.12.935. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. O'Callaghan C., Milner A. D., Swarbrick A. Paradoxical deterioration in lung function after nebulised salbutamol in wheezy infants. Lancet. 1986 Dec 20;2(8521-22):1424–1425. doi: 10.1016/s0140-6736(86)92735-2. [DOI] [PubMed] [Google Scholar]
  21. Olivenstein R., Wolkove N., Cohen C., Frank H., Kreisman H. A comparison of responses to albuterol delivered by two aerosol devices. Chest. 1986 Sep;90(3):392–395. doi: 10.1378/chest.90.3.392. [DOI] [PubMed] [Google Scholar]
  22. Pedersen J. Z., Bundgaard A. Comparative efficacy of different methods of nebulising terbutaline. Eur J Clin Pharmacol. 1983;25(6):739–742. doi: 10.1007/BF00542512. [DOI] [PubMed] [Google Scholar]
  23. Pliss L. B., Gallagher E. J. Aerosol vs injected epinephrine in acute asthma. Ann Emerg Med. 1981 Jul;10(7):353–355. doi: 10.1016/s0196-0644(81)80235-1. [DOI] [PubMed] [Google Scholar]
  24. Prendiville A., Rose A., Maxwell D. L., Silverman M. Hypoxaemia in wheezy infants after bronchodilator treatment. Arch Dis Child. 1987 Oct;62(10):997–1000. doi: 10.1136/adc.62.10.997. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Ros S. P. Emergency management of childhood bronchial asthma: a multicenter survey. Ann Allergy. 1991 Mar;66(3):231–234. [PubMed] [Google Scholar]
  26. Salzman G. A., Steele M. T., Pribble J. P., Elenbaas R. M., Pyszczynski D. R. Aerosolized metaproterenol in the treatment of asthmatics with severe airflow obstruction. Comparison of two delivery methods. Chest. 1989 May;95(5):1017–1020. doi: 10.1378/chest.95.5.1017. [DOI] [PubMed] [Google Scholar]
  27. Schoeffel R. E., Anderson S. D., Altounyan R. E. Bronchial hyperreactivity in response to inhalation of ultrasonically nebulised solutions of distilled water and saline. Br Med J (Clin Res Ed) 1981 Nov 14;283(6302):1285–1287. doi: 10.1136/bmj.283.6302.1285. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Schöni M. H., Kraemer R. Osmolality changes in nebulizer solutions. Eur Respir J. 1989 Oct;2(9):887–892. [PubMed] [Google Scholar]
  29. Tal A., Bavilski C., Yohai D., Bearman J. E., Gorodischer R., Moses S. W. Dexamethasone and salbutamol in the treatment of acute wheezing in infants. Pediatrics. 1983 Jan;71(1):13–18. [PubMed] [Google Scholar]
  30. Tal A., Pasterkamp H., Leahy F. Arterial oxygen desaturation following salbutamol inhalation in acute asthma. Chest. 1984 Dec;86(6):868–869. doi: 10.1378/chest.86.6.868. [DOI] [PubMed] [Google Scholar]
  31. Tenholder M. F., Bryson M. J., Whitlock W. L. A model for conversion from small volume nebulizer to metered dose inhaler aerosol therapy. Chest. 1992 Mar;101(3):634–637. doi: 10.1378/chest.101.3.634. [DOI] [PubMed] [Google Scholar]
  32. Tinkelman D. G., Vanderpool G. E., Carroll M. S., Lotner G. Z., Spangler D. L. Comparison of nebulized terbutaline (TERB) and subcutaneous epinephrine (EPI) in the treatment of acute asthma. Ann Allergy. 1983 Jun;50(6):398–401. [PubMed] [Google Scholar]
  33. Turner J. R., Corkery K. J., Eckman D., Gelb A. M., Lipavsky A., Sheppard D. Equivalence of continuous flow nebulizer and metered-dose inhaler with reservoir bag for treatment of acute airflow obstruction. Chest. 1988 Mar;93(3):476–481. doi: 10.1378/chest.93.3.476. [DOI] [PubMed] [Google Scholar]
  34. Weber R. W., Petty W. E., Nelson H. S. Aerosolized terbutaline in asthmatics. Comparison of dosage strength, schedule, and method of administration. J Allergy Clin Immunol. 1979 Feb;63(2):116–121. doi: 10.1016/0091-6749(79)90201-x. [DOI] [PubMed] [Google Scholar]

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